THE IMPACT OF MAGNETIC RESONANCE IMAGING ON BI-RADS CLASSIFICATION AND MALIGNANCY PREDICTION IN ULTRASOUND-DETECTED NON-MASS BREAST LESION Ultrasonografide Saptanan Kitlesel Olmayan Meme Lezyonlarında Manyetik Rezonans Görüntülemenin BI-RADS Sınıflandırmasına Etkisi ve Malignite Öngörüsüne Katkısı

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Gündoğdu S., ELVERİCİ E., Karabekmez L. G., Sarıkaya P. Z. B.

Journal of Kirikkale University Faculty of Medicine, cilt.28, sa.2, ss.278-283, 2026 (Scopus, TRDizin)

Özet

Objective: To assess the contribution of magnetic resonance imaging to Breast Imaging Reporting and Data System (BI-RADS) reclassification and biopsy decision making in patients with non-mass breast lesions identified on ultrasound. Material and Methods: This retrospective study included 392 patients who underwent breast magnetic resonance imaging following the identification of non-mass breast lesions on ultrasound; 135 had histopathologic verification and were analyzed. BI-RADS categories on ultrasound and magnetic resonance imaging were compared, and reclassification patterns were defined as upgrade (ultrasound <4 to magnetic resonance imaging ≥4), downgrade (ultrasound ≥4 to magnetic resonance imaging <4), or stable. Diagnostic accuracy metrics were calculated using BI-RADS ≥4 as the threshold for clinically significant disease. Results: Among 135 patients with pathology, of the lesions 64.4% were benign, 5.9% were high-risk, and 29.6% were malignant. Using BI-RADS ≥4, magnetic resonance imaging demonstrated higher sensitivity and negative predictive value (95.5% and 90.0%) than ultrasound (61.4% and 77.9%) but substantially reduced specificity (21.2% vs. 70.6%). Magnetic resonance imaging upgraded 48.8% of lesions and downgraded 4.7%. High-risk/malignant disease was detected in 23.8% of upgraded lesions, while all downgraded lesions were benign. Conclusion: Magnetic resonance imaging meaningfully influences BI-RADS reclassification in non-mass breast lesions by improving lesion exclusion confidence but at the cost of lower specificity and reduced biopsy yield. Magnetic resonance imaging-driven downgrade appears safe and may help avoid unnecessary biopsies in selected cases.