Goals: The use of breast MRI for the evaluation of palpable breast masses has not been supported in the literature. Despite this lack of data, magnetic resonance imaging (MRI) is occasionally used in practice to characterize a palpable finding, after conventional imaging was found to be non-contributory.
Methods: The breast MRI database at our center was queried for studies performed between January 2010 and December 2015 for the clinical indication of palpable breast finding with negative standard imaging. Medical files were reviewed for demographic data, clinical information, radiology and pathology reports. Benign versus malignant outcomes were determined by pathological result or 12 months of follow up.
Results: Investigation of palpable breast finding was the clinical indication for 167 of 7782 (2%) exams performed. Thirty-two (19%) women in the study had positive MRI findings. Most (20, 63%) of these findings corresponded to the palpable area including 3 carcinomas. Only one carcinoma required MRI guided biopsy for diagnosis. Seventeen women with a negative MRI underwent US guided biopsy from the palpable area with a diagnosis of 1 carcinoma. One carcinoma was incidentally detected in another location. Within our population the sensitivity for detecting malignancy was 80%, specificity 78%, negative predictive value 99% and positive predictive value 13%.
Conclusions: Although cancer was found in 4 cases in the palpable area, only in one was the biopsy directed by MRI. A new palpable finding with non-contributory standard imaging should prompt a needle-guided biopsy and not further evaluation by MRI.
