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Characteristics and Pathologic Results of Foci on Breast Magnetic Resonance Imaging: A Systematic Review and
Chenyu Zhang1, Quankun Lin1, Wei Zhai2
1Department of Breast Surgery, Xinhua Hospital Affiliated of Shanghai Jiaotong University School of Medicine, Shanghai, China.
Background:
Although T2-weighted imaging (T2WI) hypointensity, delayed enhancement washout pattern, interval growth, and new appearance of a focus have been associated with malignancy, the results are not consistent.
Purpose:
To investigate the malignancy rate and identify the clinical and imaging characteristics associated with malignancy among foci in breast MRI.
Study Type:
Meta-analysis.
Subjects:
32 articles with 2645 foci.
Field Strength/Sequence:
1.5 T and 3.0 T. T1WI, T2WI, and DCE-MRI.
Assessment:
PubMed, Embase, Scopus, and Cochrane databases were searched for articles published from January 2013 to December 2023, using the search terms: "focus," "foci," "small mass," "size," "breast magnetic resonance imaging," and "breast MRI." Extracted data included the reference standard, number of benign/malignant foci, size criterion, BI-RADS categories, amount of fibroglandular tissue, background parenchymal enhancement, T2WI signal intensity, delayed enhancement pattern.
Statistical Tests:
Pooled data were analyzed using Revman 5.4 software. Between-study heterogeneity was investigated with I 2-statistics. If I 2 < 50% (reflecting no substantial heterogeneity), a fixed effects model was used for analysis. If I 2 > 50%, random effects model analysis was used. For continuous variables, the standardized mean difference (SMD) and 95% confidence interval (CI) were used to represent the results. Malignancy rate of each study was transformed via the Freeman-Tukey Doublearcsine method. Odds ratios (OR) with 95% CIs were calculated for dichotomous variables. p values ≤ 0.05 were considered significant.
Results:
The pooled malignancy rate of 2645 foci was 16% (95% CI: 13%-19%). There was a significant association between malignant foci and older age (OR = 5.82, 95% CI: 2.08-9.56), T2WI hypointensity (OR = 2.28, 95% CI: 1.19-4.35) and delayed enhancement washout pattern (OR = 2.78, 95% CI: 1.87-4.12). Hyperintense foci were significantly more likely to be benign (OR = 0.41, 95% CI: 0.21-0.79).
Data Conclusion:
An enhancing focus with T2WI hypointensity and a washout pattern, especially in older patients, is significantly more likely to be malignant. Therefore, careful attention should be paid to it and could justify consideration of biopsy.
Evidence Level:
3.
Technical Efficacy:
Stage 3.
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