Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 5/2018

Open Access 01-05-2018 | Breast

Breast lesions classified as probably benign (BI-RADS 3) on magnetic resonance imaging: a systematic review and meta-analysis

Authors: Claudio Spick, Hubert Bickel, Stephan H. Polanec, Pascal A. Baltzer

Published in: European Radiology | Issue 5/2018

Login to get access

Abstract

Purpose

To investigate prevalence, malignancy rates, imaging features, and follow-up intervals for probably benign (BI-RADS 3) lesions on breast magnetic resonance imaging (MRI).

Methods

A systematic database-review of articles published through 22/06/2016 was performed. Eligible studies reported BI-RADS 3 lesions on breast MRI. Two independent reviewers performed a literature review and data extraction. Data collection included study characteristics, number/type of BI-RADS 3 lesions, final diagnosis (histopathology and/or follow-up). Sources of bias (QUADAS-2) were assessed. Meta-analysis included data-pooling, heterogeneity testing, and meta-regression.

Results

Fifteen studies were included. Prevalence was reported in 11 studies (range: 1.2-24.3%). Malignancy rates ranged between 0.5-10.1% (pooled 61/2814, 1.6%, 95%-CI:0.9-2.3% (random-effects-model), I2=53%, P=0.007). In a subgroup of 11 studies (2183 lesions), highest malignancy rates were observed in non-mass lesions (pooled 25/714, 2.3%, 95%-CI:0.8-3.9%, I2=52%, P=0.021) followed by mass lesions (pooled 15/771, 1.5%, 95%-CI:0.7-2.4%, I2=0%, P=0.929), and foci (pooled 10/698, 1%, 95%-CI:0.3-1.7%, I2=0%, P=0.800). There was non-significant negative association between prevalence and malignancy rates (P=0.077). Malignant lesions were diagnosed at all follow-up time points.

Conclusion

While prevalence of MRI BI-RADS 3 lesions was strongly heterogeneous, pooled malignancy rates met BI-RADS benchmarks (<2%). Malignancy rates varied, exceeding 2% in non-mass lesions. Twenty-four-month surveillance is required to detect all malignant lesions.

Key points

• Probably benign (BI-RADS 3) lesions showed a pooled malignancy-rate of 1.6% (95%-CI:0.9-2.3%).
• Malignancy rates differ and are highest in non-mass lesions (2.3%, 95%-CI:0.8-3.9%).
• The prevalence of BI-RADS 3 lesions on breast MRI ranged from 1.2-24.3%.
• Malignant lesions were diagnosed at follow-up time points up to 24 months.
Literature
1.
American College of Radiology Breast Imaging Reporting and Data System (BI-RADS). 5th ed. Reston, VA: American College of Radiology; 2013.
2.
Comstock C, Sung JS (2013) BI-RADS 3 for magnetic resonance imaging. Magn Reson Imaging Clin N Am 21:561–570CrossRefPubMed
3.
Lee KA (2014) Breast Imaging Reporting and Data System category 3 for magnetic resonance imaging. Top Magn Reson Imaging TMRI 23:337–344CrossRefPubMed
4.
Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097CrossRefPubMedPubMedCentral
5.
Jalali S, Wohlin C (2012) Systematic literature studies: database searches vs. backward snowballing. ACM Press, p 29
6.
Whiting PF, Rutjes AWS, Westwood ME et al (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155:529–536CrossRefPubMed
7.
8.
Higgins JPT, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558CrossRefPubMed
9.
Duval S, Tweedie R (2000) Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56:455–463CrossRefPubMed
10.
Kuhl CK, Schmutzler RK, Leutner CC et al (2000) Breast MR imaging screening in 192 women proved or suspected to be carriers of a breast cancer susceptibility gene: preliminary results. Radiology 215:267–279CrossRefPubMed
11.
Liberman L, Morris EA, Benton CL et al (2003) Probably benign lesions at breast magnetic resonance imaging: preliminary experience in high-risk women. Cancer 98:377–388CrossRefPubMed
12.
Kriege M, Brekelmans CTM, Boetes C et al (2004) Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med 351:427–437CrossRefPubMed
13.
Sadowski EA, Kelcz F (2005) Frequency of malignancy in lesions classified as probably benign after dynamic contrast-enhanced breast MRI examination. J Magn Reson Imaging JMRI 21:556–564CrossRefPubMed
14.
Eby PR, DeMartini WB, Gutierrez RL et al (2009) Characteristics of probably benign breast MRI lesions. AJR Am J Roentgenol 193:861–867CrossRefPubMed
15.
Weinstein SP, Hanna LG, Gatsonis C et al (2010) Frequency of malignancy seen in probably benign lesions at contrast-enhanced breast MR imaging: findings from ACRIN 6667. Radiology 255:731–737CrossRefPubMedPubMedCentral
16.
Hauth E, Umutlu L, Kümmel S et al (2010) Follow-up of probably benign lesions (BI-RADS 3 category) in breast MR imaging. Breast J 16:297–304CrossRefPubMed
17.
Marshall AL, Domchek SM, Weinstein SP (2012) Follow-up frequency and compliance in women with probably benign findings on breast magnetic resonance imaging. Acad Radiol 19:406–411CrossRefPubMed
18.
Lourenco AP, Chung MTM, Mainiero MB (2014) Probably benign breast MRI lesions: frequency, lesion type, and rate of malignancy. J Magn Reson Imaging JMRI 39:789–794CrossRefPubMed
19.
Bahrs SD, Baur A, Hattermann V et al (1987) (2014) BI-RADS® 3 lesions at contrast-enhanced breast MRI: is an initial short-interval follow-up necessary? Acta Radiol Stockh Swed 55:260–265
20.
Spick C, Szolar DHM, Baltzer PA et al (2014) Rate of malignancy in MRI-detected probably benign (BI-RADS 3) lesions. AJR Am J Roentgenol 202:684–689CrossRefPubMed
21.
Grimm LJ, Anderson AL, Baker JA et al (2015) Frequency of malignancy and imaging characteristics of probably benign lesions seen at breast MRI. AJR Am J Roentgenol 205:442–447CrossRefPubMed
22.
Chikarmane SA, Birdwell RL, Poole PS et al (2016) Characteristics, malignancy rate, and follow-up of BI-RADS category 3 lesions identified at breast MR imaging: implications for MR image interpretation and management. Radiology 280:707–715CrossRefPubMed
23.
Boisserie-Lacroix M, Ziadé C, Hurtevent-Labrot G et al (2016) Is a one-year follow-up an efficient method for better management of MRI BI-RADS(®) 3 lesions? Breast Edinb Scotl 27:1–7CrossRef
24.
Guillaume R, Taieb S, Ceugnart L et al (2016) BIRADS 3 MRI lesions: Was the initial score appropriate and what is the value of the blooming sign as an additional parameter to better characterize these lesions? Eur J Radiol 85:337–345CrossRefPubMed
25.
26.
Schnall MD, Blume J, Bluemke DA et al (2006) Diagnostic architectural and dynamic features at breast MR imaging: multicenter study. Radiology 238:42–53CrossRefPubMed
27.
Baltzer PAT, Benndorf M, Dietzel M et al (2010) False-positive findings at contrast-enhanced breast MRI: a BI-RADS descriptor study. AJR Am J Roentgenol 194:1658–1663CrossRefPubMed
28.
Woitek R, Spick C, Schernthaner M, et al (2017) A simple classification system (the Tree flowchart) for breast MRI can reduce the number of unnecessary biopsies in MRI-only lesions. Eur Radiol
29.
Marino MA, Clauser P, Woitek R et al (2016) A simple scoring system for breast MRI interpretation: does it compensate for reader experience? Eur Radiol 26:2529–2537CrossRefPubMed
30.
Baum F, Fischer U, Vosshenrich R, Grabbe E (2002) Classification of hypervascularized lesions in CE MR imaging of the breast. Eur Radiol 12:1087–1092CrossRefPubMed
31.
Partridge SC, Nissan N, Rahbar H et al (2017) Diffusion-weighted breast MRI: Clinical applications and emerging techniques. J Magn Reson Imaging JMRI 45:337–355CrossRefPubMed
32.
Pinker K, Bickel H, Helbich TH et al (2013) Combined contrast-enhanced magnetic resonance and diffusion-weighted imaging reading adapted to the “Breast Imaging Reporting and Data System” for multiparametric 3-T imaging of breast lesions. Eur Radiol 23:1791–1802CrossRefPubMed
33.
Baltzer A, Dietzel M, Kaiser CG, Baltzer PA (2016) Combined reading of contrast enhanced and diffusion weighted magnetic resonance imaging by using a simple sum score. Eur Radiol 26:884–891CrossRefPubMed
34.
Spick C, Pinker-Domenig K, Rudas M et al (2014) MRI-only lesions: application of diffusion-weighted imaging obviates unnecessary MR-guided breast biopsies. Eur Radiol 24:1204–1210CrossRefPubMed
35.
Woodhams R, Matsunaga K, Iwabuchi K et al (2005) Diffusion-weighted imaging of malignant breast tumors: the usefulness of apparent diffusion coefficient (ADC) value and ADC map for the detection of malignant breast tumors and evaluation of cancer extension. J Comput Assist Tomogr 29:644–649CrossRefPubMed
36.
Metadata
Title
Breast lesions classified as probably benign (BI-RADS 3) on magnetic resonance imaging: a systematic review and meta-analysis
Authors
Claudio Spick
Hubert Bickel
Stephan H. Polanec
Pascal A. Baltzer
Publication date
01-05-2018
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 5/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-017-5127-y

Other articles of this Issue 5/2018

European Radiology 5/2018 Go to the issue

Urogenital

A direct comparison of contrast-enhanced ultrasound and dynamic contrast-enhanced magnetic resonance imaging for prostate cancer detection and prediction of aggressiveness

Cardiac

Accuracy of computed tomography for selecting the revascularization method based on SYNTAX score II

Breast

A survey by the European Society of Breast Imaging on the utilisation of breast MRI in clinical practice

Cardiac

Round-the-clock performance of coronary CT angiography for suspected acute coronary syndrome: Results from the BEACON trial

Magnetic Resonance

Imaging putative foetal cerebral blood oxygenation using susceptibility weighted imaging (SWI)

Computed Tomography

Tin-filtered low-dose chest CT to quantify macroscopic calcification burden of the thoracic aorta