Is biopsy necessary? Role of DCE-MRI in BIRADS-3 lesions

We aimed to evaluate BIRADS-3 breast lesions with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and compare with histopathology, and to investigate the effectiveness of breast MRI for follow-up and management.

A total of 84 BIRADS-3 lesions reported by US or mammography and evaluated by DCE-MRI between September 2014 and October 2015 were included in this study. All patients underwent percutaneous or surgical biopsy for histopathologic diagnosis. Morphologic and kinematic features on MRI were compared with histopathologic results.

Of the 84 BIRADS-3 breast lesions, 9 (10.7%) had malignant features on DCE-MRI and all were verified with histopathologic results. DCE-MRI had 96.7% sensitivity, 72% specificity, 92% positive predictive value, and 82.5% negative predictive value. MRI and histopathology results were correlated for the diagnosis of malignant lesions. The sensitivity and negative predictive value of MRI for diagnosis of malignant lesions were both 100%.

Differentiation of benign versus malignant lesions was accomplished with 100% accuracy with DCE-MRI. We suggest that DCE-MRI should be an additional diagnostic tool and problem-solving modality for BIRADS-3 lesions, particularly in patients with relative risk factors.