High-risk lesions in the breast diagnosed by MRI-guided core biopsy: upgrade rates and features associated with malignancy

Eumee Cha, Emily B. Ambinder, Eniola T. Oluyemi, Lisa A. Mullen, Babita Panigrahi, Joanna Rossi, Philip A. Di Carlo, Kelly S. Myers

Research output: Contribution to journalArticlepeer-review


Purpose: This study assessed the upgrade rates of high-risk lesions (HRLs) in the breast diagnosed by MRI-guided core biopsy and evaluated imaging and clinical features associated with upgrade to malignancy. Methods: This IRB-approved, retrospective study included MRI-guided breast biopsy exams yielding HRLs from August 1, 2011, to August 31, 2020. HRLs included atypical ductal hyperplasia (ADH), lobular carcinoma in situ (LCIS), atypical lobular hyperplasia (ALH), radial scar, and papilloma. Only lesions that underwent excision or at least 2 years of MRI imaging follow-up were included. For each HRL, patient history, imaging features, and outcomes were recorded. Results: Seventy-two lesions in 65 patients were included in the study, with 8/72 (11.1%) of the lesions upgraded to malignancy. Upgrade rates were 16.7% (2/12) for ADH, 100% (1/1) for pleomorphic LCIS, 40% (2/5) for other LCIS, 0% (0/19) for ALH, 0% (0/18) for papilloma, and 0% (0/7) for radial scar/complex sclerosing lesion. Additionally, two cases of marked ADH bordering on DCIS and one case of marked ALH bordering on LCIS, were upgraded. Lesions were more likely to be upgraded if they presented as T2 hypointense (versus isotense, OR 6.46, 95% CI 1.27–32.92) or as linear or segmental non-mass enhancement (NME, versus focal or regional, p = 0.008). Conclusion: Our data support the recommendation that ADH and LCIS on MRI-guided biopsy warrant surgical excision due to high upgrade rates. HRLs that present as T2 hypointense, or as linear or segmental NME, should be viewed with suspicion as these were associated with higher upgrade rates to malignancy.

Original languageEnglish (US)
Pages (from-to)517-525
Number of pages9
JournalBreast Cancer Research and Treatment
Issue number3
StatePublished - Dec 2022


  • High-risk lesions
  • MRI-guided core biopsy
  • Upgrade rate

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


Dive into the research topics of 'High-risk lesions in the breast diagnosed by MRI-guided core biopsy: upgrade rates and features associated with malignancy'. Together they form a unique fingerprint.

Cite this