Radiologic-Pathologic Correlation of Nonmass Enhancement Contiguous with Malignant Index Breast Cancer Masses at Preoperative Breast MRI

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Nonmass enhancement directly adjacent to malignant index breast cancer masses yielded malignant pathologic findings in more than half of cases.


To determine the pathologic features of nonmass enhancement (NME) directly adjacent to biopsy-proven malignant masses (index masses) at preoperative MRI and determine imaging characteristics that are associated with a malignant pathologic condition.

Materials and Methods

This retrospective study involved the review of breast MRI and mammography examinations performed for evaluating disease extent in patients newly diagnosed with breast cancer from July 1, 2016, to September 30, 2019. Inclusion criteria were limited to patients with an index mass and the presence of NME extending directly from the mass margins. Wilcoxon rank sum test, Fisher exact test, and χ2 test were used to analyze cancer, patient, and imaging characteristics associated with the NME diagnosis.


Fifty-eight patients (mean age, 58 years ± 12 [SD]; all women) were included. Malignant pathologic findings for mass-associated NME occurred in 64% (37 of 58) of patients, 43% (16 of 37) with ductal carcinoma in situ and 57% (21 of 37) with invasive carcinoma. NME was more likely to be malignant when associated with an index cancer that had a low Ki-67 index (<20%) (P = .04). The presence of calcifications at mammography correlating with mass-associated NME was not significantly associated with malignant pathologic conditions (P = .19). The span of suspicious enhancement measured at MRI overestimated the true span of disease at histologic evaluation (P < .001), while there was no evidence of a difference between span of calcifications at mammography and true span of disease at histologic evaluation (P = .27).


Mass-associated NME at preoperative MRI was malignant in most patients with newly diagnosed breast cancer. The span of suspicious enhancement measured at MRI overestimated the true span of disease found at histologic evaluation.

Keywords: Breast, Mammography

© RSNA, 2024

See also the commentary by Newell in this issue.


  • 1. How common is breast cancer? American Cancer Society. Accessed November 15, 2021. Google Scholar
  • 2. Zhu X, Cao Y, Li R, Zhu M, Chen X. Diagnostic performance of mammography and magnetic resonance imaging for evaluating mammographically visible breast masses. J Int Med Res 2021;49(9):300060520973092. Crossref, MedlineGoogle Scholar
  • 3. Orel SG, Schnall MD. MR imaging of the breast for the detection, diagnosis, and staging of breast cancer. Radiology 2001;220(1):13–30. LinkGoogle Scholar
  • 4. Fischer U, Zachariae O, Baum F, von Heyden D, Funke M, Liersch T. The influence of preoperative MRI of the breasts on recurrence rate in patients with breast cancer. Eur Radiol 2004;14(10):1725–1731. Crossref, MedlineGoogle Scholar
  • 5. Plana MN, Carreira C, Muriel A, et al. Magnetic resonance imaging in the preoperative assessment of patients with primary breast cancer: systematic review of diagnostic accuracy and meta-analysis. Eur Radiol 2012;22(1):26–38. Crossref, MedlineGoogle Scholar
  • 6. Houssami N, Ciatto S, Macaskill P, et al. Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol 2008;26(19):3248–3258. Crossref, MedlineGoogle Scholar
  • 7. Sardanelli F, Trimboli RM, Houssami N, et al. Magnetic resonance imaging before breast cancer surgery: results of an observational multicenter international prospective analysis (MIPA). Eur Radiol 2022;32(3):1611–1623. Crossref, MedlineGoogle Scholar
  • 8. Liberman L, Morris EA, Dershaw DD, Abramson AF, Tan LK. MR imaging of the ipsilateral breast in women with percutaneously proven breast cancer. AJR Am J Roentgenol 2003;180(4):901–910. Crossref, MedlineGoogle Scholar
  • 9. Liberman L, Morris EA, Kim CM, et al. MR imaging findings in the contralateral breast of women with recently diagnosed breast cancer. AJR Am J Roentgenol 2003;180(2):333–341. Crossref, MedlineGoogle Scholar
  • 10. Rosen EL, Smith-Foley SA, DeMartini WB, Eby PR, Peacock S, Lehman CD. BI-RADS MRI enhancement characteristics of ductal carcinoma in situ. Breast J 2007;13(6):545–550. Crossref, MedlineGoogle Scholar
  • 11. Greenwood HI, Heller SL, Kim S, Sigmund EE, Shaylor SD, Moy L. Ductal carcinoma in situ of the breasts: review of MR imaging features. RadioGraphics 2013;33(6):1569–1588. LinkGoogle Scholar
  • 12. Di Ninno AAM, Mello GGN, Torres US, et al. MRI as a complementary tool for the assessment of suspicious mammographic calcifications: Does it have a role? Clin Imaging 2021;74:76–83. Crossref, MedlineGoogle Scholar
  • 13. Kang JH, Youk JH, Kim JA, et al. Identification of preoperative magnetic resonance Imaging features associated with positive resection margins in breast cancer: a retrospective study. Korean J Radiol 2018;19(5):897–904. Crossref, MedlineGoogle Scholar
  • 14. Bahl M, Baker JA, Kinsey EN, Ghate SV. MRI predictors of tumor-positive margins after breast-conserving surgery. Clin Imaging 2019;57:45–49. Crossref, MedlineGoogle Scholar
  • 15. Baltzer PA, Benndorf M, Dietzel M, Gajda M, Runnebaum IB, Kaiser WA. False-positive findings at contrast-enhanced breast MRI: a BI-RADS descriptor study. AJR Am J Roentgenol 2010;194(6):1658–1663. Crossref, MedlineGoogle Scholar
  • 16. Types of Breast Cancer. Accessed December 26, 2021. Google Scholar
  • 17. Harbeck N, Rastogi P, Martin M, et al. Adjuvant abemaciclib combined with endocrine therapy for high-risk early breast cancer: updated efficacy and Ki-67 analysis from the monarchE study. Ann Oncol 2021;32(12):1571–1581. Crossref, MedlineGoogle Scholar
  • 18. Morris EA, Comstock CE, Lee CH, et al. ACR BI-RADS Magnetic Resonance Imaging. In: ACR BI-RADS Atlas, Breast Imaging Reporting and Data System. Reston, Va: American College of Radiology, 2013. Google Scholar
  • 19. Gweon HM, Jeong J, Son EJ, Youk JH, Kim JA, Ko KH. The clinical significance of accompanying NME on preoperative MR imaging in breast cancer patients. PLoS One 2017;12(5):e0178445. Crossref, MedlineGoogle Scholar
  • 20. Inwald EC, Klinkhammer-Schalke M, Hofstädter F, et al. Ki-67 is a prognostic parameter in breast cancer patients: results of a large population-based cohort of a cancer registry. Breast Cancer Res Treat 2013;139(2):539–552. Crossref, MedlineGoogle Scholar
  • 21. Liu S, Wu XD, Xu WJ, Lin Q, Liu XJ, Li Y. Is there a correlation between the presence of a spiculated mass on mammogram and luminal a subtype breast cancer? Korean J Radiol 2016;17(6):846–852. Crossref, MedlineGoogle Scholar
  • 22. Gao B, Zhang H, Zhang SD, et al. Mammographic and clinicopathological features of triple-negative breast cancer. Br J Radiol 2014;87(1039):20130496. Crossref, MedlineGoogle Scholar
  • 23. Zhu X, Chen L, Huang B, et al. The prognostic and predictive potential of Ki-67 in triple-negative breast cancer. Sci Rep 2020;10(1):225. Crossref, MedlineGoogle Scholar
  • 24. Grimsby GM, Gray R, Dueck A, et al. Is there concordance of invasive breast cancer pathologic tumor size with magnetic resonance imaging? Am J Surg 2009;198(4):500–504. Crossref, MedlineGoogle Scholar
  • 25. Onesti JK, Mangus BE, Helmer SD, Osland JS. Breast cancer tumor size: correlation between magnetic resonance imaging and pathology measurements. Am J Surg 2008;196(6):844–848; discussion 849–850. Crossref, MedlineGoogle Scholar
  • 26. Rominger M, Berg D, Frauenfelder T, Ramaswamy A, Timmesfeld N. Which factors influence MRI-pathology concordance of tumour size measurements in breast cancer? Eur Radiol 2016;26(5):1457–1465. Crossref, MedlineGoogle Scholar
  • 27. Lunkiewicz M, Forte S, Freiwald B, Singer G, Leo C, Kubik-Huch RA. Interobserver variability and likelihood of malignancy for fifth edition BI-RADS MRI descriptors in non-mass breast lesions. Eur Radiol 2020;30(1):77–86. Crossref, MedlineGoogle Scholar
  • 28. Kim JA, Son EJ, Youk JH, et al. MRI findings of pure ductal carcinoma in situ: kinetic characteristics compared according to lesion type and histopathologic factors. AJR Am J Roentgenol 2011;196(6):1450–1456. Crossref, MedlineGoogle Scholar
  • 29. Mann RM, Hoogeveen YL, Blickman JG, Boetes C. MRI compared to conventional diagnostic work-up in the detection and evaluation of invasive lobular carcinoma of the breast: a review of existing literature. Breast Cancer Res Treat 2008;107(1):1–14. Crossref, MedlineGoogle Scholar
  • 30. Tran T, Sundaram CP, Bahler CD, et al. Correcting the shrinkage effects of formalin fixation and tissue processing for renal tumors: toward standardization of pathological reporting of tumor size. J Cancer 2015;6(8):759–766. Crossref, MedlineGoogle Scholar
  • 31. Yeap BH, Muniandy S, Lee SK, Sabaratnam S, Singh M. Specimen shrinkage and its influence on margin assessment in breast cancer. Asian J Surg 2007;30(3):183–187. Crossref, MedlineGoogle Scholar

Article History

Received: May 2 2023
Revision requested: June 4 2023
Revision received: Oct 4 2023
Accepted: Dec 15 2023
Published online: Feb 02 2024