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Idiopathic Granulomatous Mastitis or Breast Cancer? A Comparative MRI Study in Patients Presenting with Non-Mass Enhancement

Objective: To compare and determine discriminative magnetic resonance imaging (MRI) findings of idiopathic granulomatous mastitis (IGM) and breast cancer (BC) that present as non-mass enhancement. Materials and Methods: This retrospective study includes 68 IGM and 75 BC cases that presented with non...

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Autores principales: Soylu Boy, Fatma Nur, Esen Icten, Gul, Kayadibi, Yasemin, Tasdelen, Iksan, Alver, Dolunay
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10137757/
https://www.ncbi.nlm.nih.gov/pubmed/37189576
http://dx.doi.org/10.3390/diagnostics13081475
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author Soylu Boy, Fatma Nur
Esen Icten, Gul
Kayadibi, Yasemin
Tasdelen, Iksan
Alver, Dolunay
author_facet Soylu Boy, Fatma Nur
Esen Icten, Gul
Kayadibi, Yasemin
Tasdelen, Iksan
Alver, Dolunay
author_sort Soylu Boy, Fatma Nur
collection PubMed
description Objective: To compare and determine discriminative magnetic resonance imaging (MRI) findings of idiopathic granulomatous mastitis (IGM) and breast cancer (BC) that present as non-mass enhancement. Materials and Methods: This retrospective study includes 68 IGM and 75 BC cases that presented with non-mass enhancement on breast MRI. All patients with a previous history of breast surgery, radiotherapy, or chemotherapy due to BC or a previous history of mastitis were excluded. On MRI images, presence of architectural distortion skin thickening, edema, hyperintense ducts containing protein, dilated fat-containing ducts and axillary adenopathies were noted. Cysts with enhancing walls, lesion size, lesion location, fistulas, distribution, internal enhancement pattern and kinetic features of non-mass enhancement were recorded. Apparent diffusion coefficient (ADC) values were calculated. Pearson chi-square test, Fisher’s exact test, independent t test and Mann–Whitney U test were used as needed for statistical analysis and comparison. Multivariate logistic regression model was used to determine the independent predictors. Results: IGM patients were significantly younger than BC patients (p < 0.001). Cysts with thin (p < 0.05) or thick walls (p = 0.001), multiple cystic lesions, (p < 0.001), cystic lesions draining to the skin (p < 0.001), and skin fistulas (p < 0.05) were detected more often in IGM. Central (p < 0.05) and periareolar (p < 0.001) location and focal skin thickening (p < 0.05) were significantly more common in IGM. Architectural distortion (p = 0.001) and diffuse skin thickening (p < 0.05) were associated with BC. Multiple regional distribution was more common in IGM, whereas diffuse distribution and clumped enhancement were more common in BC (p < 0.05). In kinetic analysis, persistent enhancement was more common in IGM, whereas plateau and wash-out types were more common in BC (p < 0.001). Independent predictors for BC were age, diffuse skin thickening and kinetic curve types. There was no significant difference in the diffusion characteristics. Based on these findings, MRI had a sensitivity, specificity and accuracy of 88%, 67.65%, and 78.32%, respectively, in differentiating IGM from BC. Conclusions: In conclusion, for non-mass enhancement, MRI can rule out malignancy with a considerably high sensitivity; however, specificity is still low, as many IGM patients have overlapping findings. Final diagnosis should be complemented with histopathology whenever necessary.
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spelling pubmed-101377572023-04-28 Idiopathic Granulomatous Mastitis or Breast Cancer? A Comparative MRI Study in Patients Presenting with Non-Mass Enhancement Soylu Boy, Fatma Nur Esen Icten, Gul Kayadibi, Yasemin Tasdelen, Iksan Alver, Dolunay Diagnostics (Basel) Article Objective: To compare and determine discriminative magnetic resonance imaging (MRI) findings of idiopathic granulomatous mastitis (IGM) and breast cancer (BC) that present as non-mass enhancement. Materials and Methods: This retrospective study includes 68 IGM and 75 BC cases that presented with non-mass enhancement on breast MRI. All patients with a previous history of breast surgery, radiotherapy, or chemotherapy due to BC or a previous history of mastitis were excluded. On MRI images, presence of architectural distortion skin thickening, edema, hyperintense ducts containing protein, dilated fat-containing ducts and axillary adenopathies were noted. Cysts with enhancing walls, lesion size, lesion location, fistulas, distribution, internal enhancement pattern and kinetic features of non-mass enhancement were recorded. Apparent diffusion coefficient (ADC) values were calculated. Pearson chi-square test, Fisher’s exact test, independent t test and Mann–Whitney U test were used as needed for statistical analysis and comparison. Multivariate logistic regression model was used to determine the independent predictors. Results: IGM patients were significantly younger than BC patients (p < 0.001). Cysts with thin (p < 0.05) or thick walls (p = 0.001), multiple cystic lesions, (p < 0.001), cystic lesions draining to the skin (p < 0.001), and skin fistulas (p < 0.05) were detected more often in IGM. Central (p < 0.05) and periareolar (p < 0.001) location and focal skin thickening (p < 0.05) were significantly more common in IGM. Architectural distortion (p = 0.001) and diffuse skin thickening (p < 0.05) were associated with BC. Multiple regional distribution was more common in IGM, whereas diffuse distribution and clumped enhancement were more common in BC (p < 0.05). In kinetic analysis, persistent enhancement was more common in IGM, whereas plateau and wash-out types were more common in BC (p < 0.001). Independent predictors for BC were age, diffuse skin thickening and kinetic curve types. There was no significant difference in the diffusion characteristics. Based on these findings, MRI had a sensitivity, specificity and accuracy of 88%, 67.65%, and 78.32%, respectively, in differentiating IGM from BC. Conclusions: In conclusion, for non-mass enhancement, MRI can rule out malignancy with a considerably high sensitivity; however, specificity is still low, as many IGM patients have overlapping findings. Final diagnosis should be complemented with histopathology whenever necessary. MDPI 2023-04-19 /pmc/articles/PMC10137757/ /pubmed/37189576 http://dx.doi.org/10.3390/diagnostics13081475 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Soylu Boy, Fatma Nur
Esen Icten, Gul
Kayadibi, Yasemin
Tasdelen, Iksan
Alver, Dolunay
Idiopathic Granulomatous Mastitis or Breast Cancer? A Comparative MRI Study in Patients Presenting with Non-Mass Enhancement
title Idiopathic Granulomatous Mastitis or Breast Cancer? A Comparative MRI Study in Patients Presenting with Non-Mass Enhancement
title_full Idiopathic Granulomatous Mastitis or Breast Cancer? A Comparative MRI Study in Patients Presenting with Non-Mass Enhancement
title_fullStr Idiopathic Granulomatous Mastitis or Breast Cancer? A Comparative MRI Study in Patients Presenting with Non-Mass Enhancement
title_full_unstemmed Idiopathic Granulomatous Mastitis or Breast Cancer? A Comparative MRI Study in Patients Presenting with Non-Mass Enhancement
title_short Idiopathic Granulomatous Mastitis or Breast Cancer? A Comparative MRI Study in Patients Presenting with Non-Mass Enhancement
title_sort idiopathic granulomatous mastitis or breast cancer? a comparative mri study in patients presenting with non-mass enhancement
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10137757/
https://www.ncbi.nlm.nih.gov/pubmed/37189576
http://dx.doi.org/10.3390/diagnostics13081475
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