Improved diagnostic value of whole-lesion histogram and texture analyses on multiparametric breast MRI for papillary neoplasms with non-mass enhancement.

Background: Differentiating between benign and malignant entities remains a complex aspect in the diagnosis of breast papillary neoplasms. This study aimed to assess if analyzing whole-lesion histograms and texture features on multiparametric magnetic resonance imaging (MRI) can enhance the diagnostic accuracy of breast papillary neoplasms presenting as non-mass enhancement (NME). Methods: In this retrospective analysis, 98 female patients with 98 papillary neoplasms exhibiting NME on dynamic contrast-enhanced (DCE) MRI were enrolled. Two radiologists independently assessed all lesions and later established a consensus on morphological features based on the Breast Imaging Reporting and Data System (BI-RADS) criteria. Quantitative histogram and texture metrics were extracted from four MRI sequences: diffusion-weighted imaging (DWI) with b values of 50 and 1,000 s/mm Results: According to BI-RADS, benign and malignant papillary neoplasms with NME differed significantly in the amount of fibroglandular tissue (FGT), distribution, and time-intensity curve (TIC) pattern (P=0.04, 0.008, <0.001, respectively), yielding an area under the ROC curve (AUC) of 0.792 (sensitivity 67.4%, specificity 84.6%). Quantitative analysis revealed differences in the ADC Conclusions: Compared to the qualitative BI-RADS assessment, quantitative analysis of whole-lesion histogram and texture on multiparametric MRI is proven to be more effective in distinguishing between benign and malignant papillary breast neoplasms with NME, in order to avoid overtreatment.