@article{5705,
  author = {Emmanuelle Bouic Pages and Ingrid Millet and Denis Hoa and Fernanda Curros Doyon and Patrice Taourel},
  title = {Undiagnosed breast cancer at MR imaging: analysis of causes.},
  abstract = {<p><b>PURPOSE: </b>To retrospectively review the causes of false-negative results on prior magnetic resonance (MR) imaging studies in patients who developed breast cancer as revealed on a follow-up MR imaging study and to determine the presumptive causes of these false-negative findings.</p><p><b>MATERIALS AND METHODS: </b>Fifty-eight pairs of MR imaging studies from one institution were assessed, consisting of a prior study without a diagnosis of cancer and a diagnostic study with subsequent findings of 60 cancers in 58 women at MR imaging (mean interval between prior and diagnostic MR examinations, 13.8 months). Two radiologists reviewed in consensus, in a nonblinded fashion, each pair of MR studies, comparing the diagnostic and the prior MR imaging studies to evaluate the rate of false-negative findings. The prospective reports were then analyzed to classify false-negatives findings in breast enhancement of breast cancers not identified at the time of imaging, potentially misinterpreted, and mismanaged. False-negative results on prior MR studies were retrospectively reassessed to identify possibly reasons why cancers had been not recognized, potentially misinterpreted, or mismanaged.</p><p><b>RESULTS: </b>Twenty-eight (47% [95% confidence interval {CI}: 34%, 59%]) of the 60 cancers were retrospectively diagnosed as Breast Imaging Reporting and Data System grade 3, 4, or 5 lesions. Analysis of the prospective reports showed that six lesions (10% [95% CI: 2%, 18%]) had been not identified at the time of diagnosis, 15 lesions (25% [95% CI: 14%, 36%]) were potentially misinterpreted, and seven lesions (12% [95% CI: 3%, 20%]) were mismanaged. The main causes of misinterpretation were smooth margins of a mass (n=4), stability in size (n=3), and location of a nonmass in a postsurgical area (n=5). Mismanagement was mainly due to inadequate correlations between MR imaging and ultrasonographic (US) features, with inaccurate sampling with US guidance in five cases.</p><p><b>CONCLUSION: </b>In patients with breast cancer seen at MR imaging, retrospective evaluation of the prior MR imaging studies showed potential observer error in 47% of cases, resulting more from misinterpretation than from nonrecognition or mismanagement of cancers.</p>},
  year = {2012},
  journal = {Radiology},
  volume = {264},
  pages = {40-50},
  month = {07/2012},
  issn = {1527-1315},
  doi = {10.1148/radiol.12111917},
  language = {eng},
}