Probability of malignancy for lesions detected on breast MRI: a predictive model incorporating BI-RADS imaging features and patient characteristics

Eur Radiol. 2011 Aug;21(8):1609-17. doi: 10.1007/s00330-011-2094-6. Epub 2011 Feb 27.


Objectives: To predict the probability of malignancy for MRI-detected breast lesions with a multivariate model incorporating patient and lesion characteristics.

Methods: Retrospective review of 2565 breast MR examinations from 1/03-11/06. BI-RADS 3, 4 and 5 lesions initially detected on MRI for new cancer or high-risk screening were included and outcomes determined by imaging, biopsy or tumor registry linkage. Variables were indication for MRI, age, lesion size, BI-RADS lesion type and kinetics. Associations with malignancy were assessed using generalized estimating equations and lesion probabilities of malignancy were calculated.

Results: 855 lesions (155 malignant, 700 benign) were included. Strongest associations with malignancy were for kinetics (washout versus persistent; OR 4.2, 95% CI 2.5-7.1) and clinical indication (new cancer versus high-risk screening; OR 3.0, 95% CI 1.7-5.1). Also significant were age > = 50 years, size > = 10 mm and lesion-type mass. The most predictive model (AUC 0.70) incorporated indication, size and kinetics. The highest probability of malignancy (41.1%) was for lesions on MRI for new cancer, > = 10 mm with washout. The lowest (1.2%) was for lesions on high-risk screening, <10 mm with persistent kinetics.

Conclusions: A multivariate model shows promise as a decision support tool in predicting malignancy for MRI-detected breast lesions.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Breast Neoplasms / diagnosis*
  • Contrast Media
  • Female
  • Gadolinium DTPA
  • Humans
  • Image Interpretation, Computer-Assisted
  • Logistic Models
  • Magnetic Resonance Imaging / methods*
  • Middle Aged
  • Predictive Value of Tests
  • Probability
  • ROC Curve
  • Retrospective Studies


  • Contrast Media
  • gadodiamide
  • Gadolinium DTPA