The Role of Contrast-Enhanced MRI in Differentiation Between Recurrent Breast Cancer and Benign Post-Operative Lesions

Nabaa Aswad Shakir; Saja Ali Ahmed; Shaymaa Khalid Abdulqader; Jehan Mohammed Al-Musawi

doi:10.54133/ajms.v8i2.1883

Authors

Nabaa Aswad Shakir Department of Surgery, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq https://orcid.org/0000-0001-5565-0033
Saja Ali Ahmed Department of Surgery, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq https://orcid.org/0000-0001-5741-1992
Shaymaa Khalid Abdulqader Department of Surgery, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq https://orcid.org/0000-0001-7029-0451
Jehan Mohammed Al-Musawi Department of Medicine, College of Medicine, Kufa University, Najaf, Iraq https://orcid.org/0000-0003-4508-0035

DOI:

https://doi.org/10.54133/ajms.v8i2.1883

Keywords:

Breast contrast-enhanced MRI, Accuracy, Benign postoperative changes, Recurrent breast cancer

Abstract

Background: Magnetic resonance imaging (MRI) is highly sensitive to detect clinically suspected lesions that mammography and sonography may miss. However, routine postoperative MRI surveillance is not recommended unless there is concerning clinical or radiological evidence. Objective: To evaluate the role of MRI in assessing postoperative breast lesions and distinguishing benign changes from recurrence. Methods: This prospective cohort analysis was conducted at the National Center for Early Detection of Breast Cancer, Oncology Teaching Hospital, Medical City, from January 2022 to August 2022. The study enrolled breast cancer patients who had undergone breast-conserving surgery (BCS) or mastectomy within the past 24 months and were currently under radiological surveillance or presented with a new clinically detected mass. Results: A total of 42 lesions from 32 patients were analyzed; 21(65.7%) were under routine follow-up, while 11(34.3%) presented with a new mass. Mammography and/or ultrasound detected 36(85.7%) lesions, while MRI identified six (14.3%) additional lesions. Histopathology confirmed malignancy in 22(68.2%) patients. Five of six MRI-discovered lesions were malignant in histology, with a mean diameter of 7.5mm, ranging from 6-11mm. Irregular shape, speculated margin, heterogeneous enhancement, and diffusion restrictions were significantly associated with malignancy. Using histopathology as the gold standard, MRI demonstrated 100% sensitivity, 55% specificity, and 78.6% accuracy. Conclusions: Dynamic contrast-enhanced MRI can improve the characterization of postoperative breast lesions. This method can help minimize benign lesion biopsies and detect recurring malignancies and multifocality when traditional imaging fails.

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