Management of Probably Benign Breast Findings

Interpretation of MRI Findings

The National Comprehensive Cancer Network recommends that physiologic foci of enhancement in the breast with no mass or architectural distortion represents normal tissue enhancement 1
Asymmetrical fibroglandular tissue with no defined mass corresponds to findings on tomosynthesis or ultrasound, according to the National Comprehensive Cancer Network 1, 2
A small hyperenhancing focus with type I kinetics is most likely benign, as stated by the National Comprehensive Cancer Network 1
No other suspicious mass, non-mass-like enhancement, or significant lymphadenopathy is identified, which is a finding supported by the National Comprehensive Cancer Network 1

Small enhancing foci with type I kinetics are considered probably benign findings (BI-RADS 3) with a malignancy risk of less than 2%, according to the National Comprehensive Cancer Network 2
The National Comprehensive Cancer Network recommends diagnostic imaging at 6 months, and then every 6 to 12 months for 1 to 2 years, for BI-RADS category 3 findings 1, 3
At the first 6-month follow-up, a unilateral mammogram of the index breast should be performed, as recommended by the National Comprehensive Cancer Network 1
The NCCN guidelines specifically recommend follow-up with physical examination and imaging (mammogram and ultrasound) at 6 months for probably benign findings, according to the National Comprehensive Cancer Network 2

The recommended 6-month follow-up should include targeted mammogram of the breast and targeted ultrasound of the area of concern, as recommended by the National Comprehensive Cancer Network 1, 2
If findings remain stable at 6 months, additional follow-up at 12 months is recommended by the National Comprehensive Cancer Network 1, 2
After 1-2 years of stability, the patient can return to routine screening, according to the National Comprehensive Cancer Network 1, 3

Biopsy should be considered if the asymmetry or enhancing focus increases in size on follow-up imaging, or if new suspicious features develop, as recommended by the National Comprehensive Cancer Network 1, 2
The American College of Radiology suggests that biopsy should also be considered if the patient has high-risk factors or experiences significant anxiety about the findings 4, 5