MRI of the Lactating Breast: Computer-Aided Diagnosis False Positive Rates and Background Parenchymal Enhancement Kinetic Features

Noam Nissan*, Vera Sorin, Ethan Bauer, Debbie Anaby, David Samoocha, Yael Yagil, Renata Faermann, Osnat Halshtok-Neiman, Anat Shalmon, Michael Gotlieb, Miri Sklair-Levy

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Rationale and Objectives: To investigate the application of computer-added diagnosis (CAD) in dynamic contrast-enhanced (DCE) MRI of the healthy lactating breast, focusing on false-positive rates and background parenchymal enhancement (BPE) coloring patterns in comparison with breast cancer features in non-lactating patients. Materials and Methods: The study population was composed of 58 healthy lactating patients and control groups of 113 healthy premenopausal non-lactating patients and 55 premenopausal non-lactating patients with newly-diagnosed breast cancer. Patients were scanned on 1.5-T MRI using conventional DCE protocol. A retrospective analysis of DCE-derived CAD properties was conducted using a commercial software that is regularly utilized in our routine radiological work-up. Qualitative morphological characterization and automatically-obtained quantitative parametric measurements of the BPE-induced CAD coloring were categorized and subgroups’ trends and differences between the lactating and cancer cohorts were statistically assessed. Results: CAD false-positive coloring was found in the majority of lactating cases (87%). Lactation BPE coloring was characteristically non-mass enhancement (NME)-like shaped (87%), bilateral (79%) and symmetric (64%), whereas, unilateral coloring was associated with prior irradiation (p <0.0001). Inter-individual variability in CAD appearance of both scoring-grade and kinetic-curve dominance was found among the lactating cohort. When compared with healthy non-lactating controls, CAD false positive probability was significantly increased [Odds ratio 40.2, p <0001], while in comparison with the breast cancer cohort, CAD features were mostly inconclusive, even though increased size parameters were significantly associated with lactation-BPE (p <0.00001). Conclusion: BPE was identified as a common source for false-positive CAD coloring on breast DCE-MRI among lactating population. Despite several typical characteristics, overlapping features with breast malignancy warrant a careful evaluation and clinical correlation in all cases with suspected lactation induced CAD coloring.

Original languageEnglish
Pages (from-to)1332-1341
Number of pages10
JournalAcademic Radiology
Volume29
Issue number9
DOIs
StatePublished - Sep 2022

Keywords

  • BPE
  • CAD MRI
  • DWI
  • MRI lactation
  • PABC
  • pregnancy-associated breast cancer

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