Evaluation of Breast Lesions Using Multiparametric 3-Tesla Magnetic Resonance Imaging: A Cross-Sectional Study

Background Breast cancer is the most common malignancy affecting women globally. Early and accurate characterization of breast lesions is essential for the accurate diagnosis of breast carcinoma, reducing unnecessary biopsies and improving overall survival. Multiparametric magnetic resonance imaging (MRI) at 3 Tesla (3T), incorporating dynamic contrast-enhanced MRI (DCE-MRI), diffusion-weighted imaging (DWI), and proton MR spectroscopy (MRS), has emerged as a promising diagnostic modality for breast lesion characterization. Objective This study aimed to evaluate the diagnostic accuracy of multiparametric 3T MRI in differentiating benign and malignant breast lesions using the Breast Imaging Reporting and Data System (BI-RADS) classification. Methods This hospital-based cross-sectional study was conducted in the Department of Radiodiagnosis in collaboration with the Department of General Surgery at the Regional Institute of Medical Sciences, Imphal, India, from January 2021 to October 2022. A total of 62 female patients aged above 18 years presenting with breast lesions were included. All patients had previously undergone ultrasonography examination for palpable breast lesions, either within the Department of Radiodiagnosis or at outside centers. Patients demonstrating positive or suspicious findings on ultrasonography were subsequently referred for multiparametric MRI of the breast. Ultrasonography findings were obtained from available reports; however, no statistical comparison between ultrasound and MRI findings was performed, as this was beyond the scope of the study. MRI findings were categorized according to BI-RADS criteria as per the American College of Radiology guidelines. Histopathological evaluation served as the reference standard. Diagnostic performance parameters were calculated. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 21.0 (IBM Corp., Armonk, New York, United States). Results Among 62 participants, the mean age of the participants was 51.1±10.2 years (range: 30-80 years). The most common presenting complaint was a breast lump, 62 (100%), followed by axillary swelling, 56 (90%). On MRI, most lesions demonstrated heterogeneous enhancement, 39 (62.7%), and irregular margins, 34 (55.2%). Type III kinetic curve (washout pattern) was the most frequent, 56 (89.5%). Diffusion restriction was consistently observed in malignant lesions. Increased choline peaks were observed in lesions where MR spectroscopy was performed. Histopathological evaluation revealed 57 malignant and five benign lesions. The diagnostic performance of multiparametric MRI using the BI-RADS scoring system demonstrated a sensitivity of 93%, a specificity of 60%, a positive predictive value (PPV) of 96.4%, and a negative predictive value (NPV) of 42.9%. A statistically significant association was observed between MRI findings and histopathological diagnosis (Fisher's exact test; p=0.008). The area under the receiver operating characteristic (ROC) curve was 0.968. Conclusion Multiparametric 3T MRI is a highly sensitive imaging modality for the characterization of breast lesions, with moderate specificity. Its use improves diagnostic accuracy and demonstrates a strong correlation with histopathological findings in patients with suspicious breast lesions.