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Evaluation of Pectoralis Major Muscle in Patients with Posterior Breast Tumors on Breast MR Images: Early Experience¹

¹ From the Departments of Radiology (E.A.M., L.H.S., M.B.D., S.J.K., L.L., A.F.A., D.D.D.), Pathology (L.K.T.), and Surgery (K.J.V.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021. Received March 5, 1998; revision requested April 29, 1998; revision received April 29, 1999; accepted June 15. Address reprint requests to E.A.M. (e-mail: morrise@mskcc.org).

View larger version (110K): [in a new window]   Figure 1a. Recurrent infiltrating ductal carcinoma treated with radical mastectomy in a 45-year-old woman. Sagittal, fat-suppressed, three-dimensional, fast multiplanar spoiled gradient-recalled-echo (a) precontrast and (b) postcontrast MR images (19.7/1.7; flip angle, 30°). In b, the mass (m) obliterates the fat plane (long straight solid arrow), and there is enhancement of the underlying pectoralis major muscle (p and short straight solid arrows). At surgery, the full thickness of the pectoralis major muscle was involved with tumor. Additional areas of recurrent disease are noted inferiorly (curved arrow in b). Enhancement within the thickened skin (open arrow in b) proved to represent tumor invasion.

View larger version (113K): [in a new window]   Figure 1b. Recurrent infiltrating ductal carcinoma treated with radical mastectomy in a 45-year-old woman. Sagittal, fat-suppressed, three-dimensional, fast multiplanar spoiled gradient-recalled-echo (a) precontrast and (b) postcontrast MR images (19.7/1.7; flip angle, 30°). In b, the mass (m) obliterates the fat plane (long straight solid arrow), and there is enhancement of the underlying pectoralis major muscle (p and short straight solid arrows). At surgery, the full thickness of the pectoralis major muscle was involved with tumor. Additional areas of recurrent disease are noted inferiorly (curved arrow in b). Enhancement within the thickened skin (open arrow in b) proved to represent tumor invasion.

View larger version (135K): [in a new window]   Figure 2a. Locally advanced breast cancer in a 53-year-old woman. At physical examination, there was a 6-cm mass (m in b) fixed to the chest wall at palpation; that is, the mass was immobile at physical examination. Performing an adequate mammographic examination was compromised by the large size of the mass and the firmness of the breast. (a, b) Sagittal, fat-suppressed, three-dimensional, fast multiplanar spoiled gradient-recalled-echo (a) precontrast and (b) postcontrast MR images (19.7/1.7; flip angle, 30°). b demonstrates full-thickness involvement of the inferior aspect of the pectoralis major muscle (p and straight arrows). Obliteration of the fat plane (curved arrow in b) is identified. (c) Photomicrograph of pathologic specimen reveals infiltrating lobular cancer. The breast mass obliterates the fat plane (large arrow), and tumor cells (small arrows) invade the pectoralis major muscle. (Hematoxylin-eosin stain; original magnification, x20.)

View larger version (121K): [in a new window]   Figure 2b. Locally advanced breast cancer in a 53-year-old woman. At physical examination, there was a 6-cm mass (m in b) fixed to the chest wall at palpation; that is, the mass was immobile at physical examination. Performing an adequate mammographic examination was compromised by the large size of the mass and the firmness of the breast. (a, b) Sagittal, fat-suppressed, three-dimensional, fast multiplanar spoiled gradient-recalled-echo (a) precontrast and (b) postcontrast MR images (19.7/1.7; flip angle, 30°). b demonstrates full-thickness involvement of the inferior aspect of the pectoralis major muscle (p and straight arrows). Obliteration of the fat plane (curved arrow in b) is identified. (c) Photomicrograph of pathologic specimen reveals infiltrating lobular cancer. The breast mass obliterates the fat plane (large arrow), and tumor cells (small arrows) invade the pectoralis major muscle. (Hematoxylin-eosin stain; original magnification, x20.)

View larger version (134K): [in a new window]   Figure 2c. Locally advanced breast cancer in a 53-year-old woman. At physical examination, there was a 6-cm mass (m in b) fixed to the chest wall at palpation; that is, the mass was immobile at physical examination. Performing an adequate mammographic examination was compromised by the large size of the mass and the firmness of the breast. (a, b) Sagittal, fat-suppressed, three-dimensional, fast multiplanar spoiled gradient-recalled-echo (a) precontrast and (b) postcontrast MR images (19.7/1.7; flip angle, 30°). b demonstrates full-thickness involvement of the inferior aspect of the pectoralis major muscle (p and straight arrows). Obliteration of the fat plane (curved arrow in b) is identified. (c) Photomicrograph of pathologic specimen reveals infiltrating lobular cancer. The breast mass obliterates the fat plane (large arrow), and tumor cells (small arrows) invade the pectoralis major muscle. (Hematoxylin-eosin stain; original magnification, x20.)

View larger version (118K): [in a new window]   Figure 3a. Extremely mammographically dense breast and axillary lymph nodes sampled by using fine-needle aspiration, which demonstrated an adenocarcinoma that was suspected to be the primary cancer, in a 46-year-old woman. (a) Precontrast and (b) postcontrast sagittal, fat-suppressed, three-dimensional, fast multiplanar spoiled gradient-recalled-echo MR images (19.7/1.7; flip angle, 30°). Physical examination and mammographic findings were negative. b shows a posterior mass (m) that obliterates a fat plane (arrow), with no underlying enhancement of the pectoralis major muscle (p). Histopathologic analysis yielded a 1.3-cm infiltrating ductal carcinoma without extension into the underlying muscle.

View larger version (124K): [in a new window]   Figure 3b. Extremely mammographically dense breast and axillary lymph nodes sampled by using fine-needle aspiration, which demonstrated an adenocarcinoma that was suspected to be the primary cancer, in a 46-year-old woman. (a) Precontrast and (b) postcontrast sagittal, fat-suppressed, three-dimensional, fast multiplanar spoiled gradient-recalled-echo MR images (19.7/1.7; flip angle, 30°). Physical examination and mammographic findings were negative. b shows a posterior mass (m) that obliterates a fat plane (arrow), with no underlying enhancement of the pectoralis major muscle (p). Histopathologic analysis yielded a 1.3-cm infiltrating ductal carcinoma without extension into the underlying muscle.

View larger version (112K): [in a new window]   Figure 4a. (a) Precontrast and (b) postcontrast sagittal, fat-suppressed, three-dimensional, fast multiplanar spoiled gradient-echo MR images (19.7/1.7; flip angle, 30°) obtained in a 59-year-old woman with a 2.5-cm mass fixed to the chest wall at palpation (ie, the mass was immobile at physical examination) who had overlying skin thickening at physical examination. The patient underwent breast MR imaging because of concern of fixation to the chest wall. b demonstrates a spiculated mass (m) that involves the skin (short arrows). The spiculations (long arrow in b) extend from the mass to the underlying pectoralis major muscle (p in b). No abnormal enhancement of the muscle is identified. Histopathologic analysis yielded infiltrating ductal carcinoma without muscle involvement. The presence of spiculations alone was not indicative of involvement.

View larger version (113K): [in a new window]   Figure 4b. (a) Precontrast and (b) postcontrast sagittal, fat-suppressed, three-dimensional, fast multiplanar spoiled gradient-echo MR images (19.7/1.7; flip angle, 30°) obtained in a 59-year-old woman with a 2.5-cm mass fixed to the chest wall at palpation (ie, the mass was immobile at physical examination) who had overlying skin thickening at physical examination. The patient underwent breast MR imaging because of concern of fixation to the chest wall. b demonstrates a spiculated mass (m) that involves the skin (short arrows). The spiculations (long arrow in b) extend from the mass to the underlying pectoralis major muscle (p in b). No abnormal enhancement of the muscle is identified. Histopathologic analysis yielded infiltrating ductal carcinoma without muscle involvement. The presence of spiculations alone was not indicative of involvement.

View larger version (134K): [in a new window]   Figure 5a. (a) Precontrast and (b) postcontrast sagittal, fat-suppressed, three-dimensional, fast multiplanar spoiled gradient-recalled-echo MR images (19.7/1.7; flip angle, 30°) obtained in a 23-year-old woman with a history of contralateral cystosarcoma phyllodes tumor. A routine CT scan demonstrated a questionable mass in the posterior aspect of the breast that was not appreciated at physical examination or mammography. b demonstrates a 1.5-cm mass (m) in the posterior part of the breast, with a smooth fat plane ( f ) between the posterior margin of the mass and the underlying muscle (p). Histopathologic analysis yielded fibroadenoma.

View larger version (116K): [in a new window]   Figure 5b. (a) Precontrast and (b) postcontrast sagittal, fat-suppressed, three-dimensional, fast multiplanar spoiled gradient-recalled-echo MR images (19.7/1.7; flip angle, 30°) obtained in a 23-year-old woman with a history of contralateral cystosarcoma phyllodes tumor. A routine CT scan demonstrated a questionable mass in the posterior aspect of the breast that was not appreciated at physical examination or mammography. b demonstrates a 1.5-cm mass (m) in the posterior part of the breast, with a smooth fat plane ( f ) between the posterior margin of the mass and the underlying muscle (p). Histopathologic analysis yielded fibroadenoma.