Common occurrence of benign liver lesions in patients with newly diagnosedbreast cancer investigated by MRI for suspected liver metastases

The purpose of this study was to determine the prevalence of benign Liver l esions in patients with breast cancer who are referred to magnetic resonanc e (MR) imaging for suspected breast cancer metastases at initial presentati on. The original MR imaging reports of consecutive patients with breast can cer were reviewed: these patients had undergone MR imaging at our instituti on to investigate for suspected breast cancer liver metastases, at initial presentation between April 1993 and May 1998. Determination of the presence of benign and malignant liver lesions in each patient was made, as well as their relative frequencies, Diagnostic accuracy of MR imaging was evaluate d by correlation with histologic specimens (5 patients) and imaging follow- up (27 patients). Thirty-four patients with newly diagnosed breast carcinom a were evaluated with MR imaging. A total of 11 (32%) of these patients had benign lesions only. Of 21 (62%) total patients who had malignant liver le sions, 19 had breast cancer metastases (2 had coexistent benign lesions), 1 had metastatic carcinoid, and 1 had hepatocellular carcinoma, No liver les ions were detected in two patients (6%), In one patient with biopsy-proven sub-centimeter breast metastases, no focal lesions were shown on MR imaging , No other diagnostic errors in classification of liver lesions by MR imagi ng occurred, as shown by clinical correlation and imaging follow-up in all patients. True positive detection of malignant Liver lesion was 20/21, true negative was 13/13, false positive was 0/13, and false negative was 1/21, for a sensitivity of 95% and a specificity of 100% for the detection of mal ignant liver lesions. Benign liver lesions are common in breast cancer pati ents suspected clinically of having liver metastases. Benign lesions alone were observed in one-third of our patients. The high diagnostic accuracy of MR imaging in the evaluation of hepatic lesions underscores the value of t his technique for baseline investigation of breast cancer patients with cli nically suspected liver metastases, particularly patients in whom treatment approaches are dramatically affected by the presence of liver metastases. (C) 1999 Wiley-Liss, Inc.