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Breast Lesions Detected with MR Imaging: Utility and Histopathologic Importance of Identification with US¹

¹ From the Department of Radiology, Memorial Sloan-Kettering Guttman Diagnostic Center, 55 Fifth Ave, 12th Floor, New York, NY 10003. Received January 28, 2002; revision requested March 21; final revision received October 4; accepted October 14. Address correspondence to L.R.L. (e-mail: latrentl@mskcc.org).

View larger version (98K): [in a new window]   Figure 1. Subtraction MR image derived from precontrast and postcontrast fat-suppressed T1-weighted fast spoiled gradient-echo (17/1.8) sagittal MR images of the left breast in a 79-year-old woman. Image demonstrates a 6-mm spiculated mass (white arrow). Results of correlative mammography and directed US were negative for mass. MR-guided needle localization and biopsy yielded a 7-mm focus of low-grade DCIS.

View larger version (114K): [in a new window]   Figure 2. Contrast-enhanced fat-suppressed T1-weighted fast spoiled gradient-echo (17/1.8) sagittal MR image of the left breast in a 42-year-old woman who recently underwent lumpectomy in the upper inner quadrant, which yielded multifocal, invasive lobular carcinoma. A seroma/hematoma is seen at the lumpectomy site (short arrow). In the lower inner quadrant, there is clumped nodular enhancement (long arrows), which extends more than 2.1 cm and has no US or mammographic correlate. MR-guided needle localization and biopsy yielded multifocal, invasive lobular carcinoma, which ranged in size from 0.1 to 0.6 cm. The patient subsequently underwent mastectomy.

View larger version (107K): [in a new window]   Figure 3a. (a) Contrast-enhanced fat-suppressed T1-weighted fast spoiled gradient-echo (17/1.8) sagittal MR image of the left breast in a 50-year-old woman demonstrates a 2.9-cm indistinct, irregular enhancing mass (arrow) in the upper part of the breast. (b) Antiradial image from directed US demonstrates a 1.2-cm irregular, indistinct, hypoechoic mass (arrows). This patient underwent US-guided core biopsy, which yielded apocrine DCIS. Subsequent excision yielded 1.4 cm of microinvasive moderately differentiated DCIS.

View larger version (136K): [in a new window]   Figure 3b. (a) Contrast-enhanced fat-suppressed T1-weighted fast spoiled gradient-echo (17/1.8) sagittal MR image of the left breast in a 50-year-old woman demonstrates a 2.9-cm indistinct, irregular enhancing mass (arrow) in the upper part of the breast. (b) Antiradial image from directed US demonstrates a 1.2-cm irregular, indistinct, hypoechoic mass (arrows). This patient underwent US-guided core biopsy, which yielded apocrine DCIS. Subsequent excision yielded 1.4 cm of microinvasive moderately differentiated DCIS.

View larger version (151K): [in a new window]   Figure 4a. (a) Subtraction MR image derived from precontrast and postcontrast fat-suppressed T1-weighted fast spoiled gradient-echo (17/1.8) sagittal MR images of the left breast in a 53-year-old woman with a history of contralateral mastectomy. Image demonstrates a 6-mm round, predominantly circumscribed mass (arrow). This represented an interval change from a screening breast MR examination performed 1 year earlier. (b) Radial image from directed US examination demonstrates a 4-mm irregular, indistinct, hypoechoic mass (arrow), which correlates with the MR image. US-guided biopsy yielded adenocarcinoma. The patient subsequently underwent mastectomy, which yielded a 5-mm focus of invasive ductal carcinoma with DCIS.

View larger version (165K): [in a new window]   Figure 4b. (a) Subtraction MR image derived from precontrast and postcontrast fat-suppressed T1-weighted fast spoiled gradient-echo (17/1.8) sagittal MR images of the left breast in a 53-year-old woman with a history of contralateral mastectomy. Image demonstrates a 6-mm round, predominantly circumscribed mass (arrow). This represented an interval change from a screening breast MR examination performed 1 year earlier. (b) Radial image from directed US examination demonstrates a 4-mm irregular, indistinct, hypoechoic mass (arrow), which correlates with the MR image. US-guided biopsy yielded adenocarcinoma. The patient subsequently underwent mastectomy, which yielded a 5-mm focus of invasive ductal carcinoma with DCIS.