A clinical-radiological MRI-based combined scoring system for predicting benignity and malignancy of non-mass enhancement breast lesions

To identify non-mass lesions as benign or malignant by using breast magnetic resonance imaging and clinical features, and to establish a corresponding scoring system. A total of 199 women were enrolled, 76 of which were in the benign group and 123 in the malignant group. The Mann–Whitney U test was employed to conduct a statistical analysis of the disparities between the two groups in terms of age. The nonparametric tests were employed to conduct a statistical analysis of the disparities between the two groups in terms of gland type, background parenchymal enhancement, signal patterns on T1WI, T2WI, and DWI, morphological distribution, enhancement patterns of the lesions, early enhancement rate, and time-intensity curve (TIC) types. A scoring system was established by integrating statistically significant univariate variables into logistic regression multivariate analyses. Univariate analysis showed significant differences between benign and malignant lesions in age, signal patterns of T1WI, T2WI, and DWI, morphological distribution, enhancement patterns of the lesion, and early fast enhancement rate of the lesion. On multivariable logistic regression, age > 40 years, DWI diffusion restriction, segmental distribution of the lesion, diffuse distribution, and early fast enhancement rate of the lesion were identified as independent predictors of malignancy in non-mass lesions. A scoring system was established based on the magnitude of the odds ratio (OR) values of each variable, with an area under the curve (AUC) value of 0.843, a sensitivity of 62.6%, and a specificity of 90.79%. The scoring system for non-mass lesions in the breast has good discriminative performance, with high specificity and moderate sensitivity, and with further refinements/more data, may serve as a useful diagnostic aid in clinical practice.