Monitoring of Breast Lesions after Breast Conservative Therapy: Does A Combination of Dynamic and Functional MRI Techniques Can Add Value in Early Detection of Recurrent Malignancy?

Abstract Background: To assess efficacy of combined dynamic and functional MRI techniques in early detection of recurrent malignancy after breast conservative therapy and differentiating it from other post-operative lesions. Aim of Study: To assess efficacy of combined dynamic and functional MRI techniques in early detection of recurrent malignancy after breast conservative therapy and differentiating it from other post-operative lesions. Patients and Methods: Thirty female patients who under-went breast conservative therapy were involved in this pro-spective study. Patients were examined by sono-mammography that aroused suspicious of breast lesions followed by DCE-MRI & DWI-MRI to exclude recurrence. DWI was performed using b-values of 50, 400, 800s/mm2. All patients were subjected to histopathological confirmation which was the gold standard in this study. Results: Eight patients had pathologically proven recur-rence and 22 patients showed spectrum of post-operative changes. DCE- MRI diagnosis (considering lesion morphology, enhancement pattern) overestimated 2 lesions were scored BIRADS 4 and proved pathologically as fat necrosis. When adding the data elicited by the DWI to the DCE-MRI assessment, the statistical analysis presented 100% sensitivity, 95.4% specificity, 88.9% PPV, 100% NPV and 96.6% accuracy. Conclusion: Combination of functional & dynamic MRI techniques added high significant value in follow-up of breast lesion occurred after BCT as it can avoid biopsy in positive patients, to send negative patients to follow-up and reserving biopsy in the cases with a clinico-radiological mismatch. Breast MRI should be the imaging modality of choice in detection of the tumoral recurrence, and differentiating it from other post-operative lesions.