E1670. The Utility of Breast MRI in Patients Presenting with Clinical Symptoms in the Absence of Mammographic or Ultrasound Correlates
  1. Lily Sung; Geisinger Medical Center; Massachusetts General Hospital
  2. Kathryn Sneek; Geisinger Medical Center; University at Buffalo
  3. Monica Froicu; Geisinger Medical Center
This study seeks to evaluate the utility of breast magnetic resonance imaging (MRI) as a problem-solving tool for clinical breast symptoms without findings on prior imaging evaluation.

Materials and Methods:
Retrospective review of 4086 contrast enhanced breast MRI examinations performed from January 2015 to December 2018 demonstrated 558 (13.65%) examinations acquired to further assess clinical symptoms including palpable breast abnormalities, breast shape changes, breast pain, nipple discharge, and breast skin changes. Imaging, histopathology findings, and patient demographics were obtained from medical records.

The mean patient age was 49 years (range 17 - 90 years). Of the 558 MRIs performed for clinical symptoms, 332 (59%) studies had no corresponding findings on initial diagnostics evaluation with mammogram and/or ultrasound. MRI evaluation of the symptomatic patients with no prior corresponding imaging findings showed an MRI correlate in 58/332 cases (17%), equivocal correlate in 43/332 cases (13%) and no correlate in 231/332 (70%). 38/101 (38%) of the cases with either an MRI correlate or equivocal correlate were biopsied, and 8/38 (21%) malignancies were found. Overall, of the 332 symptomatic patients, 3/108 (3%) with a palpable abnormality, 1/37 (3%) with breast shape change (dimpling), 2/91 (2%) with breast pain, 1/66 (2%) with nipple discharge, and 1/30 (3%) with skin changes were found to have a corresponding malignancy. High-risk lesions were detected at biopsy in 1/108 (1%) of the patients with a palpable abnormality, 2/91 (2%) of the patients with breast pain and 8/66 (12%) with nipple discharge. Incidentally detected were 2/333 (0.6%) malignant or high risk lesions, which did not correspond to clinical symptoms.

The clinical utility of MRI in patients with clinical symptoms previously found to have no corresponding findings on mammogram and/or ultrasound is limited, with few malignancies found to correlate with clinical breast symptoms. A significant number of intraductal papillomas in patients with nipple discharge were noted only after MRI, lending greater validity to the use of MRI for problem solving in this subset of patients. Given the relatively low chance of malignancy detected on MRIs performed for clinical symptoms in the absence of mammographic and/or sonographic findings, the recommendation for MRI should be carefully considered possibly after thorough clinical breast examinations.