Diagnostic Accuracy of Contrast-Enhanced MRI in Detection of Malignant Breast Lesion Keeping Histopathology as Gold Standard

Abstract

Objective:  Breast cancer is one of the most common malignancies among young women worldwide, with a rising incidence. Early detection has very good outcomes. Contrast-enhanced magnetic resonance imaging (CE-MRI) is a non-invasive investigation for the evaluation of suspected breast lesions. This study aims to determine the diagnostic accuracy of CE-MRI for detecting malignant breast lesions, using histopathology as the gold standard.

Design: This is a cross-sectional study.

Place and duration of study: The site for this study was the Department of Diagnostic Radiology, Mardan Medical Complex, and the duration of the study was from December 2024 to May 2025.

Methods: A total of 230 female patients (aged 16–65)  having suspicious breast lumps on mammographic criteria were enrolled in the study. CE-MRI was done for all these patients, and interpretation was done by a consultant radiologist using defined criteria for malignancy detection. The Histopathological diagnosis via fine-needle aspiration cytology (FNAC) biopsy was used as the reference standard. For all these patients, Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy of CE-MRI were calculated.  Statistical analysis was done via the latest version of SPSS.

Results: The mean age of participants was 45.3 ± 11.2 years. Malignancy was confirmed via histopathology in 160 patients (69.6%), and 70 (30.4%) had benign lesions. The CE-MRI picked up 144 of 160 cancer patients (true positives) and missed 16 (false negatives); the sensitivity was 90.0%. In the 70 histopathologically benign cases, CE-MRI was done, which ruled out cancer in 56 (true negatives), while 14 were labeled as malignant (false positives); the specificity was 80.0%. The CE-MRI PPV was 91.1%, NPV 77.8%, and overall diagnostic accuracy 86.9%. These results showed a high diagnostic yield for CE-MRI. Subgroup analysis was done, which showed no significant difference in diagnostic performance by age group or lesion location (p > 0.05).

Conclusion:  In this study for patients with breast lumps, contrast-enhanced MRI showed high sensitivity and good specificity for the detection of malignancy. CE-MRI can accurately detect most breast cancers and can help to avoid unnecessary invasive biopsies in breast malignancy. However, for the confirmation of a definitive diagnosis, histopathological examination is necessary.