Published online Jul 28, 2022. doi: 10.4329/wjr.v14.i7.229
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
Dynamic contrast-enhanced magnetic resonance imaging (MRI) is the most frequently used MRI technique for evaluating breast cancer. Changes in signal intensity across multiple images acquired by pre- and post-contrast repeat MRI scans are used to determine the enhancement patterns. The time-signal intensity curve, also known as the kinetic curve, can be classified into three types: Type 1 (persistence), type 2 (plateau), and type 3 (washout). A higher rate of benign pathologies is indicated by the type 1 dynamic curve, while a higher rate of malignant pathologies is indicated by the type 3 dynamic curve. However, there is a dilemma with the type 2 curve. The aim of this study was to investigate the histopathological outcomes of lesions with type 2 dynamic curves, which have much overlap in the kinetic analysis between benign and malignant entities.
There have been several studies on type 3 and type 1 dynamic curves, but studies on type 2 dynamic curves are not sufficient. More research on type 2 dynamic curves, which have much overlap in kinetic analysis between benign and malignant entities, is needed.
The aim of this study was to examine the histopathological outcomes of lesions with type 2 dynamic curves, in which there is a high degree of overlap between benign and malignant entities in the kinetic analysis performed using dynamic contrast MRI.
Two experienced radiologists retrospectively re-evaluated lesions with type 2 dynamic curves. The included lesions were re-examined for type 2 dynamic curves by the evaluators. Additionally, the evaluators classified the lesions according to their morphological characteristics using the American College of Radiology's Breast Imaging Reporting and Data System classification. The histopathological findings of the patients were retrieved and recorded retrospectively from the hospital information system. Receiver operating characteristic analysis was done to determine the diagnostic efficacy of type 2 dynamic curves alone and in combination with morphological characteristics.
Thirty-eight lesions in 33 patients were included in the study. As a result, 12 lesions were determined to be benign, while 26 lesions were determined to be malignant. While sclerosing adenosis was the most frequently encountered benign pathology, invasive ductal carcinoma was the most frequently encountered malignant pathology. 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.
In our investigation, the significant rates of malignancy discovered histopathologically among patients with type 2 curves are remarkable. In the presence of a type 2 dynamic curve, we should exercise caution in terms of suspicion of malignancy.
Studies with larger patient populations focusing on the histopathological results of lesions with type 2 dynamic curves are needed.