Reduction of biopsy requirement with MRI in breast cancer: five-year experience in familial risk

INTRODUCTION: To evaluate the diagnostic contribution of breast magnetic resonance imaging (MRI) in detecting malignancy and its impact on biopsy recommendations in women with familial risk (positive family history) of breast cancer, based on our institution’s five-year clinical experience.
METHODS: This retrospective study included 99 female patients with a positive family history of breast cancer who underwent breast MRI at Sultan Abdülhamid Han Training and Research Hospital between January 2020 and January 2025. Conventional imaging (mammography and/or breast ultrasound) and MRI findings were interpreted using BI-RADS. Biopsy was recommended for BI-RADS 4–5 assessments. Cases in which biopsy was deferred after MRI were followed for at least 12 months.
RESULTS: Biopsy was recommended for 26/99 patients (26.3%). Sixteen patients had a BI-RADS 4 assessment on mammography and/or ultrasound; after MRI, 10/16 (62.5%) were reclassified as MRI BI-RADS 2–3, and biopsy was deferred. No malignancy was detected during a minimum 12-month follow-up. Among patients without a conventional biopsy indication, MRI identified 10 additional BI-RADS 4 lesions; biopsy was performed in 7 (5 benign, 2 malignant), while 3 had missing biopsy/follow-up data.
DISCUSSION AND CONCLUSION: In women with familial risk, breast MRI may help reduce unnecessary biopsies in selected BI-RADS 4 cases when MRI downgrades the assessment to BI-RADS 2–3 with close follow-up, and it can reveal additional malignancies not flagged by conventional imaging. Prospective studies with standardized protocols are warranted.

Keywords: Breast Cancer, Magnetic Resonance Imaging (MRI), Mammography, Breast Ultrasound (US), Familial Risk, BI-RADS