Published online before print January 31, 2003, 10.1148/radiol.2263020041
MR Imaging Screening of the Contralateral Breast in Patients with Newly Diagnosed Breast Cancer: Preliminary Results1
Steven G. Lee, MD,
Susan G. Orel, MD,
Irene J. Woo, MD,
Eva Cruz-Jove, MD,
Mary E. Putt, ScD,
Lawrence J. Solin, MD,
Brian J. Czerniecki, MD, PhD and
Mitchell D. Schnall, MD, PhD
1 From the Departments of Radiology (S.G.L., S.G.O., M.D.S.), Biostatistics and Epidemiology (M.E.P.), Radiation Oncology (L.J.S.), and Surgery (B.J.C.), Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104; Department of Radiology, Crozer-Chester Medical Center, Upland, Pa (I.J.W.); and Marques y Perez Radiologists, San Juan, PR (E.C.J.). Received February 5, 2002; revision requested April 10; revision received July 8; accepted August 15. Address correspondence to S.G.L. (e-mail: lees@rad.upenn.edu).
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Figure 1a. True-positive MR imaging finding. Images of the right breast in a 47-year-old woman with newly diagnosed mixed infiltrating and intraductal mammary carcinoma in the left breast. (a) Sagittal, gadolinium-enhanced, fat-suppressed, spoiled three-dimensional gradient-echo MR (postimaging subtraction) image (18.4/2.1) demonstrates an irregular enhancing mass (arrow) in the inferior central breast just anterior to a breast implant. Directed US (not shown) of the right breast following the MR imaging study demonstrated a 1-cm lobulated mass in the subareolar breast corresponding to the lesion seen on the MR image. (b) Sonogram from US-guided fine-needle aspiration (arrows mark the lesions, arrowheads mark the needle) revealed focal atypia with a suspicious tumor. The patient elected to undergo simple mastectomy, at which time a 2.5-cm area of DCIS was found.
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Figure 1b. True-positive MR imaging finding. Images of the right breast in a 47-year-old woman with newly diagnosed mixed infiltrating and intraductal mammary carcinoma in the left breast. (a) Sagittal, gadolinium-enhanced, fat-suppressed, spoiled three-dimensional gradient-echo MR (postimaging subtraction) image (18.4/2.1) demonstrates an irregular enhancing mass (arrow) in the inferior central breast just anterior to a breast implant. Directed US (not shown) of the right breast following the MR imaging study demonstrated a 1-cm lobulated mass in the subareolar breast corresponding to the lesion seen on the MR image. (b) Sonogram from US-guided fine-needle aspiration (arrows mark the lesions, arrowheads mark the needle) revealed focal atypia with a suspicious tumor. The patient elected to undergo simple mastectomy, at which time a 2.5-cm area of DCIS was found.
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Figure 2a. True-positive MR imaging finding. Images of both breasts in a 55-year-old woman with left breast cancer diagnosed at core biopsy. (a) Sagittal, gadolinium-enhanced, fat-suppressed, spoiled three-dimensional gradient-echo MR image (21.2/2.1) of the left breast reveals an enhancing 1-cm spiculated mass (arrow) that represented the patient’s known breast cancer (1.1-cm invasive ductal carcinoma). (b) Sagittal, gadolinium-enhanced, fat-suppressed, spoiled three-dimensional gradient-echo MR image (21.2/2.1) of the right breast reveals a mirror-image, enhancing 1-cm mass (arrow) with irregular borders. Additional mammography after MR imaging revealed a cluster of heterogeneous calcifications with an associated mass in an area corresponding to the MR imaging-detected lesion. Mammographically guided wire localization and excisional biopsy revealed a 1-cm invasive ductal carcinoma. The patient underwent bilateral breast-conservation therapy.
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Figure 2b. True-positive MR imaging finding. Images of both breasts in a 55-year-old woman with left breast cancer diagnosed at core biopsy. (a) Sagittal, gadolinium-enhanced, fat-suppressed, spoiled three-dimensional gradient-echo MR image (21.2/2.1) of the left breast reveals an enhancing 1-cm spiculated mass (arrow) that represented the patient’s known breast cancer (1.1-cm invasive ductal carcinoma). (b) Sagittal, gadolinium-enhanced, fat-suppressed, spoiled three-dimensional gradient-echo MR image (21.2/2.1) of the right breast reveals a mirror-image, enhancing 1-cm mass (arrow) with irregular borders. Additional mammography after MR imaging revealed a cluster of heterogeneous calcifications with an associated mass in an area corresponding to the MR imaging-detected lesion. Mammographically guided wire localization and excisional biopsy revealed a 1-cm invasive ductal carcinoma. The patient underwent bilateral breast-conservation therapy.
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Figure 3. True-positive MR imaging finding. Image in a 53-year-old woman with newly diagnosed invasive cancer with ductal and lobular features in the left breast. Sagittal, gadolinium-enhanced, fat-suppressed, spoiled three-dimensional gradient-echo MR image (18.2/2.1) of the right breast reveals an enhancing 1-cm mass (arrow) with irregular borders. Directed US (not shown) following MR imaging revealed a subtle ill-defined hypoechoic lesion at the 6-o’clock position. As the lesion was better visualized at MR imaging, an MR imaging-guided core biopsy was performed, which revealed well-differentiated invasive ductal cancer. The patient underwent a bilateral mastectomy procedure.
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Figure 4. False-positive MR imaging finding. Image in a 42-year-old woman with newly diagnosed left breast DCIS with microinvasion. Sagittal, gadolinium-enhanced, fat-suppressed, spoiled three-dimensional gradient-echo MR image (21.2/2.1) of the right breast demonstrates an area of regional enhancement (arrows) with irregular borders deep in the right breast. MR imaging-guided wire localization and excisional biopsy revealed focal atypical ductal hyperplasia and florid ductal hyperplasia.
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Figure 5a. False-positive MR imaging finding. Images in a 47-year-old woman with newly diagnosed invasive cancer in the left breast. (a, b) Sagittal, gadolinium-enhanced, fat-suppressed, spoiled three-dimensional gradient-echo images (18.4/2.1) of the right breast demonstrate multiple enhancing lesions (arrows). Directed US (not shown) demonstrated three hypoechoic masses that corresponded to the MR findings. US-guided core biopsy of one of the masses revealed focal ductal hyperplasia and sclerosing adenosis. The pathologic results were discordant with the imaging findings, and excisional biopsy of at least two of these lesions was advised. The patient elected to undergo a bilateral mastectomy procedure (modified radical mastectomy on the left and simple mastectomy on the right). No cancer was found in the right breast.
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Figure 5b. False-positive MR imaging finding. Images in a 47-year-old woman with newly diagnosed invasive cancer in the left breast. (a, b) Sagittal, gadolinium-enhanced, fat-suppressed, spoiled three-dimensional gradient-echo images (18.4/2.1) of the right breast demonstrate multiple enhancing lesions (arrows). Directed US (not shown) demonstrated three hypoechoic masses that corresponded to the MR findings. US-guided core biopsy of one of the masses revealed focal ductal hyperplasia and sclerosing adenosis. The pathologic results were discordant with the imaging findings, and excisional biopsy of at least two of these lesions was advised. The patient elected to undergo a bilateral mastectomy procedure (modified radical mastectomy on the left and simple mastectomy on the right). No cancer was found in the right breast.
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Copyright © 2003 by the Radiological Society of North America.
