601
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Plana MN, Carreira C, Muriel A, Chiva M, Abraira V, Emparanza JI, Bonfill X, Zamora J. Magnetic resonance imaging in the preoperative assessment of patients with primary breast cancer: systematic review of diagnostic accuracy and meta-analysis. Eur Radiol 2011; 22:26-38. [PMID: 21847541 DOI: 10.1007/s00330-011-2238-8] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 07/11/2011] [Accepted: 07/28/2011] [Indexed: 12/12/2022]
Affiliation(s)
- María Nieves Plana
- Clinical Biostatistics Unit. Hospital Universitario Ramón y Cajal, CIBER en Epidemiología y Salud Pública (CIBERESP) and Instituto de Investigación Sanitaria (IRYCIS), Ctra. Colmenar km 9, 100 28034 Madrid, Spain
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602
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Juanpere S, Perez E, Huc O, Motos N, Pont J, Pedraza S. Imaging of breast implants-a pictorial review. Insights Imaging 2011; 2:653-670. [PMID: 22347984 PMCID: PMC3259319 DOI: 10.1007/s13244-011-0122-3] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 06/23/2011] [Accepted: 07/18/2011] [Indexed: 11/24/2022] Open
Abstract
The number of women with breast implants is increasing. Radiologists must be familiar with the normal and abnormal findings of common implants. Implant rupture is a well-known complication after surgery and is the main cause of implant removal. Although mammography and ultrasonography are the standard first steps in the diagnostic workup, magnetic resonance imaging (MRI) is the most useful imaging modality for the characterisation of breast implants because of its high spatial resolution and contrast between implants and soft tissues and absence of ionising radiation. MRI has the highest sensitivity and specificity for implant rupture, thanks to its sequences that can suppress or emphasise the signal from silicone. Regardless of the technique used, the overall aim of imaging breast implants is to provide essential information about tissue and prosthesis integrity, detect implant abnormalities and detect breast diseases unrelated to implants, such as breast cancer.
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603
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den Hartogh MD, van Asselen B, Monninkhof EM, van den Bosch MAAJ, van Vulpen M, van Diest PJ, Gilhuijs KGA, Witkamp AJ, van de Bunt L, Mali WPTM, van den Bongard HJGD. Excised and irradiated volumes in relation to the tumor size in breast-conserving therapy. Breast Cancer Res Treat 2011; 129:857-65. [PMID: 21822639 DOI: 10.1007/s10549-011-1696-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 07/22/2011] [Indexed: 11/26/2022]
Abstract
In early-stage breast cancer and DCIS patients, breast-conserving therapy is today's standard of care. The purpose of this study was to evaluate the relation between the microscopic tumor diameter (mTD), the excised specimen (ES) volume, and the irradiated postoperative complex (POC) volume, in patients treated with breast-conserving therapy. In 186 patients with pTis-2N0 breast cancer, the mTDs, ES, and POC volumes (as delineated on the radiotherapy-planning CT scan), were retrospectively determined. Linear regression analysis was performed to study the association between the mTD, and the ES and POC volumes. The explained variance (r (2)) was calculated to establish the proportion of variation in the outcome variable that could be explained by the determinant (P ≤ 0.05). Moreover, the influence of tumor characteristics, age, surgical procedures, and breast size was studied. Median mTD was 1.2 cm (range 0.1-3.6 cm), median ES volume was 60 cm(3) (range 6-230 cm(3)) and median POC volume was 15 cm(3) (range 0.5-374 cm(3)). The POC was not clearly visible on the majority of the CT scans, based on a median assigned cavity visualization score of 3 (range 1-5). The explained variance for the mTD on the ES volume was low (r(2) = 0.08, P < 0.001). A slightly stronger association was observed in palpable tumors (r(2) = 0.23, P < 0.001) and invasive lobular carcinomas (r(2) = 0.39, P = 0.01). Furthermore, weak associations were observed between POC volume and mTD (r(2) = 0.04, P = 0.01), and POC and ES volume (r(2) = 0.23, P < 0.001). A weak association was observed between breast volume and ES volume (r(2) = 0.27, P < 0.001). In conclusion, both the excised and the irradiated POC volumes did not show a clinically relevant association with the mTD in women with early-stage breast cancer treated with breast-conserving therapy. Future studies should focus on improvement of surgical localization, development of image-guided, minimally invasive operation techniques, and more accurate image-guided target volume delineation in radiotherapy.
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Affiliation(s)
- M D den Hartogh
- Department of Radiation Oncology, Utrecht University Medical Center, PO Box 85500, 3508 GA Utrecht, The Netherlands.
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604
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Setz-Pels W, Duijm LEM, Groenewoud JH, Voogd AC, Jansen FH, Hooijen MJHH, Louwman MWJ. Detection of Bilateral Breast Cancer at Biennial Screening Mammography in the Netherlands: A Population-based Study. Radiology 2011; 260:357-63. [PMID: 21474705 DOI: 10.1148/radiol.11102117] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Wikke Setz-Pels
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, PO Box 1350, 5602 ZA, Eindhoven, The Netherlands.
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605
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Heldahl MG, Lundgren S, Jensen LR, Gribbestad IS, Bathen TF. Monitoring neoadjuvant chemotherapy in breast cancer patients: Improved MR assessment at 3 T? J Magn Reson Imaging 2011; 34:547-56. [DOI: 10.1002/jmri.22642] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2010] [Accepted: 04/06/2011] [Indexed: 12/19/2022] Open
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606
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O'Flynn EA, Wilson R, Nerurkar A, Johnston SR, Allen SD. Metastatic Breast Cancer in a Young Adult Man After Total-Body Irradiation for Acute Lymphoblastic Leukemia. J Clin Oncol 2011; 29:e607-9. [DOI: 10.1200/jco.2011.34.6809] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Robin Wilson
- Royal Marsden Hospital, Sutton, Surrey, United Kingdom
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607
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Petralia G, Bonello L, Priolo F, Summers P, Bellomi M. Breast MR with special focus on DW-MRI and DCE-MRI. Cancer Imaging 2011; 11:76-90. [PMID: 21771711 PMCID: PMC3205756 DOI: 10.1102/1470-7330.2011.0014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The use of magnetic resonance imaging (MRI) for the assessment of breast lesions was first described in the 1970s; however, its wide application in clinical routine is relatively recent. The basic principles for diagnosis of a breast lesion rely on the evaluation of signal intensity in T2-weighted sequences, on morphologic assessment and on the evaluation of contrast enhancement behaviour. The quantification of dynamic contrast behaviour by dynamic contrast-enhanced (DCE) MRI and evaluation of the diffusivity of water molecules by means of diffusion-weighted MRI (DW-MRI) have shown promise in the work-up of breast lesions. Therefore, breast MRI has gained a role for all indications that could benefit from its high sensitivity, such as detection of multifocal lesions, detection of contralateral carcinoma and in patients with familial disposition. Breast MRI has been shown to have a role in monitoring of neoadjuvant chemotherapy, for the evaluation of therapeutic results during the course of therapy. Breast MRI can improve the determination of the remaining tumour size at the end of therapy in patients with a minor response. DCE-MRI and DW-MRI have shown potential for improving the early assessment of tumour response to therapy and the assessment of residual tumour after the end of therapy. Breast MRI is important in the postoperative work-up of breast cancers. High sensitivity and specificity have been reported for the diagnosis of recurrence; however, pitfalls such as liponecrosis and changes after radiation therapy have to be carefully considered.
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Affiliation(s)
- G Petralia
- Division of Radiology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
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608
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Variation of breast vascular maps on dynamic contrast-enhanced MRI after primary chemotherapy of locally advanced breast cancer. AJR Am J Roentgenol 2011; 196:1214-8. [PMID: 21512094 DOI: 10.2214/ajr.10.5239] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to assess changes in breast vascular maps on dynamic contrast-enhanced MRI (DCE-MRI) after primary chemotherapy in patients with locally advanced breast cancer (LABC). SUBJECTS AND METHODS Thirty-four patients with unilateral LABC underwent DCE-MRI before and after anthracycline- and taxane-based primary chemotherapy. The number of vessels 30 mm or longer in length and 2 mm or larger in maximum transverse diameter were counted on maximum intensity projections of the first subtracted phase for each of the two breasts. Patients achieving pathologic response or small clusters of residual cancer cells after primary chemotherapy were considered as responders, and those with an inferior pathologic response were considered as nonresponders. RESULTS The mean (± SD) number of vessels in the breast harboring the cancer and in the contralateral breast was 2.7 ± 1.3 and 1.1 ± 1.0 (p < 0.001), respectively, before primary chemotherapy and 1.3 ± 1.1 and 1.1 ± 1.1 (p = 0.147), respectively, after primary chemotherapy. Overall, primary chemotherapy was associated with a significant reduction in DCE-MRI vascular maps in the breast harboring the cancer only (p < 0.001). Of the 34 patients, 10 were considered responders and 24 were nonresponders. The mean number of vessels in the breast harboring the cancer changed from 2.7 ± 1.1 to 0.6 ± 0.8 for the 10 responders and from 2.7 ± 1.4 to only 1.6 ± 0.9 for the 24 nonresponders. The mean reduction of vascular map in the breast harboring the cancer was significantly higher in responders compared with nonresponders (p = 0.017). CONCLUSION Before primary chemotherapy, DCE-MRI vascular maps were asymmetrically increased ipsilaterally to the LABC. After primary chemotherapy, vascular maps significantly changed only in the breast harboring the cancer, with significant differences between responders and nonresponders.
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609
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Rinaldi P, Costantini M, Belli P, Giuliani M, Bufi E, Fubelli R, Distefano D, Romani M, Bonomo L. Extra-mammary findings in breast MRI. Eur Radiol 2011; 21:2268-76. [PMID: 21688004 DOI: 10.1007/s00330-011-2183-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 05/05/2011] [Accepted: 05/13/2011] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Incidental extra-mammary findings in breast Magnetic Resonance Imaging (MRI) may be benign in nature, but may also represent a metastasis or another important lesion. We aimed to analyse the prevalence and clinical relevance of these unexpected findings. METHODS A retrospective review of 1535 breast MRIs was conducted. Only axial sequences were reassessed. Confirmation examinations were obtained in all cases. RESULTS 285 patients had a confirmed incidental finding, which were located in the liver (51.9%), lung (11.2%), bone (7%), mediastinal lymph nodes (4.2%) or consisted of pleural/pericardial effusion (15.4%). 20.4% of incidental findings were confirmed to be malignant. Positive predictive value for MRI to detect a metastatic lesion was high if located within the bone (89%), lymph nodes (83%) and lung (59%), while it was low if located within the liver (9%) or if it consisted of pleural/pericardial effusion (6%). The axial enhanced sequence showed superior sensitivity to unenhanced images in detecting metastatic lesions, especially if only smaller (≤10 mm.) lesions were considered. CONCLUSIONS The prevalence of metastatic incidental extra-mammary findings is not negligible. Particular attention should be to incidental findings located within the lung, bone and mediastinal lymph nodes.
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Affiliation(s)
- Pierluigi Rinaldi
- Department of Bio-Imaging and Radiological Sciences, Catholic University - Policlinic A. Gemelli, L.go A. Gemelli 8, 00168 Rome, Italy.
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610
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Boisserie-Lacroix M, Adenet C, Trillaud H. [Evaluation of suspicious nipple discharge with MRI: review of 50 cases]. ACTA ACUST UNITED AC 2011; 92:412-20. [PMID: 21621107 DOI: 10.1016/j.jradio.2011.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 12/06/2010] [Accepted: 03/17/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine the role of MRI in the evaluation and management of patients with suspicious nipple discharge and normal mammographic and US evaluation. PATIENTS AND METHODS A total of 50 patients with suspicious nipple discharge and normal mammographic and US evaluation prospectively underwent MRI. The first 16 patients underwent routine breast MRI, while MR-ductography with image fusion at the console was added for the last 34 patients. RESULTS In 22 of 25 high-risk and malignant lesions, MRI showed enhancement whereas it was normal in three cases. In 25 benign cases (resolution of discharge/benign non-proliferative breast disease), MRI was negative in 22 cases and falsely positive in three cases. CONCLUSION In this clinical setting, MRI shows excellent sensitivity, PPV and NPV. A negative result on MRI would support clinical follow-up as opposed to surgery.
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611
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Orzalesi L, Aldrovandi S, Calabrese C, Casella D, Brancato B, Cataliotti L. Nipple discharge after nipple-sparing mastectomy: should the areola complex always be removed? Clin Breast Cancer 2011; 11:270-2. [PMID: 21729659 DOI: 10.1016/j.clbc.2011.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Revised: 01/17/2011] [Accepted: 02/22/2011] [Indexed: 11/26/2022]
Abstract
Nipple discharge (ND) is a common symptom with a reported incidence of 2% to 5% of patients referred to breast cancer clinics. Approximately 90% of ND is of benign etiology. An underlying carcinoma is present with a rate of 6% to 21%. This is more frequent if it is associated with clinical or radiologic abnormality. ND after nipple-sparing mastectomy (NSM) is a rare event as the whole retroareolar glandular tissue is usually completely removed with mastectomy. ND is otherwise possible if a small amount of tissue is accidentally left by the surgeon or with the aim of reducing the risk of the nipple-areola complex (NAC) necrosis. This condition can be of concern as it may imply a local recurrence and therefore implicate NAC removal. Herein we report a case of a ND in an NSM in which only a selective duct excision allowed NAC preservation.
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Affiliation(s)
- Lorenzo Orzalesi
- Breast Unit, University of Florence, Viale Morgagni 85, Florence, Italy.
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612
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Siegmann KC, Krämer B, Claussen C. Current Status and New Developments in Breast MRI. Breast Care (Basel) 2011; 6:87-92. [PMID: 21673817 PMCID: PMC3104897 DOI: 10.1159/000328273] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
SUMMARY: Breast magnetic resonance imaging (MRI) is the most sensitive imaging modality for the detection of breast cancer. Its specificity is equivalent to that of mammography. Nowadays, breast MRI is an absolutely essential breast imaging method. Technical innovations allow dynamic contrast-enhanced (DCE) MRI of both breasts with high image quality. Thereby, DCE breast MRI should always be performed with regard to current standards. New quantitative techniques such as diffusion-weighted MRI are promising. However, they still have potential pitfalls, in particular with regard to the diagnosis of non-mass lesions and small breast lesions. Ongoing technical innovations can possibly help to further optimize breast MRI.
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Affiliation(s)
- Katja C. Siegmann
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Germany
| | - Bernhard Krämer
- Department of Obstetrics and Gynaecology, University Hospital Tuebingen, Germany
| | - Claus Claussen
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Germany
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613
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614
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Size assessment of breast lesions by means of a computer-aided detection (CAD) system for magnetic resonance mammography. LA RADIOLOGIA MEDICA 2011; 116:1039-49. [PMID: 21424564 DOI: 10.1007/s11547-011-0664-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 10/04/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to investigate the efficacy of a dedicated software tool for automated volume measurement of breast lesions in contrast-enhanced (CE) magnetic resonance mammography (MRM). MATERIAL AND METHODS The size of 52 breast lesions with a known histopathological diagnosis (three benign, 49 malignant) was automatically evaluated using different techniques. The volume of all lesions was measured automatically (AVM) from CE 3D MRM examinations by means of a computer-aided detection (CAD) system and compared with the size estimates based on maximum diameter measurement (MDM) on MRM, ultrasonography (US), mammography and histopathology. RESULTS Compared with histopathology as the reference method, AVM understimated lesion size by 4% on average. This result was similar to MDM (3% understimation, not significantly different) but significantly better than US and mammographic lesion measurements (24% and 33% size underestimation, respectively). CONCLUSIONS AVM is as accurate as MDM but faster. Both methods are more accurate for size assessment of breast lesions compared with US and mammography.
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615
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Saha S, Sirop S, Korant A, Kanaan M, Shekher R, Strahle D, Hicks M, Hicks R, Lawrence L, Wiese D. Nodal positivity in breast cancer correlated with the number of lesions detected by magnetic resonance imaging versus mammogram. Am J Surg 2011; 201:390-4; discussion 394-5. [DOI: 10.1016/j.amjsurg.2010.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 11/02/2010] [Accepted: 11/04/2010] [Indexed: 11/16/2022]
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616
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O'Flynn EAM, DeSouza NM. Functional magnetic resonance: biomarkers of response in breast cancer. Breast Cancer Res 2011; 13:204. [PMID: 21392409 PMCID: PMC3109577 DOI: 10.1186/bcr2815] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Functional magnetic resonance (MR) encompasses a spectrum of techniques that depict physiological and molecular processes before morphological changes are visible on conventional imaging. As understanding of the pathophysiological and biomolecular processes involved in breast malignancies evolves, newer functional MR techniques can be employed that define early predictive and surrogate biomarkers for monitoring response to chemotherapy. Neoadjuvant chemotherapy is increasingly used in women with primary breast malignancies to down-stage the tumour and enable successful breast conservation surgery. It also plays a role in the treatment of undetected micrometastases. Cardinal physiological features of tumours that occur as a result of interactions between cancer cells, stromal cells and secreted factors and cytokines and how they change with treatment provide the opportunity to detect changes in the tumour microenvironment prior to any morphological change. Through sequential imaging, tumour response can be assessed and non-responders can be identified early to enable alternative therapies to be considered. This review summarises the functional magnetic resonance biomarkers of response in patients with breast cancer that are currently available and under development. We describe the current state of each biomarker and explore their potential clinical uses and limitations in assessing treatment response. With the aid of selected interesting cases, biomarkers related to dynamic contrast-enhanced MRI, diffusion-weighted MRI, T2*/BOLD and MR spectroscopy are described and illustrated. The potential of newer approaches, such as MR elastography, are also reviewed.
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Affiliation(s)
- Elizabeth A M O'Flynn
- Clinical Magnetic Resonance Group, Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, Surrey, SM2 5PT, UK.
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617
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Camps Herrero J. [Breast magnetic resonance imaging: state of the art and clinical applications]. RADIOLOGIA 2011; 53:27-38. [PMID: 21310445 DOI: 10.1016/j.rx.2010.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Revised: 08/17/2010] [Accepted: 08/28/2010] [Indexed: 11/16/2022]
Abstract
Breast magnetic resonance imaging is a modality that is being progressively integrated into the breast radiologist's daily clinical practice. There is consensus on the minimal technical requirements that a breast MR exam should have in order to attain diagnostic quality. Diagnostic criteria are mainly based on the American College of Radiology's BI-RADS magnetic resonance imaging categories. Breast cancer staging is a main clinical application, but it is not universally accepted. Other applications are: response evaluation in patients treated with chemotherapy, screening in high-risk patients, cancer of unknown origin, assessment of a possible relapse and breast implant evaluation.
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Affiliation(s)
- J Camps Herrero
- Unidad de Mama, Hospital de la Ribera, Alzira, Valencia, España.
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618
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Guarneri V, Pecchi A, Piacentini F, Barbieri E, Dieci MV, Ficarra G, Tazzioli G, Frassoldati A, Battista R, Canossi B, Mauri C, D'Amico R, Conte P, Torricelli P. Magnetic resonance imaging and ultrasonography in predicting infiltrating residual disease after preoperative chemotherapy in stage II-III breast cancer. Ann Surg Oncol 2011; 18:2150-7. [PMID: 21301969 DOI: 10.1245/s10434-011-1590-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study was designed to evaluate the accuracy of breast magnetic resonance imaging (MRI) and ultrasonography (US) in predicting the extent of breast residual disease after preoperative chemotherapy. METHODS Patients with stage II-III invasive breast tumors who received preoperative chemotherapy and were imaged with post-treatment MRI were included. Histopathological verification was available for all patients. The longest diameter of residual tumor measured with MRI and US has been compared with the infiltrating residual tumor size at pathologic evaluation. RESULTS A total of 108 patients were enrolled: 59 were imaged with both MRI and US (MRI group), and 49 were imaged with US only (non-MRI group). The non-MRI group was enrolled as an external control to avoid possible bias in the selection of patients. In the MRI group, the means of the deltas between MRI residual tumor size and pathologic size and between US and pathologic size were 0.16 cm and -0.06 cm respectively (P = not significant). Overall, a discrepancy limited in the interval from -0.5 cm to +0.5 cm compared with the pathologic size was observed in 54% and 51% of the patients with MRI and US, respectively (P = not significant). The linear correlation between the radiological measurement and pathologic tumor size was r = 0.53 for MRI and r = 0.66 for breast US. In the non-MRI group, the mean of the deltas between US residual tumor size and pathologic size was 0.06 cm, and the linear correlation was r = 0.79. CONCLUSIONS In this series of patients, MRI and US do not show significant differences in predicting the breast residual infiltrating tumor after preoperative chemotherapy.
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Affiliation(s)
- Valentina Guarneri
- Department of Oncology, Hematology and Respiratory Diseases, Modena University Hospital, Modena, Italy.
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619
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Medeiros LR, Duarte CS, Rosa DD, Edelweiss MI, Edelweiss M, Silva FR, Winnnikow EP, Simões Pires PD, Rosa MI. Accuracy of magnetic resonance in suspicious breast lesions: a systematic quantitative review and meta-analysis. Breast Cancer Res Treat 2011; 126:273-85. [PMID: 21221772 DOI: 10.1007/s10549-010-1326-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 12/20/2010] [Indexed: 12/21/2022]
Abstract
Dynamic contrast-enhanced breast magnetic resonance (MR) is a promising emerging technique for evaluating breast lesions. A quantitative systematic review was performed to estimate the accuracy of breast MR in the diagnosis of high-risk breast lesions and breast cancer. A comprehensive search of the Cochrane Library, MEDLINE, CANCERLIT, LILACS, and EMBASE databases was performed from January 1985 to August 2010. The medical subjects heading (MeSH) and text words for the terms "breast neoplasm", "breast lesions", "breast cancer" and "magnetic resonance" were combined with the MeSH term diagnosis ("sensitivity and specificity"). Studies that compared breast MR with paraffin-embedded sections parameters for the diagnosis of breast lesions (benign, high-risk borderline, and breast cancer) were included. Sixty-nine studies were analyzed, which included 9,298 women with 9,884 breast lesions. Interrater overall agreement between breast MR and paraffin section diagnosis was 79% (κ = 0.55), indicating moderate agreement. Pooled sensitivity and specificity were 90% [95% CI 88-92%] and 75% [95% CI 70-79%], respectively. The pooled likelihood positive ratio was 3.64 (95% CI 3.0-4.2) and the negative ratio was 0.12 (95% CI 0.09-0.15). For breast cancer or high-risk lesions versus benign lesions, the AUC was 0.91 for breast MR and the point Q* was 0.84. In summary, breast MR is a useful pre-operative test for predicting the diagnosis of breast lesions.
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Affiliation(s)
- Lidia Rosi Medeiros
- Postgraduate Program in Medicine, Medical Sciences at Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
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620
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Camps Herrero J. Breast Magnetic Resonance Imaging: State of the art and clinical applications. RADIOLOGIA 2011. [DOI: 10.1016/s2173-5107(11)70003-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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621
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MR imaging of triple-negative breast cancer. Breast Cancer 2010; 18:161-4. [PMID: 21181317 DOI: 10.1007/s12282-010-0236-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 09/23/2010] [Indexed: 10/18/2022]
Abstract
Little is known about the MR imaging features of triple-negative breast cancer (TNBC), but TNBC has a worse prognosis because it has no effective therapeutic targets, such as estrogen receptor for endocrine therapy and human epidermal growth factor receptor 2 (HER2) for anti-HER2 therapy. MR findings of a unifocal lesion, mass lesion type, smooth mass margin, rim heterogeneous enhancement, persistent enhancement pattern, and very high signal intensity on T2-weighted images are typical features of breast MR imaging associated with TNBC. Although TNBC can mimic a benign morphology, the early MR imaging recognition of TNBC could assist in both the pretreatment planning and the prognosis, as well as adding to our understanding of the biological behavior of TNBC.
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622
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Vessel analysis on contrast-enhanced MRI of the breast: global or local vascularity? AJR Am J Roentgenol 2010; 195:1246-9. [PMID: 20966335 DOI: 10.2214/ajr.10.4984] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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623
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Vererbbarer Brustkrebs jenseits von BRCA1- und BRCA2-Genmutationen. Wien Med Wochenschr 2010; 160:478-82. [DOI: 10.1007/s10354-010-0831-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 09/08/2010] [Indexed: 10/19/2022]
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624
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Comparison of magnetic resonance imaging and multidetector computed tomography for evaluating intraductal tumor extension of breast cancer. Jpn J Radiol 2010; 28:563-70. [DOI: 10.1007/s11604-010-0474-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 06/03/2010] [Indexed: 11/26/2022]
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625
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Riedl CC, Ponhold L, Gruber R, Pinker K, Helbich TH. [New information on high risk breast screening]. Radiologe 2010; 50:955-6, 958-63. [PMID: 20945147 DOI: 10.1007/s00117-010-2011-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Women with an elevated risk for breast cancer require intensified screening beginning at an early age. Such high risk screening differs considerably from screening in the general population. After an expert has evaluated the exact risk a breast MRI examination should be offered at least once a year and beginning latest at the age of 30 depending on the patients risk category. Complementary mammograms should not be performed before the age of 35. An additional ultrasound examination is no longer recommended. To ensure a high sensitivity and specificity high risk screening should be performed only at a nationally or regionally approved and audited service. Adequate knowledge about the phenotypical characteristics of familial breast cancer is essential. Besides the common malignant phenotypes, benign morphologies (round or oval shape and smooth margins) as well as a low prevalence of calcifications have been described. Using MRI benign contrast media kinetics as well as non-solid lesions with focal, regional and segmental enhancement can often be visualized.
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Affiliation(s)
- C C Riedl
- Abteilung für Allgemeine Radiologie und Kinderradiologie, Division für Molekulare und Gender-Bildgebung, Universitätsklinik für Radiodiagnostik, Medizinische Universität Wien, Währinger Gürtel 18-20, A-1090 Wien, Österreich
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626
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Sardanelli F. Additional findings at preoperative MRI: a simple golden rule for a complex problem? Breast Cancer Res Treat 2010; 124:717-21. [PMID: 20803241 DOI: 10.1007/s10549-010-1144-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2010] [Accepted: 08/18/2010] [Indexed: 10/19/2022]
Affiliation(s)
- Francesco Sardanelli
- Dipartimento di Scienze Medico-Chirurgiche, Unità di Radiologia, Università degli Studi di Milano, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy.
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627
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Heywang-Köbrunner SH, Nährig J, Hacker A, Sedlacek S, Höfler H. B3 Lesions: Radiological Assessment and Multi-Disciplinary Aspects. Breast Care (Basel) 2010; 5:209-217. [PMID: 22590440 PMCID: PMC3346165 DOI: 10.1159/000319326] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
B3 lesions comprise different histopathological entities that are considered benign but 'of unknown biological potential'. These entities may act as risk indicators (for both breasts) or as non-obligatory precursors of malignancy. Being diagnosed at percutaneous breast biopsy, an additional risk of underestimate exists. Imaging appearances, histopathological appearance and risk of associated malignancy are presented. B3 lesions of high risk, which thus should usually be excised, include atypical ductal hyperplasia (ADH), pleomorphic or necrotic type of lobular neoplasia (LIN 3), and papillary lesions with atypias. Intermediate risk may be associated with classic lobular carcinoma in situ (LIN 2) or flat epithelial atypia (FEA), and low risk with radial sclerosing lesions (RSLs) and papillary lesions without atypias. LIN 1 is mostly an incidental finding acting as risk indicator. Follow-up is adequate if the initial diagnostic problem is solved. According to international guidelines, risk and subsequent recommendations should be discussed for each individual patient, taking into account biological risk, representative sampling, lesion size, lesion extent, percentage of lesion removal, other individual risks, and the possibility of surveillance. With vacuum-assisted breast biopsy (VABB), surgery may be avoided for more of the small lesions at low risk. Further data collection and diligent evaluation may help to better assess the individual risk, to better adapt treatment recommendations and avoid overtreatment.
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Affiliation(s)
- Sylvia H. Heywang-Köbrunner
- Referenzzentrum Mammographie München, TU München, Germany
- Radiologie Haudhausen, München, TU München, Germany
| | - Jörg Nährig
- Institut für Pathologie, TU München, Germany
| | - Astrid Hacker
- Referenzzentrum Mammographie München, TU München, Germany
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628
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Giannini V, Vignati A, Morra L, Persano D, Brizzi D, Carbonaro L, Bert A, Sardanelli F, Regge D. A fully automatic algorithm for segmentation of the breasts in DCE-MR images. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2010:3146-3149. [PMID: 21096592 DOI: 10.1109/iembs.2010.5627191] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Automatic segmentation of the breast and axillary region is an important preprocessing step for automatic lesion detection in breast MR and dynamic contrast-enhanced-MR studies. In this paper, we present a fully automatic procedure based on the detection of the upper border of the pectoral muscle. Compared with previous methods based on thresholding, this method is more robust to noise and field inhomogeneities. The method was quantitatively evaluated on 31 cases acquired from two centers by comparing the results with a manual segmentation. Results indicate good overall agreement within the reference segmentation (overlap=0.79 ± 0.09, recall=0.95 ± 0.02, precision=0.82 ± 0.1).
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