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Follow-up results of BI-RADS 3 lesions on magnetic resonance imaging: a retrospective study
Özge Aslan1, Ayşenur Oktay1, Fatih Eroğlu1
1Ege University Faculty of Medicine, Department of Radiology, İzmir, Türkiye
Purpose:
The categorization of Breast Imaging Reporting and Data System (BI-RADS) 3 lesions is not as clear in magnetic resonance imaging (MRI) as it is in mammography (MG). With the increasing number of MRI scans currently being conducted globally, incidentally detected lesions falling into the probably benign category are frequently being observed. In this study, our aim was to investigate the imaging characteristics and follow-up results of BI-RADS 3 lesions detected by MRI and to determine their malignancy rates.
Methods:
Breast MRI scans performed between January 2010 and January 2020 and classified as BI-RADS 3 lesions were retrospectively analyzed. The study included 216 lesions with known biopsy or surgical excision results or with at least one year of radiological follow-up. We assessed the patients' age, the presence of breast cancer, the follow-up interval, and the imaging findings at the beginning and during the follow-up. Lesions that remained stable, disappeared, or decreased in size and had a benign histopathological diagnosis were classified as benign. Lesions with the histopathological diagnosis of malignancy, identified by either biopsy or surgical excision, were classified as malignant. We determined the malignancy rate based on the histopathology and follow-up results.
Results:
Considering the follow-up results of all cases, 8% of lesions were excised, 0.5% decreased in size, 1.4% became enlarged, 17.1% disappeared, and 73% remained stable. The malignancy rate was 2.8%. A significant relationship was found between lesion shape and malignancy, as progression to malignancy was more likely in round lesions than in other types. An irregular margin, heterogeneous enhancement, and kinetic curve (type 2) features were significant for lesion upgrade to malignancy.
Conclusion:
The malignancy rate in BI-RADS 3 lesions detected by MRI is low and falls within the accepted cancer rate for MG and sonography. Changes in size, morphology, and enhancement pattern should be considered in terms of malignancy development during follow-up. The follow-up intervals should be determined on a case-by-case basis.
Insights
Magnetic resonance imaging (MRI) shows a low malignancy rate for Breast Imaging Reporting and Data System (BI-RADS) 3 lesions. Round shapes and irregular margins may indicate malignancy, necessitating individualized follow-up.
Area of Science:
- Radiology and Imaging Science
- Oncology
- Breast Imaging
Background:
- Breast Imaging Reporting and Data System (BI-RADS) 3 lesion categorization lacks clarity in magnetic resonance imaging (MRI) compared to mammography.
- Increasing global MRI use leads to frequent incidental detection of BI-RADS 3 lesions, requiring further investigation.
- Understanding the behavior and malignancy potential of MRI-detected BI-RADS 3 lesions is crucial for patient management.
Purpose of the Study:
- To investigate the imaging characteristics of BI-RADS 3 lesions detected by MRI.
- To analyze the follow-up results of these lesions.
- To determine the malignancy rates of BI-RADS 3 lesions identified via MRI.
Main Methods:
- Retrospective analysis of 216 breast MRI scans classified as BI-RADS 3 between January 2010 and January 2020.
- Inclusion criteria: known biopsy/excision results or at least one year of radiological follow-up.
- Assessment of patient age, cancer presence, follow-up intervals, and imaging findings; classification based on histopathology and follow-up.
Main Results:
- Of the 216 lesions, 73% remained stable, 17.1% disappeared, 8% were excised, 1.4% enlarged, and 0.5% decreased in size.
- The overall malignancy rate was 2.8%.
- Round lesion shape, irregular margins, heterogeneous enhancement, and kinetic curve type 2 were significantly associated with malignancy.
Conclusions:
- MRI-detected BI-RADS 3 lesions have a low malignancy rate, comparable to mammography and sonography.
- Changes in lesion size, morphology, and enhancement patterns during follow-up are important indicators of potential malignancy.
- Follow-up intervals for BI-RADS 3 lesions on MRI should be individualized based on lesion characteristics and clinical context.
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