Birads 3 lesions breast mr - cpd.utoronto.ca · BI-RADS 3 lesions NME- Non Mass-like Enhancement...

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BIRADS 3 LESIONS BREAST MR Kavita Dhamanaskar Radiologist @ Juravinski hospital, Hamilton Disclosures None relevant

Transcript of Birads 3 lesions breast mr - cpd.utoronto.ca · BI-RADS 3 lesions NME- Non Mass-like Enhancement...

BIRADS 3 LESIONS BREAST MR

Kavita Dhamanaskar Radiologist @ Juravinski hospital, Hamilton

Disclosures

�N

one relevant

Learning objectives

�D

efinition and Characterization of BI-R

ADS 3

lesions on MR

�Correlation w

ith conventional imaging

�Follow

up protocols

BI-R

ADS 3

category on MR

�“A finding assessed using this category should have �����

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BI-R

ADS 3

lesions on MR

: Challenges �

No strong data for definitive characterization of B

i-rads 3 lesions

�D

ifferences in study design and criteria from published studies

�R

isks and benefits of short term follow

- up –

Patient anxiety and non compliance

–H

igh risk lesion mim

icks

BI-R

ADS 3

Lesions

FOCI

NM

E- Non M

asslike enhancement

MASS

Birads 3

lesions on MR

FO

CI

�Foci are defined as sm

all dots (</=

5m

m) of enhancem

ent that are unique and stand out from

the BPE.

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all to be accurately assessed with respect

to margin or internal enhancem

ent.

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REAST M

RI

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Birads 3

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anL., M

ason G., M

orris E.A

., et al: Does size m

atter? Positive predictive value of M

RI-detected breast

lesions as a function of lesion size. AJR

Am

J Roentgenol2006; 186: pp. 426-430

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byP.R

., DeM

artiniW.B

., Gutierrez R

.L., et al: Characteristics of probably benign breast M

RI lesions. A

JR A

m J

Roentgenol2009; 193: pp. 861-867

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disappeared. –

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ith/without w

ashout characteristics –

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up MR (6m

onths). –

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arrants BIOPSY B

irads 3 lesions on M

R

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Lesions

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NM

E- Non M

asslike enhancement

MASS

BI-R

ADS 3

lesions N

ME- N

on Mass-like Enhancem

ent �

Overall M

R interpretation trend is tow

ards lower num

ber of cases designated as B

irads 3

�Som

e reasons- –

Bilateral NM

E now labelled BPE and belongs to BI-RAD

S 1 (ACR BI-RADS

lexicon)

�N

ME that is unique and separate from

the overall background enhancement

should undergo assessment based on m

orphology and kinetics. –

Not included are segm

ental, linear or clumped nodular enhancem

ent (BI-RADS 4)

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lesions- NM

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ass-like Enhancement

MR

Bx-

Benign breast

tissue w

proliferative change

Bilateral N

ME

Findings resolved at 6 m

onth FU M

R

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ADS 3

Lesions

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asslike enhancement

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Chronic inflamed cysts- w

ell defined thin rim enhancem

ent (birads �G

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ith thin rim enhancem

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surgery (bi-Rads �

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Cancer yield ??

�TH

E EVIDEN

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Summ

ary of Literature on MR

Imaging–

detected Probably B

enign (BI-R

ADS Category 3

) Lesions

*Num

bers in parentheses are percentages. †Num

bers in parentheses are raw data.

Radiology. 2016 S

ep;280(3):707-15.doi: 10.1148/radiol.2016151548. Epub

2016 Apr 18.

Characteristics, M

alignancy Rate, and Follow

-up of BI-R

ADS C

ategory 3 Lesions Identified at Breast M

R

Imaging: Im

plications for MR

Image Interpretation and M

anagement.

Chikarm

aneS

A1,B

irdwell R

L1,P

oole PS

1,Sippo

DA

1,Giess

CS

1.

“Probably benign” interpretations in H

igh risk wom

en at MR

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ine the results of probably benign lesions on FU.

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*Liberman

L, Morris E

A, B

enton CL, et al. P

robably benign lesions at breast magnetic resonance im

aging:prelim

inary experience in high-risk wom

en. Cancer 2003;98(2):377–88.

Freq. of malignancy in probably benign

lesions at CE-X�

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) of 106- stable –

23 (21.7%) – had tissue diagnosis –

–18 had benign pathology, 2 had AH

& 1 had D

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iensteinet al R

adiology:Volume 255: N

umber 3—

June 2010

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lesions �

Study by Lourenco et al describes -Frequency, Lesion Type, and Rate

of Malignancy

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125- foci (2- 4mm

size) Cancer Yield- 0.8%

–52 non m

ass like (6- 35mm

) Cancer Yield- 3.8%

–171 m

asses with sm

ooth margins (5-20m

m) Cancer Yield- 1.2%

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BI- R

ADS 3

Breast M

R category

Notes:

�B

reast MR

comm

only used in higher risk wom

en

�Low

specificity of MR

in small lesions w

ith overlap between

high risk lesions and benign lesions

�Learning curve of radiologists

�B

aseline Study Vs follow up im

aging

�A desirable goal for the frequency of m

aking category 3

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�As experience grow

s and with internal audits this num

ber �� ��������

-*�

As per published studies/literature

BI- R

ADS 3

Breast M

R category

Notes:

�M

amm

ogram and U

ltrasound- useful to ultimately assign a B

I-RAD

S 3

for a first time detected finding on B

aseline or screening MR

�M

asses have highest correlation on ultrasound

�Foci and N

ME not usually identified and can go straight to M

R follow

up or M

R biopsy (high risk)

BI- R

ADS 3

Breast M

R category

Notes:

Summ

ary �

BI-R

ads 3 category is not easy to assign and requires a m

ethodological approach

�Com

monly 3

types

–Foci

–N

ME

–M

ass

�Correlation to prior im

aging including MR

, mam

mogram

s and ultrasound would help

in accurate characterization and BI-R

ADS designation

�Clinical characteristics and risk factors need to be taken into account

�1 �� 8

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�years to establish benignity

�For N

ME attributable to phase of m

enstrual cycle may consider repeat M

R in 6

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