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Observer Variability and Applicability of BI-RADS Terminology for Breast MR Imaging

Invasive Carcinomas as Focal Masses

¹ Department of Radiology, Memorial Sloan-Kettering Cancer Center, Cornell University Medical College, 1275 York Ave., New York, NY 10021.
² Department of Physics, Memorial Sloan-Kettering Cancer Center, Cornell University Medical College, New York, NY 10021.

View larger version (125K): [in a new window]   Fig. 1. —67-year-old woman with positive biopsy findings of axillary lymph node suspicious for primary breast cancer and negative finding on physical examination and mammogram. Contrast-enhanced fat-saturated fast gradient-echo MR image (TR/TE, 6.5/1.6; flip angle, 10°) shows irregular mass with heterogeneous enhancement (arrows) classified by consensus as Breast Imaging Reporting and Data System category 5 [6]. Mastectomy yielded invasive and in situ ductal carcinoma.

View larger version (126K): [in a new window]   Fig. 2. —40-year-old woman with palpable mass (not shown) and biopsy-proven invasive lobular carcinoma. Fat-saturated contrast-enhanced fast gradient-echo MR image (TR/TE, 6.5/1.6; flip angle, 10°; slice thickness, 2.5 mm) obtained for preoperative staging shows additional nonpalpable round circumscribed 0.4-cm mass with homogeneous enhancement (arrows) classified by consensus as Breast Imaging Reporting and Data System category 3 [6]. Biopsy yielded invasive lobular carcinoma. Note that examination technique resulted in suboptimal interpretation of lesion. Although in-plane resolution is adequate, window setting does not show sufficient contrast. Also, slice thickness may have been too great for analysis of such a small lesion.

View larger version (151K): [in a new window]   Fig. 3. —69-year-old woman with oval homogeneously enhancing irregular mass (arrows) classified as suspicious abnormality, Breast Imaging Reporting and Data System category 4 [6], on contrast-enhanced fat-saturated fast gradient-echo image (TR/TE, 6.5/1.6; flip angle, 10°). Pathology yielded invasive lobular carcinoma.

View larger version (153K): [in a new window]   Fig. 4. —46-year-old woman underwent MR imaging for extent of disease assessment. Fat-saturated contrast-enhanced fast gradient-echo MR image (TR/TE, 6.5/1.6; flip angle, 10°) shows multiple suspicious foci, all within same quadrant including round and indistinct mass with homogeneous enhancement (arrows) classified as Breast Imaging Reporting and Data System category 4 [6]. Mastectomy yielded multifocal invasive poorly differentiated mammary carcinoma.

View larger version (150K): [in a new window]   Fig. 5. —46-year-old woman with suspicious mammographic abnormality underwent MR imaging for extent of disease assessment. Oval, irregular mass with peripheral rim enhancement, highly suggestive of malignancy (Breat Imaging Reporting and Data System category 5 [6]) was seen using contrast-enhanced fat-saturated fast gradient-echo MR image (TR/TE, 6.5/1.6; flip angle, 10°). Biopsy yielded infiltrating ductal carcinoma.

View larger version (113K): [in a new window]   Fig. 6. —38-year-old woman underwent breast MR imaging for suspected multicentric carcinoma (multiple sites of tumor in different quadrants). Contrast-enhanced fat-saturated fast gradient-echo MR image (TR/TE, 6.5/1.6; flip angle, 10°) shows spiculated mass with heterogeneous enhancement, classified as highly suggestive of malignancy, Breast Imaging Reporting and Data System category 5 [6]. Other similar-appearing masses compatible with multicentric carcinoma were identified in another quadrant. Pathology of this lesion yielded invasive and in situ ductal carcinoma.

View larger version (127K): [in a new window]   Fig. 7. —68-year-old woman underwent MR examination for questionable mammographic abnormality. Contrast-enhanced fat-saturated fast gradient-echo MR image (TR/TE, 6.5/1.6; flip angle, 10°) shows lobulated, circumscribed mass with homogeneous enhancement classified as Breast Imaging Reporting and Data System category 4 [6]. Sonographically guided core biopsy yielded invasive lobular carcinoma.

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