Hatice Kübra Özdemir, Oğuzhan Tokur
Advanced Radiology and Imaging - 2025;2(3):59-62
Objectives: Type 2 dynamic contrast-enhancement curves on breast magnetic resonance imaging (MRI) represent an intermediate kinetic pattern that often creates diagnostic uncertainty due to considerable overlap between benign and malignant lesions. This study aimed to analyze the histopathological outcomes of breast lesions demonstrating a Type 2 curve and to assess whether combining kinetic and morphological features improves diagnostic accuracy. Methods: A retrospective review was performed on 644 dynamic contrast-enhanced breast MRI examinations conducted between January 2022 and January 2023. 32 lesions in 27 patients that exhibited a Type 2 kinetic curve and had available histopathological data were included. All lesions were reassessed by two experienced radiologists, curve types were verified using region of interest analysis, and lesions were categorized according to Breast Imaging Reporting and Data System (BI-RADS) morphology. Sensitivity and specificity values were calculated for the Type 2 curve alone and in combination with BI-RADS categories. Results: Among the 32 lesions, 72.7% were malignant and 27.3% were benign. The most common benign lesion was sclerosing adenosis, while invasive ductal carcinoma was the most frequent malignant diagnosis. When evaluated alone, the Type 2 kinetic pattern demonstrated limited sensitivity (33.1%) and moderate specificity (72.7%) for predicting malignancy. However, diagnostic performance increased markedly when morphological assessment was incorporated. BI-RADS 4 lesions showed a malignancy rate of 68.8%, and all BI-RADS 5 lesions were malignant, yielding a positive predictive value of 100%. Combining dynamic curves with BI-RADS morphology produced significantly higher sensitivity and specificity compared with relying on kinetic patterns alone. Conclusion: A substantial proportion of breast lesions demonstrating a Type 2 dynamic curve were malignant, indicating that this intermediate kinetic pattern should be interpreted with caution. Because Type 2 curves may also occur in benign lesions, they should not be used in isolation for diagnostic decision- making. Larger, preferably prospective studies are needed to clarify the clinical significance of Type 2 curves in breast MRI.
