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Small Hypoattenuating Hepatic Lesions at Contrast-enhanced CT: Prognostic Importance in Patients with Breast Cancer¹

¹ From the Department of Radiology, University of California San Francisco, Box 0628, M-372, 505 Parnassus Ave, San Francisco, CA 94143-0628. Received September 11, 2003; revision requested November 24; final revision received March 18, 2004; accepted April 8. Address correspondence to F.V.C (e-mail: fergus.coakley@radiology.ucsf.edu).

View larger version (25K): [in a new window]   Figure 1. Graph depicts the size and number distribution of small hypoattenuating hepatic lesions present at baseline CT in 54 of 153 patients (35%) with breast cancer. The distribution indicates that many patients have at least one such lesion, and that many of these lesions are 1 cm or less in size.

View larger version (18K): [in a new window]   Figure 2a. Graphs show the probability of remaining free of definite hepatic metastases in relation to the presence, size, and number of small hypoattenuating hepatic lesions at baseline CT in 153 patients with breast cancer. (a) Probability of remaining free of hepatic metastases based on the presence of hypoattenuating lesions at CT. Kaplan-Meier analysis showed no significant difference (P = .56) between patients with hypoattenuating lesions (n = 54; 38 censored, 15 developing metastases []) and patients without hypoattenuating lesions (n = 99; 71 censored, 28 developing metastases []). (b) Probability of remaining free of hepatic metastases based on the size of hypoattenuating lesions at CT. Kaplan-Meier analysis showed no significant difference (P = .55) between patients with no hypoattenuating hepatic lesions (n = 99; 71 censored, 28 developing metastases []) and patients with lesions of 0-10 mm (n = 35; 27 censored, eight developing metastases []) or between patients with no hypoattenuating hepatic lesions and patients with one or more lesions of 11-15 mm (n = 19; 12 censored, seven developing metastases []). (c) Probability of remaining free of hepatic metastases based on the number of hypoattenuating lesions at CT. Kaplan-Meier analysis showed no significant difference (P = .30) between patients with no hepatic lesions (n = 99; 71 censored, 28 developing metastases []) and patients with one to three lesions (n = 39; 30 censored, nine developing metastases []) or between patients with no hepatic lesions and patients with four or more lesions (n = 14; eight censored, six developing metastases []).

View larger version (19K): [in a new window]   Figure 2b. Graphs show the probability of remaining free of definite hepatic metastases in relation to the presence, size, and number of small hypoattenuating hepatic lesions at baseline CT in 153 patients with breast cancer. (a) Probability of remaining free of hepatic metastases based on the presence of hypoattenuating lesions at CT. Kaplan-Meier analysis showed no significant difference (P = .56) between patients with hypoattenuating lesions (n = 54; 38 censored, 15 developing metastases []) and patients without hypoattenuating lesions (n = 99; 71 censored, 28 developing metastases []). (b) Probability of remaining free of hepatic metastases based on the size of hypoattenuating lesions at CT. Kaplan-Meier analysis showed no significant difference (P = .55) between patients with no hypoattenuating hepatic lesions (n = 99; 71 censored, 28 developing metastases []) and patients with lesions of 0-10 mm (n = 35; 27 censored, eight developing metastases []) or between patients with no hypoattenuating hepatic lesions and patients with one or more lesions of 11-15 mm (n = 19; 12 censored, seven developing metastases []). (c) Probability of remaining free of hepatic metastases based on the number of hypoattenuating lesions at CT. Kaplan-Meier analysis showed no significant difference (P = .30) between patients with no hepatic lesions (n = 99; 71 censored, 28 developing metastases []) and patients with one to three lesions (n = 39; 30 censored, nine developing metastases []) or between patients with no hepatic lesions and patients with four or more lesions (n = 14; eight censored, six developing metastases []).

View larger version (20K): [in a new window]   Figure 2c. Graphs show the probability of remaining free of definite hepatic metastases in relation to the presence, size, and number of small hypoattenuating hepatic lesions at baseline CT in 153 patients with breast cancer. (a) Probability of remaining free of hepatic metastases based on the presence of hypoattenuating lesions at CT. Kaplan-Meier analysis showed no significant difference (P = .56) between patients with hypoattenuating lesions (n = 54; 38 censored, 15 developing metastases []) and patients without hypoattenuating lesions (n = 99; 71 censored, 28 developing metastases []). (b) Probability of remaining free of hepatic metastases based on the size of hypoattenuating lesions at CT. Kaplan-Meier analysis showed no significant difference (P = .55) between patients with no hypoattenuating hepatic lesions (n = 99; 71 censored, 28 developing metastases []) and patients with lesions of 0-10 mm (n = 35; 27 censored, eight developing metastases []) or between patients with no hypoattenuating hepatic lesions and patients with one or more lesions of 11-15 mm (n = 19; 12 censored, seven developing metastases []). (c) Probability of remaining free of hepatic metastases based on the number of hypoattenuating lesions at CT. Kaplan-Meier analysis showed no significant difference (P = .30) between patients with no hepatic lesions (n = 99; 71 censored, 28 developing metastases []) and patients with one to three lesions (n = 39; 30 censored, nine developing metastases []) or between patients with no hepatic lesions and patients with four or more lesions (n = 14; eight censored, six developing metastases []).

View larger version (124K): [in a new window]   Figure 3a. Images of a 53-year-old woman with invasive ductal breast carcinoma and stage IV bone metastases. (a) Portal venous phase contrast-enhanced transverse CT section of the abdomen shows a small hypoattenuating lesion (arrow) in the right hepatic lobe. (b) Portal venous phase contrast-enhanced transverse CT section of the abdomen obtained 20 months later shows two new heterogeneous masses (black arrows) consistent with metastases. Appearance of the small hypoattenuating hepatic lesion (white arrow) remains unchanged. Stability of the small hypoattenuating lesion suggests a small benign entity, possibly a cyst.

View larger version (132K): [in a new window]   Figure 3b. Images of a 53-year-old woman with invasive ductal breast carcinoma and stage IV bone metastases. (a) Portal venous phase contrast-enhanced transverse CT section of the abdomen shows a small hypoattenuating lesion (arrow) in the right hepatic lobe. (b) Portal venous phase contrast-enhanced transverse CT section of the abdomen obtained 20 months later shows two new heterogeneous masses (black arrows) consistent with metastases. Appearance of the small hypoattenuating hepatic lesion (white arrow) remains unchanged. Stability of the small hypoattenuating lesion suggests a small benign entity, possibly a cyst.