News | MRI Breast | January 15, 2021

New Suspicious Lesions on Breast MRI in Neoadjuvant Therapy

New suspicious findings occurred in 5.5% of breast MRI examinations performed to monitor response to neoadjuvant therapy; none of these new lesions were malignant

A, Contrast-enhanced axial T1-weighted fat-saturated image from baseline MRI before initiation of neoadjuvant therapy shows irregular mass (arrow) in upper inner right breast corresponding to biopsy-proven carcinoma. B, Contrast-enhanced axial T1-weighted fat-saturated image from follow-up MRI performed 3 months after initiation of neoadjuvant therapy shows decrease in size of right breast cancer (arrow). C, Contrast-enhanced axial T1-weighted fat-saturated image 3 months after initiation of neoadjuvant the

A, Contrast-enhanced axial T1-weighted fat-saturated image from baseline MRI before initiation of neoadjuvant therapy shows irregular mass (arrow) in upper inner right breast corresponding to biopsy-proven carcinoma. B, Contrast-enhanced axial T1-weighted fat-saturated image from follow-up MRI performed 3 months after initiation of neoadjuvant therapy shows decrease in size of right breast cancer (arrow). C, Contrast-enhanced axial T1-weighted fat-saturated image 3 months after initiation of neoadjuvant therapy shows new mass (arrow) in upper outer left breast that was assessed as BI-RADS 4. Pathologic examination from MRI-guided core biopsy of new suspicious mass revealed benign usual ductal hyperplasia. No atypia or malignancy was identified. Image courtesy of American Roentgen Ray Society (ARRS), American Journal of Roentgenology (AJR)

January 15, 2021 — According to ARRS' American Journal of Roentgenology (AJR), new suspicious findings occurred in 5.5% of breast MRI examinations performed to monitor response to neoadjuvant therapy; none of these new lesions were malignant.

"Our findings suggest that new lesions that arise in the setting of neoadjuvant therapy are highly unlikely to represent a new site of malignancy, particularly if the index malignancy shows treatment response," wrote Donna A. Eckstein and colleagues in the department of radiology and biomedical imaging at the University of California, San Francisco.

Based on a presentation at the ARRS 2019 Annual Meeting, Honolulu, HI, the researchers' retrospective review pinpointed all breast MRI examinations performed to assess response to neoadjuvant therapy between 2010 and 2018. Cases with new suspicious lesions assessed as BI-RADS 4 or 5 and found after the initiation of neoadjuvant treatment were included. Meanwhile, exclusion criteria were cases with no pretreatment MRI, cases in which the suspicious lesion was present on the baseline MRI but remained suspicious, and cases with insufficient follow-up. Pathologic examination determined malignant outcomes, whereas benignity was established by pathologic examination, follow-up imaging, or both.

A total of 419 breast MRI examinations in 297 women (mean patient age, 45 years; range, 32-65 years) were performed to assess response to neoadjuvant treatment. After exclusions, 23 MRI examinations (5.5%) with new suspicious findings distinct from the site of known malignancy comprised the final study cohort. Of these 23 lesions, 13 new suspicious findings (56.5%) were contralateral to the known malignancy, nine (39.1%) were ipsilateral, and one (4.3%) involved the bilateral breasts. Lesion types included mass (16, 69.6%), nonmass enhancement (5, 21.7%), and focus (2, 8.7%).

Noting that, currently, there are no guidelines for the management of new suspicious imaging findings identified on MRI during the course of neoadjuvant systemic breast cancer treatment, "results in this small cohort suggest that these new findings are highly likely to be benign, particularly in the setting of response to therapy, which may potentially obviate biopsies in these patients in the future," wrote Eckstein et al.

"However," the authors of this AJR article concluded, "larger studies across different facilities are needed to confirm whether biopsy may be safely averted in this scenario."

For more information: www.arrs.org

Related Content

Registration is now open for the Radiological Society of North America (RSNA) 107th Scientific Assembly and Annual Meeting, the world’s largest annual radiology forum, to be held at McCormick Place Chicago, Nov. 28 – Dec. 2, 2021

Getty Images

News | RSNA | July 21, 2021
July 21, 2021 — Registration is now open for the Radiological Society of North America (...
According to ARRS’ American Journal of Roentgenology (AJR), return to routine screening for BI-RADS 3 lesions on supplemental automated whole-breast US (ABUS) substantially reduces the recall rate, while being unlikely to result in adverse outcome

Normal right mediolateral oblique (A) and craniocarudal (B) view screening mammograms demonstrate density C breasts. Coronal (C), transverse (D), and reconstructed lateral (E) views from supplemental automatic breast ultrasound (ABUS) demonstrates 7 mm circumscribed slightly hypoechoic circumscribed lesion at 11 o’clock position in right breast. Lesion was classified as BI-RADS 3. Patient has undergone yearly mammograms for 4 years following the ABUS examination with no breast cancer diagnosis.

News | Breast Imaging | July 16, 2021
July 16, 2021 —...
Volpara now holds 98 granted patents across 27 countries
News | Breast Imaging | July 16, 2021
July 16, 2021 — Volpara has recently been granted another patent by the...
Interviews with the 1,000 at-risk patients also led to some interesting conclusions, Fine said. Even in the early days of 3D mammography, most women interviewed had at least heard about the technology.

Getty Images

News | Mammography | July 15, 2021
July 15, 2021 —  For any type of diagnostic test, technology that helps improve the reliability of test results is a
ujifilm's robust medical systems portfolio includes a comprehensive product lineup covering CT, MRI, fluoroscopy, digital radiography, women’s health, ultrasound, systems integration, endoscopy and endosurgery, enterprise imaging, assisted reproductive technology, cell culture media, cell therapy development, In-Vitro diagnostics (IVD), and investigational drug development
News | Radiology Imaging | July 14, 2021
July 14, 2021 — Fujifilm announced the launch of the ...
A new study set out to learn more about breast health for Black women and to establish a better understanding of the breast screening landscape by analyzing mammograms, screening intervals and interpretation performance for Asian, Black and white women across health systems throughout the United States, with participation from Advocate Health Care, Sanford Health and the University of Pennsylvania Health System.

Getty Images

Feature | Breast Imaging | July 06, 2021 | By Linda Goler Blount, MPH
Due to dangerous implications for years to come, facilities must increase efficiency and capacity for breast cancer care to recover from the impact of COVID-19

Getty Images

Feature | Breast Imaging | July 06, 2021 | By Ananth Ravi, Ph.D.
The challenges
Breast cancer recently surpassed lung cancer as the number 1 diagnosed cancer in the U.S., excluding nonmelanoma skin cancer. Additionally, the National Cancer Institute recently predicted an almost 10,000 excess deaths from breast and colorectal cancers over the next 10 years as a direct result of the pandemic, making it now more important than ever for women to take control over their breast health.
News | Artificial Intelligence | June 25, 2021
June 25, 2021 — Breast cancer recently ...
According to a new study, by the Harvey L. Neiman Health Policy Institute and the American College of Radiology’s National Mammography Database Committee, the most influential radiologist characteristics impacting mammography interpretive performance were geography, breast sub-specialization, performance of diagnostic mammography, and performance of diagnostic ultrasound.

Getty Images

News | Breast Imaging | June 23, 2021
June 23, 2021 — According to a new ...