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Breast Cancer

Breast Nodule Found on MRI Not Benign

06/24/2009

Question:

What does it mean when a nodule that was not found on two mammograms and a sonagram, but found on an MRI,which came back as not fitting the criteria of a benign nodule and has mild enhanced characteristics mean? It measures 8mm. My mother had breast cancer 15 years ago. They also missed her on a mammogram. They want to do a biopsy, but I want them to just take it out.

Answer:

Mammogram can miss 12-15% of breast cancers. Mammography's sensitivity does decrease in patients with dense breasts. However mammography is the only screening exam that has been clinically proven to decrease mortality from breast cancer.

Ultrasound has not been recommended as a screening tool after a multicenter trial done through the American College of Radiology published last year. Too many biopsies were recommended on benign lesions. (The biopsy rate was too high and the PPV was too low)

MRI is a very sensitive test, yet not very specific. It picks up many lesions, both benign and cancer. Therefore it is not surprising that a lesion was picked up on MRI and not mammography or ultrasound. However there is a good chance that this may be benign. A biopsy would be the next step, with MRI guidance. If the biopsy comes back benign there is no reason for surgery. If it comes back suspicious the area can be removed with surgery. If it comes back cancer then the receptor status can be determined before the patient's definitive surgery.

I hope that helps.

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Response by:

Donna  Plecha, MD Donna Plecha, MD
Assistant Professor of Radiology
School of Medicine
Case Western Reserve University