Management of Non-Mass Enhancement on Breast MRI: Diagnostic Challenges and Clinical Strategies

Abstract

Non-mass enhancement (NME) on breast magnetic resonance imaging (MRI) is a diagnostically challenging entity that can be easily confused with background parenchymal enhancement and physiological
changes. This article provides an overview of the concept, imaging features, and diagnostic challenges of NME according to BI-RADS, while also analyzing clinical management strategies based on multimodality
correlation and histopathological results. Sources include the American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS, 5th edition, 2013), recent international studies, and illustrative clinical cases from local practice. The article highlights the role of risk stratification (BI-RADS 3, 4a, 4b), indications for MRI-guided biopsy versus alternative modalities such as ultrasound and mammography, as well as the value of short-term follow-up in reducing unnecessary biopsies. Future research prospects focus on refining grading criteria for NME and standardizing MRI-guided biopsy protocols. In conclusion, the management of NME requires a comprehensive approach, taking into account clinical context and individual risk factors to optimize diagnostic accuracy and treatment outcomes.