To evaluate the role of dynamic contrast enhanced magnetic resonance imaging ( DCE-MRI) in clinical management of breast lesions with BI-RADS 4 microcalcifications at mammography.

We retrospectively analyzed the clinical data of 87 patients who underwent wire-guided biopsy and showed BI-RADS 4 microcalcifications at mammography in the Sichuan Provincial Maternity and Child Health Care Hospital from February 2017 to January 2019. The necessity of preoperative DCE-MRI of those patients was evaluated. The McNemar test was used to compare the detection rates of breast cancer between MRI and pathology. The Fisher exact test was used to compare the sensitivity and the χ² test was used to compare the specificity, positive and negative predictive values between mammography and MRI in the diagnosis of breast cancer.

Histopathologic results confirmed 71 cases of benign microcalcifications, 6 DCIS and 10 invasive ductal carcinomas (IDC). Malignancy rates were 2.4% (1/42), 24.3% (9/37) and 6/8 in the BI-RADS 4A, 4B and 4C patients, respectively. The sensitivity, specificity, positive, negative predictive values and diagnostic accuracy of DCE-MRI in the diagnosis of BI-RADS 4 microcalcifications were (14/16), 74.7% (53/71), 43.8% (14/32), 96.4% (53/55) and 77.0%(67/87), respectively. The specificity of DCE-MRI was significantly higher than that of mammography [74.7%(53/71)vs 57.8%(41/71), χ²=4.532, P=0.033]. Totally 53 out of 71 benign cases (74.7%) could avoid unnecessary biopsies based on the findings of DCE-MRI, but two out of 16 malignant cases (12.5%) was diagnosed negative by DCE-MRI.

DCE-MRI can avoid unnecessary biopsies of BI-RADS 4 microcalcifications at mammopraphy, reduce missed-diagnosis of malignant tumors and help to make rational clinical decisions in patients with BI-RADS 4 microcalcifications.