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Undetected Malignancies of the Breast: Dynamic Contrast-enhanced MR Imaging at 1.0 T¹

¹ From the Departments of Radiology (A.T., A.H., T.B., T.W.V., S.S., M.T.), Gynaecology (M.S.), and Pathology (H.A.L.), Johannes Gutenberg University of Mainz, Langenbeckstrasse 1, D-55131 Mainz, Germany. Received March 2, 2001; revision requested April 16; final revision received February 6, 2002; accepted March 6. Supported by a grant from the Deutsche Forschungsgemeinschaft (Th 315/7-1). Address correspondence to A.T. (e-mail: teifke@radiologie.klinik.uni-mainz.de).

View larger version (32K): [in a new window]   Figure 1. Receiver operating characteristic curves show the sensitivity and specificity of the different breast imaging modalities with reference to the BI-RADS analogous assessment categories: category 1 = negative, category 2 = benign, category 3 = probably benign, category 4 = suspicious, category 5 = highly suggestive of malignancy (Az values listed in Table 3).

View larger version (62K): [in a new window]   Figure 2. Transverse T2-weighted turbo spin-echo MR image (5,432/90) shows edema in the right breast after conservative surgical therapy and radiation therapy in a 58-year-old woman. Recurrent carcinoma (arrow), 8 mm in diameter, is located outside the coil volume and was not enclosed in the measurement field of the contrast-enhanced dynamic study.

View larger version (145K): [in a new window]   Figure 3a. Images depict masked carcinoma. (a) US image obtained in the antiradial plane demonstrates an invasive ductal cancer 2 cm in maximal diameter (between cursors) in a 48-year-old woman. (b) Coronal maximum intensity projection of the subtraction images (15/7; flip angle, 30°) obtained with T1-weighted dynamic fast low-angle shot 3D sequence from the first postcontrast and the precontrast study shows that the tumor in the right breast is completely obscured by equally enhanced surrounding parenchyma. (c) Sagittally reconstructed MR image depicts a signal void (arrow), which represents the central tumor fibrosis.

View larger version (49K): [in a new window]   Figure 3b. Images depict masked carcinoma. (a) US image obtained in the antiradial plane demonstrates an invasive ductal cancer 2 cm in maximal diameter (between cursors) in a 48-year-old woman. (b) Coronal maximum intensity projection of the subtraction images (15/7; flip angle, 30°) obtained with T1-weighted dynamic fast low-angle shot 3D sequence from the first postcontrast and the precontrast study shows that the tumor in the right breast is completely obscured by equally enhanced surrounding parenchyma. (c) Sagittally reconstructed MR image depicts a signal void (arrow), which represents the central tumor fibrosis.

View larger version (63K): [in a new window]   Figure 3c. Images depict masked carcinoma. (a) US image obtained in the antiradial plane demonstrates an invasive ductal cancer 2 cm in maximal diameter (between cursors) in a 48-year-old woman. (b) Coronal maximum intensity projection of the subtraction images (15/7; flip angle, 30°) obtained with T1-weighted dynamic fast low-angle shot 3D sequence from the first postcontrast and the precontrast study shows that the tumor in the right breast is completely obscured by equally enhanced surrounding parenchyma. (c) Sagittally reconstructed MR image depicts a signal void (arrow), which represents the central tumor fibrosis.

View larger version (156K): [in a new window]   Figure 4a. Images of occult T3 carcinoma in a 61-year-old woman. (a) Specimen radiograph depicts a cluster of microcalcifications (arrow) that had been the indication for an excision biopsy. No other focus suspicious for cancer was seen. (b) Histologic slide of the marked area (box) in a shows breast parenchyma with little fibrosis at low magnification. (Hematoxylin-eosin stain; original magnification, x25.) (c) Histologic specimen at high magnification of the marked region (box) in b reveals small clusters of malignant epithelial cells (arrows) in the fibrous tissue. Similarly dispersed tumor cell clusters were found throughout the entire breast. (Hematoxylin-eosin stain; original magnification, x250.)

View larger version (178K): [in a new window]   Figure 4b. Images of occult T3 carcinoma in a 61-year-old woman. (a) Specimen radiograph depicts a cluster of microcalcifications (arrow) that had been the indication for an excision biopsy. No other focus suspicious for cancer was seen. (b) Histologic slide of the marked area (box) in a shows breast parenchyma with little fibrosis at low magnification. (Hematoxylin-eosin stain; original magnification, x25.) (c) Histologic specimen at high magnification of the marked region (box) in b reveals small clusters of malignant epithelial cells (arrows) in the fibrous tissue. Similarly dispersed tumor cell clusters were found throughout the entire breast. (Hematoxylin-eosin stain; original magnification, x250.)

View larger version (193K): [in a new window]   Figure 4c. Images of occult T3 carcinoma in a 61-year-old woman. (a) Specimen radiograph depicts a cluster of microcalcifications (arrow) that had been the indication for an excision biopsy. No other focus suspicious for cancer was seen. (b) Histologic slide of the marked area (box) in a shows breast parenchyma with little fibrosis at low magnification. (Hematoxylin-eosin stain; original magnification, x25.) (c) Histologic specimen at high magnification of the marked region (box) in b reveals small clusters of malignant epithelial cells (arrows) in the fibrous tissue. Similarly dispersed tumor cell clusters were found throughout the entire breast. (Hematoxylin-eosin stain; original magnification, x250.)