Increasing the accuracy of Bİ-RADS diagnosis in benign-malignant breast lesions with and without mass, with kinetic, semi-quantitative contrast values, morphological and sequence features in dynamic contrast breast MRİ

Aim: The aim of our study is to evaluate the contribution of kinetic, semi-quantitative contrast values, morphological and sequence features in dynamic breast Magnetic Resonance Imaging (MRI) to BI-RADS and the differentiation of massive and non-massive benign-malignant lesions. Material and Method: Breast MRIs taken in the radiology clinic of our hospital between February 2016 and December 2020 were scanned retrospectively, 75 patients and 84 breast lesions were included in the study. Patients undergoing surgical/medical treatment for primary breast malignancy and lesions less than 5 mm in diameter on breast MRI were not included in the study. Lesions were divided into masses and non-mass enhancement. All patients were divided into two groups as benign and malignant pathological diagnosis based on clinical/radiological follow-up, fine needle aspiration biopsy (FNAB), tru-cut cutting biopsy, wire marking excisional biopsy and surgical diagnosis. In addition, BI-RADS category 1, 2 and 3 lesions were considered benign, BI-RADS category 4 and 5 lesions were considered malignant, and the lesions were divided into 2 separate groups. The size, morphology, sequence, semiquantitative values and kinetic enhancement patterns of all lesions were evaluated and their relationship with the pathological benign-malignant and BI-RADS benign-malignant groups was evaluated. Results: There was no statistically significant difference in terms of location, quadrant and depth, sequence characteristics, breast ACR type and breast background contrast of the lesions evaluated as pathological benign-malignant and BI-RADS benign-malignant. A statistically significant difference was found in breast enhancement symmetry, and the probability of malignancy was found to be high in breasts with asymmetric enhancement. A statistically significant difference was found according to the shape, border features and internal enhancement patterns of vii the masses, and most of the benign lesions were contrasted as oval-round shaped, smooth contoured, homogeneous and internally non-enhancing septa. Malignant lesions, on the other hand, were irregularly shaped, with irregular-spiculated margins, and showed heterogeneous contrast enhancement. The number of lesions showing non-massive enhancement was not sufficient in our study, and no statistically significant difference was found in terms of distribution and enhancement patterns. A statistically significant difference was found according to the time-signal intensity early and late curves, and benign lesions showed more type 1 and malignant lesions mostly type 2-3 enhancement curve. Findings accompanying mass or non-mass enhancements (nipple retraction, nipple invasion, etc.) were significant and often accompanied malignant lesions. Among the semi-quantitative values, we included in our study, a significant difference was found in "time to peak, wash out rate and brevity of enhancement" between both groups, but no statistically significant difference was found in "relative enhancement, maximum enhancement, T0, wash in rate and area under the curve". In "maximum relative enhancement", there was no significant difference in pathological benign-malignant, but a significant difference was found in MRI BI-RADS benign-malignant grouping. Conclusions: In conclusion, in our study, which consisted of massive and non-massive lesions, morphological features such as shape, edge feature, distribution and contrasting pattern were detected as the most important criteria in the differentiation of pathology and MRI-BIRADS benign-malignant lesions. Dynamic MRI such as the kinetic curves of the lesions, semiquantitative-quantitative values. It was seen that it had a significant advantage over other imaging methods because it allowed numerical parameters, and that the semi-quantitative values of "time to peak, wash-out rate and brevity of enhancement" were significant. Keywords: Kinetic, magnetic resonance imaging, breast lesions, morphology, semiquantitative