Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Jul 28, 2022; 14(7): 229-237
Published online Jul 28, 2022. doi: 10.4329/wjr.v14.i7.229
Type 2 dynamic curves: A diagnostic dilemma
Erdal Karavas, Bunyamin Ece, Sonay Aydın
Erdal Karavas, Sonay Aydın, Department of Radiology, Erzincan University, Erzincan 24142, Turkey
Bunyamin Ece, Department of Radiology, Kastamonu University, Kastamonu 37150, Turkey
Author contributions: Karavas E participated in design and oversight of the study, and drafted the manuscript; Ece B participated in design of the study and drafted the manuscript; and Aydin S participated in design of the study, drafted the manuscript, and performed statistical analysis.
Institutional review board statement: The study was reviewed and approved by the Erzincan University Institutional Review Board (ethics committee number: 34336249-604.01.02-E.30236).
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at bunyaminece@hotmail.com. Informed consent was not obtained since the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bunyamin Ece, MD, Associate Professor, Doctor, Department of Radiology, Kastamonu University, Kuzeykent 57, Alay Street No. 4, Kastamonu 37150, Turkey. bunyaminece@hotmail.com
Received: February 19, 2022
Peer-review started: February 19, 2022
First decision: April 8, 2022
Revised: April 16, 2022
Accepted: July 6, 2022
Article in press: July 6, 2022
Published online: July 28, 2022
Abstract
BACKGROUND

Magnetic resonance imaging (MRI) with multiparametric dynamic contrast plays a critical role in the assessment of breast lesions. Dynamic curves are a critical parameter in determining the benign or malignant nature of lesions. Dynamic curves of type 1 are known to represent benign masses, while dynamic curves of type 3 are known to identify malignant masses. Type 2 dynamic curves have a sensitivity of 42.6% and specificity of 75% for malignancy detection.

AIM

To investigate the pathological diagnosis of lesions with type 2 dynamic curves.

METHODS

We evaluated breast MRI examinations performed between 2020 and 2021 retrospectively and included lesions with type 2 dynamic curves. We included 38 lesions from 33 patients. The lesions were evaluated for their pathological diagnosis and morphological characteristics.

RESULTS

Twenty-six lesions were malignant, while twelve were benign. The most frequently encountered benign lesion (7/12, 58.3%) was sclerosing adenosis, while the most frequently encountered malignant diagnosis was invasive ductal cancer. The presence of a type 2 dynamic curve had a sensitivity of 40.2% and specificity of 73.4% for predicting malignancy. By combining type 2 curves and morphological features, the sensitivity and specificity were increased.

CONCLUSION

The high rates of malignancy detected histopathologically among patients with type 2 dynamic curves in our study are remarkable. Type 2 dynamic curves can be detected in benign breast masses, especially in sclerosing adenosis cases. Considering morphological features can increase the diagnostic accuracy in cases with type 2 dynamic curves.

Keywords: Type 2, Dynamic curve, Benign, Malignant, Breast, Magnetic resonance imaging

Core Tip: Dynamic contrast-enhanced magnetic resonance imaging (MRI) plays a critical role in the evaluation of breast lesions. The sensitivity and specificity of dynamic curves acquired using MRI are variable. While type 1 curves indicate more benign pathologies and type 3 curves indicate more malignant pathologies, there is a significant overlap in type 2 dynamic curves. We examined the histopathological outcomes of lesions with type 2 curves retrospectively. The histopathology results of lesions with type 2 curves were malignant at a rate of 68.4%. The presence of a type 2 dynamic curve had a sensitivity of 40.2% and specificity of 73.4% for predicting malignancy. By combining type 2 curves and morphological features, the area under the curve, sensitivity, and specificity were increased.