Abstract
Aim: We aimed to investigate the magnetic resonance imaging (MRI) features of benign, atypical, or malignant papillary breast lesions and to assess the additional value of diffusion-weighted imaging (DWI) and turbo inversion recovery magnitude (TIRM) sequences to routine breast MRI.
Background: Differentiation between benign and malignant papillary breast lesions is essential for patient management. However, morphologic features and enhancement patterns of malignant papillary lesions may overlap with those of benign papilloma.
Methods: Seventy-two papillary breast lesions (50 benign, 22 atypical or malignant) were included in the current study, retrospectively. We divided the patients into two groups: benign papillary breast lesions and atypical or malignant papillary breast lesions. Morphologic, dynamic, turbo inversion recovery magnitude (TIRM) values and diffusion features of the papillary lesions were compared between two groups.
Results: Benign papillary lesions were smaller in size (p=0.006 and p=0.005, for radiologists 1 and 2 respectively), closer to the areola (p=0.045 and 0.049 for radiologist 1 and 2 respectively), and had higher ADC values (p=0.001 for two radiologists) than the atypical or malignant group. ROC curves showed diagnostic accuracy for ADC (AUC=0.770 and 0.762, p & amp; lt; 0.0001 for two radiologists), and showed a cut-off value of ≤ 957 x 10-6 mm2/s (radiologist 1) and ≤ 910 x 10-6 mm2/s (radiologist 2).
Conclusion: MRI is a useful method for differentiation between benign and malignant papillary breast lesions. Centrally located, lesser in size, and higher ADC values should be considered benign, whereas peripherally located, larger in size, and lower ADC values should be considered malignant.
Keywords: Breast MRI, diffusion weighted imaging, papillary breast lesions, TIRM sequences, benign breast lesion, mammography.
[1]
Brookes MJ, Bourke AG. Radiological appearances of papillary breast lesions. Clin Radiol 2008; 63(11): 1265-73.
[http://dx.doi.org/10.1016/j.crad.2008.02.012] [PMID: 18929044]
[http://dx.doi.org/10.1016/j.crad.2008.02.012] [PMID: 18929044]
[2]
WHO Classification of Tumors Editorial Board. WHO classification
of tumors. 5. Breast tumors. Lyon: International Agency for Research
on Cancer 2019. Available from: https://www.iarc.who.int/news-events/who-classification-of-tumours-5th-edition-volume-2-breast-tumours/
[3]
Kurz KD, Roy S, Saleh A, Diallo-Danebrock R, Skaane P. MRI features of intraductal papilloma of the breast: Sheep in wolf’s clothing? Acta Radiol 2011; 52(3): 264-72.
[http://dx.doi.org/10.1258/ar.2011.100434] [PMID: 21498361]
[http://dx.doi.org/10.1258/ar.2011.100434] [PMID: 21498361]
[4]
Daniel BL, Gardner RW, Birdwell RL, Nowels KW, Johnson D. Magnetic resonance imaging of intraductal papilloma of the breast. Magn Reson Imaging 2003; 21(8): 887-92.
[http://dx.doi.org/10.1016/S0730-725X(03)00192-9] [PMID: 14599539]
[http://dx.doi.org/10.1016/S0730-725X(03)00192-9] [PMID: 14599539]
[5]
Bhattarai N, Kanemaki Y, Kurihara Y, Nakajima Y, Fukuda M, Maeda I. Intraductal papilloma: Features on MR ductography using a micro-scopic coil. AJR Am J Roentgenol 2006; 186(1): 44-7.
[http://dx.doi.org/10.2214/AJR.04.1600] [PMID: 16357375]
[http://dx.doi.org/10.2214/AJR.04.1600] [PMID: 16357375]
[6]
Dietzel M, Kaiser C, Baltzer PA. Magnetic resonance imaging of intraductal papillomas: Typical findings and differential diagnosis. J Comput Assist Tomogr 2015; 39(2): 176-84.
[http://dx.doi.org/10.1097/RCT.0000000000000188] [PMID: 25423553]
[http://dx.doi.org/10.1097/RCT.0000000000000188] [PMID: 25423553]
[7]
Eiada R, Chong J, Kulkarni S, Goldberg F, Muradali D. Papillary lesions of the breast: MRI, ultrasound, and mammographic appearances. AJR Am J Roentgenol 2012; 198(2): 264-71.
[http://dx.doi.org/10.2214/AJR.11.7922] [PMID: 22268167]
[http://dx.doi.org/10.2214/AJR.11.7922] [PMID: 22268167]
[8]
Youk JH, Kim EK, Kwak JY, Son EJ. Atypical papilloma diagnosed by sonographically guided 14-gauge core needle biopsy of breast mass. AJR 2010; 194(5): 1397-404.
[9]
Parsian S, Rahbar H, Allison KH, et al. Nonmalignant breast lesions: ADCs of benign and high-risk subtypes assessed as false-positive at dynamic enhanced MR imaging. Radiology 2012; 265(3): 696-706.
[http://dx.doi.org/10.1148/radiol.12112672] [PMID: 23033500]
[http://dx.doi.org/10.1148/radiol.12112672] [PMID: 23033500]
[10]
Ei Khouli RH, Jacobs MA, Mezban SD, et al. Diffusion-weighted imaging improves the diagnostic accuracy of conventional 3.0-T breast MR imaging. Radiology 2010; 256(1): 64-73.
[http://dx.doi.org/10.1148/radiol.10091367] [PMID: 20574085]
[http://dx.doi.org/10.1148/radiol.10091367] [PMID: 20574085]
[11]
Park MJ, Cha ES, Kang BJ, Ihn YK, Baik JH. The role of diffusion-weighted imaging and the Apparent Diffusion Coefficient (ADC) values for breast tumors. Korean J Radiol 2007; 8(5): 390-6.
[http://dx.doi.org/10.3348/kjr.2007.8.5.390] [PMID: 17923781]
[http://dx.doi.org/10.3348/kjr.2007.8.5.390] [PMID: 17923781]
[12]
Yoshikawa MI, Ohsumi S, Sugata S, et al. Comparison of breast cancer detection by diffusion-weighted magnetic resonance imaging and mammography. Radiat Med 2007; 25(5): 218-23.
[http://dx.doi.org/10.1007/s11604-007-0128-4] [PMID: 17581710]
[http://dx.doi.org/10.1007/s11604-007-0128-4] [PMID: 17581710]
[13]
Ahmadiyeh N, Stoleru MA, Raza S, Lester SC, Golshan M. Management of intraductal papillomas of the breast: an analysis of 129 cases and their outcome. Ann Surg Oncol 2009; 16(8): 2264-9.
[http://dx.doi.org/10.1245/s10434-009-0534-1] [PMID: 19484312]
[http://dx.doi.org/10.1245/s10434-009-0534-1] [PMID: 19484312]
[14]
Jaffer S, Nagi C, Bleiweiss IJ. Excision is indicated for intraductal papilloma of the breast diagnosed on core needle biopsy. Cancer 2009; 115(13): 2837-43.
[http://dx.doi.org/10.1002/cncr.24321] [PMID: 19402174]
[http://dx.doi.org/10.1002/cncr.24321] [PMID: 19402174]
[15]
Richter-Ehrenstein C, Tombokan F, Fallenberg EM, Schneider A, Denkert C. Intraductal papillomas of the breast: diagnosis and manage-ment of 151 patients. Breast 2011; 20(6): 501-4.
[http://dx.doi.org/10.1016/j.breast.2011.05.004] [PMID: 21640590]
[http://dx.doi.org/10.1016/j.breast.2011.05.004] [PMID: 21640590]
[16]
Yildiz S, Toprak H, Ersoy YE, et al. Contribution of diffusion-weighted imaging to dynamic contrast-enhanced MRI in the characterization of papillary breast lesions. Breast J 2018; 24(2): 176-9.
[http://dx.doi.org/10.1111/tbj.12861]
[http://dx.doi.org/10.1111/tbj.12861]
[17]
Bu Y, Xia J, Joseph B, et al. Non-contrast MRI for breast screening: Preliminary study on detectability of benign and malignant lesions in women with dense breasts. Breast Cancer Res Treat 2019; 177(3): 629-39.
[http://dx.doi.org/10.1007/s10549-019-05342-5] [PMID: 31325074]
[http://dx.doi.org/10.1007/s10549-019-05342-5] [PMID: 31325074]
[18]
Partridge SC, Nissan N, Rahbar H, Kitsch AE, Sigmund EE. Diffusion-weighted breast MRI: Clinical applications and emerging techniques. J Magn Reson Imaging 2017; 45(2): 337-55.
[http://dx.doi.org/10.1002/jmri.25479] [PMID: 27690173]
[http://dx.doi.org/10.1002/jmri.25479] [PMID: 27690173]
[19]
Surov A, Meyer HJ, Wienke A. Can Apparent Diffusion Coefficient (ADC) distinguish breast cancer from benign breast findings? A meta-analysis based on 13 847 lesions. BMC Cancer 2019; 19(1): 955.
[http://dx.doi.org/10.1186/s12885-019-6201-4] [PMID: 31615463]
[http://dx.doi.org/10.1186/s12885-019-6201-4] [PMID: 31615463]
[20]
Tagliati C, Ercolani P, Marconi E, Simonetti BF, Giuseppetti GM, Giovagnoni A. Apparent diffusion coefficient value in breast papillary lesions without atypia at core needle biopsy. Clin Imaging 2020; 59(2): 148-53.
[http://dx.doi.org/10.1016/j.clinimag.2019.10.010] [PMID: 31821971]
[http://dx.doi.org/10.1016/j.clinimag.2019.10.010] [PMID: 31821971]
[21]
Tozaki M, Fukuma E. 1H MR spectroscopy and diffusion-weighted imaging of the breast: are they useful tools for characterizing breast lesions before biopsy? AJR Am J Roentgenol 2009; 193(3): 840-9.
[http://dx.doi.org/10.2214/AJR.08.2128] [PMID: 19696300]
[http://dx.doi.org/10.2214/AJR.08.2128] [PMID: 19696300]
[22]
Maric J, Boban J, Ivkovic-Kapicl T, Djilas D, Vucaj-Cirilovic V, Bogdanovic-Stojanovic D. Differentiation of breast lesions and distinguish-ing their histological subtypes using diffusion-weighted imaging and ADC values. Front Oncol 2020; 10: 332.
[http://dx.doi.org/10.3389/fonc.2020.00332] [PMID: 32232007]
[http://dx.doi.org/10.3389/fonc.2020.00332] [PMID: 32232007]
[23]
Yang X, Dong M, Li S, et al. Diffusion-weighted imaging or dynamic contrast-enhanced curve: a retrospective analysis of contrast-enhanced magnetic resonance imaging-based differential diagnoses of benign and malignant breast lesions. Eur Radiol 2020; 30(9): 4795-805.
[http://dx.doi.org/10.1007/s00330-020-06883-w] [PMID: 32350660]
[http://dx.doi.org/10.1007/s00330-020-06883-w] [PMID: 32350660]
[24]
McDonald ES, Romanoff J, Rahbar H, et al. Mean apparent diffusion coefficient is a sufficient conventional diffusion-weighted MRI metric to improve breast MRI diagnostic performance: Results from the ECOG-ACRIN cancer research group A6702 diffusion imaging trial. Radiology 2021; 298(1): 60-70.
[http://dx.doi.org/10.1148/radiol.2020202465] [PMID: 33201788]
[http://dx.doi.org/10.1148/radiol.2020202465] [PMID: 33201788]
[25]
Spick C, Pinker-Domenig K, Rudas M, Helbich TH, Baltzer PA. MRI-only lesions: application of diffusion-weighted imaging obviates un-necessary MR-guided breast biopsies. Eur Radiol 2014; 24(6): 1204-10.
[http://dx.doi.org/10.1007/s00330-014-3153-6] [PMID: 24706105]
[http://dx.doi.org/10.1007/s00330-014-3153-6] [PMID: 24706105]
[26]
Baltzer A, Dietzel M, Kaiser CG, Baltzer PA. Combined reading of contrast enhanced and diffusion weighted magnetic resonance imaging by using a simple sum score. Eur Radiol 2016; 26(3): 884-91.
[http://dx.doi.org/10.1007/s00330-015-3886-x] [PMID: 26115653]
[http://dx.doi.org/10.1007/s00330-015-3886-x] [PMID: 26115653]
[27]
Kul S, Cansu A, Alhan E, Dinc H, Gunes G, Reis A. Contribution of diffusion-weighted imaging to dynamic contrast-enhanced MRI in the characterization of breast tumors. AJR Am J Roentgenol 2011; 196(1): 210-7.
[http://dx.doi.org/10.2214/AJR.10.4258] [PMID: 21178069]
[http://dx.doi.org/10.2214/AJR.10.4258] [PMID: 21178069]
[28]
Şahin C, Arıbal E. The role of apparent diffusion coefficient values in
the differential diagnosis of breast lesions in diffusion-weighted MRI. Diagn Interv Radiol 2013; 19(6): 457-62.
[http://dx.doi.org/10.5152/dir.2013.12132] [PMID: 24004972]
[http://dx.doi.org/10.5152/dir.2013.12132] [PMID: 24004972]
[29]
Satake H, Nishio A, Ikeda M, et al. Predictive value for malignancy of suspicious breast masses of BI-RADS categories 4 and 5 using ultra-sound elastography and MR diffusion-weighted imaging. AJR Am J Roentgenol 2011; 196(1): 202-9.
[http://dx.doi.org/10.2214/AJR.09.4108] [PMID: 21178068]
[http://dx.doi.org/10.2214/AJR.09.4108] [PMID: 21178068]
[30]
American College of Radiology. ACR BI-RADs Magnetic Resonance ImagingACR Breast Imaging Reporting and Data System, Breast Imag-ing Atlas. Reston, VA: ACR 2013.
[31]
Bode MK, Rissanen T, Apaja-Sarkkinen M. Ultrasonography-guided core needle biopsy in differential diagnosis of papillary breast tumors. Acta Radiol 2009; 50(7): 722-9.
[http://dx.doi.org/10.1080/02841850902977963] [PMID: 19488890]
[http://dx.doi.org/10.1080/02841850902977963] [PMID: 19488890]
[32]
Shin HJ, Kim HH, Kim SM, et al. Papillary lesions of the breast diagnosed at percutaneous sonographically guided biopsy: Comparison of sonographic features and biopsy methods. AJR Am J Roentgenol 2008; 190(3): 630-6.
[http://dx.doi.org/10.2214/AJR.07.2664] [PMID: 18287432]
[http://dx.doi.org/10.2214/AJR.07.2664] [PMID: 18287432]
[33]
Zhu Y, Zhang S, Liu P, Lu H, Xu Y, Yang WT. Solitary intraductal papillomas of the breast: MRI features and differentiation from small invasive ductal carcinomas. AJR Am J Roentgenol 2012; 199(4): 936-42.
[http://dx.doi.org/10.2214/AJR.12.8507] [PMID: 22997390]
[http://dx.doi.org/10.2214/AJR.12.8507] [PMID: 22997390]
[34]
Sarica O, Uluc F, Tasmali D. Magnetic resonance imaging features of papillary breast lesions. Eur J Radiol 2014; 83(3): 524-30.
[http://dx.doi.org/10.1016/j.ejrad.2013.12.007] [PMID: 24387934]
[http://dx.doi.org/10.1016/j.ejrad.2013.12.007] [PMID: 24387934]
[35]
Tominaga J, Hama H, Kimura N, Takahashi S. Magnetic resonance imaging of intraductal papillomas of the breast. J Comput Assist Tomogr 2011; 35(1): 153-7.
[http://dx.doi.org/10.1097/RCT.0b013e31820020f0] [PMID: 21245701]
[http://dx.doi.org/10.1097/RCT.0b013e31820020f0] [PMID: 21245701]
[36]
Karadeniz E, Arslan S, Akcay MN. Subaşi ID, Demirci E. Papillary lesions of the breast. Chirurgia (Bucur) 2016; 111(3): 225-9.
[PMID: 27452933]
[PMID: 27452933]
[37]
Youk JH, Kim EK, Kwak JY, Son EJ, Park BW, Kim SI. Benign papilloma without atypia diagnosed at US-guided 14-gauge core-needle biopsy: Clinical and US features predictive of upgrade to malignancy. Radiology 2011; 258(1): 81-8.
[http://dx.doi.org/10.1148/radiol.10100728] [PMID: 20971773]
[http://dx.doi.org/10.1148/radiol.10100728] [PMID: 20971773]
[38]
Kuehner G, Darbinian J, Habel L, et al. Benign papillary breast mass lesions: Favorable outcomes with surgical excision or imaging surveil-lance. Ann Surg Oncol 2019; 26(6): 1695-703.
[http://dx.doi.org/10.1245/s10434-019-07180-7] [PMID: 30737665]
[http://dx.doi.org/10.1245/s10434-019-07180-7] [PMID: 30737665]
[39]
Renshaw AA, Derhagopian RP, Tizol-Blanco DM, Gould EW. Papillomas and atypical papillomas in breast core needle biopsy specimens: Risk of carcinoma in subsequent excision. Am J Clin Pathol 2004; 122(2): 217-21.
[http://dx.doi.org/10.1309/K1BNJXETEY3H06UL] [PMID: 15323138]
[http://dx.doi.org/10.1309/K1BNJXETEY3H06UL] [PMID: 15323138]
[40]
Sydnor MK, Wilson JD, Hijaz TA, Massey HD, Shaw de Paredes ES. Underestimation of the presence of breast carcinoma in papillary le-sions initially diagnosed at core-needle biopsy. Radiology 2007; 242(1): 58-62.
[http://dx.doi.org/10.1148/radiol.2421031988] [PMID: 17090707]
[http://dx.doi.org/10.1148/radiol.2421031988] [PMID: 17090707]
[41]
Yabuuchi H, Matsuo Y, Sunami S, et al. Detection of non-palpable breast cancer in asymptomatic women by using unenhanced diffusion-weighted and T2-weighted MR imaging: comparison with mammography and dynamic contrast-enhanced MR imaging. Eur Radiol 2011; 21(1): 11-7.
[http://dx.doi.org/10.1007/s00330-010-1890-8] [PMID: 20640898]
[http://dx.doi.org/10.1007/s00330-010-1890-8] [PMID: 20640898]
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