Limits...
Breast MRI for evaluating patients with metastatic axillary lymph node and initially negative mammography and sonography.

Ko EY, Han BK, Shin JH, Kang SS - Korean J Radiol (2007 Sep-Oct)

Bottom Line: Two MR-negative patients were free of carcinoma in the ipsilateral breast during their follow-up period (39 and 44 months, respectively).All the non-MR-correlated sonographic abnormalities were benign.Breast MR imaging can identify otherwise occult breast cancer in patients with metastatic axillary lymph nodes.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and the Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Objective: We wanted to investigate the ability of breast MR imaging to identify the primary malignancy in patients with axillary lymph node metastases and initially negative mammography and sonography, and we correlated those results with the conventional imaging.

Materials and methods: From September 2001 to April 2006, 12 patients with axillary lymph node metastases and initially negative mammography and sonography underwent breast MR imaging to identify occult breast carcinoma. We analyzed the findings of the MR imaging, the MR-correlated mammography and the second-look sonography. We followed up both the MR-positive and MR-negative patients.

Results: MR imaging detected occult breast carcinoma in 10 of 12 (83%) patients. Two MR-negative patients were free of carcinoma in the ipsilateral breast during their follow-up period (39 and 44 months, respectively). In nine out of 10 patients, the MR-correlated mammography and second-look sonography localized lesions that were not detected on the initial exam. All the non-MR-correlated sonographic abnormalities were benign.

Conclusion: Breast MR imaging can identify otherwise occult breast cancer in patients with metastatic axillary lymph nodes. Localization of the lesions through MR-correlated mammography and second-look sonography is practically feasible in most cases.

Show MeSH

Related in: MedlinePlus

A 57-year-old woman with palpable right axillary lymph node metastasis. The mammogram (A) and US showed negative findings in the breast. The standard subtraction image of the contrast enhanced-MRI (B) showed a 1.8-cm sized area of linear enhancement with an early washout pattern, suggesting malignancy in the outer portion of the right breast. MR-guided second-look US (C) and spot-compression with magnification mammography (D), which targeted the areas of MR-detected lesion through the use of a vitamin E capsule attached to the surface of the right breast overlying the MR-detected lesion, could not find the corresponding lesion. After modified radical mastectomy, ductal carcinoma in situ (0.9 cm in extent) was found in the right outer breast.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2626808&req=5

Figure 5: A 57-year-old woman with palpable right axillary lymph node metastasis. The mammogram (A) and US showed negative findings in the breast. The standard subtraction image of the contrast enhanced-MRI (B) showed a 1.8-cm sized area of linear enhancement with an early washout pattern, suggesting malignancy in the outer portion of the right breast. MR-guided second-look US (C) and spot-compression with magnification mammography (D), which targeted the areas of MR-detected lesion through the use of a vitamin E capsule attached to the surface of the right breast overlying the MR-detected lesion, could not find the corresponding lesion. After modified radical mastectomy, ductal carcinoma in situ (0.9 cm in extent) was found in the right outer breast.

Mentions: MRI of the breast showed suspicious lesions in 10 patients, and these lesions had been negative on the prior conventional images. MR-guided second-look US examinations were performed in each of those 10 patients, as well as performing mammography in four patients. Subsequent localization of the lesions detected on MRI was possible on mammography (n = 1), US (n = 4) or on both examinations (n = 4) in nine out of 10 patients. In three patients, the lesions localized on MR-guided second-look examinations were category 4 there were two cases of suspicious nodules less than 1 cm in size on US (Fig. 1) and one case of faint pleomorphic calcifications with a segmental distribution on the mammogram (Fig. 2). Category 3 lesions were found in five patients with 3-mm to 8-mm sized benign-looking nodules being seen on US (Fig. 3). A category 2 lesion was found in one patient who had a few benign cysts (Fig. 4). All the lesions localized on the MR-correlated mammography or the MR-guided second-look US images were found to be malignant after US-guided core needle biopsy (n = 5), US-guided fine needle aspiration (n = 1), surgical excision after US-guided localization (n = 2) or after mammography-guided localization (n = 1). The MR-guided second-look examination failed to localize the lesion in one patient who had a 1.8-cm linear non-mass-like enhancement with focal wash out on MRI. This lesion was found to be ductal carcinoma in situ (DCIS) after performing modified radical mastectomy (Fig. 5).


Breast MRI for evaluating patients with metastatic axillary lymph node and initially negative mammography and sonography.

Ko EY, Han BK, Shin JH, Kang SS - Korean J Radiol (2007 Sep-Oct)

A 57-year-old woman with palpable right axillary lymph node metastasis. The mammogram (A) and US showed negative findings in the breast. The standard subtraction image of the contrast enhanced-MRI (B) showed a 1.8-cm sized area of linear enhancement with an early washout pattern, suggesting malignancy in the outer portion of the right breast. MR-guided second-look US (C) and spot-compression with magnification mammography (D), which targeted the areas of MR-detected lesion through the use of a vitamin E capsule attached to the surface of the right breast overlying the MR-detected lesion, could not find the corresponding lesion. After modified radical mastectomy, ductal carcinoma in situ (0.9 cm in extent) was found in the right outer breast.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2626808&req=5

Figure 5: A 57-year-old woman with palpable right axillary lymph node metastasis. The mammogram (A) and US showed negative findings in the breast. The standard subtraction image of the contrast enhanced-MRI (B) showed a 1.8-cm sized area of linear enhancement with an early washout pattern, suggesting malignancy in the outer portion of the right breast. MR-guided second-look US (C) and spot-compression with magnification mammography (D), which targeted the areas of MR-detected lesion through the use of a vitamin E capsule attached to the surface of the right breast overlying the MR-detected lesion, could not find the corresponding lesion. After modified radical mastectomy, ductal carcinoma in situ (0.9 cm in extent) was found in the right outer breast.
Mentions: MRI of the breast showed suspicious lesions in 10 patients, and these lesions had been negative on the prior conventional images. MR-guided second-look US examinations were performed in each of those 10 patients, as well as performing mammography in four patients. Subsequent localization of the lesions detected on MRI was possible on mammography (n = 1), US (n = 4) or on both examinations (n = 4) in nine out of 10 patients. In three patients, the lesions localized on MR-guided second-look examinations were category 4 there were two cases of suspicious nodules less than 1 cm in size on US (Fig. 1) and one case of faint pleomorphic calcifications with a segmental distribution on the mammogram (Fig. 2). Category 3 lesions were found in five patients with 3-mm to 8-mm sized benign-looking nodules being seen on US (Fig. 3). A category 2 lesion was found in one patient who had a few benign cysts (Fig. 4). All the lesions localized on the MR-correlated mammography or the MR-guided second-look US images were found to be malignant after US-guided core needle biopsy (n = 5), US-guided fine needle aspiration (n = 1), surgical excision after US-guided localization (n = 2) or after mammography-guided localization (n = 1). The MR-guided second-look examination failed to localize the lesion in one patient who had a 1.8-cm linear non-mass-like enhancement with focal wash out on MRI. This lesion was found to be ductal carcinoma in situ (DCIS) after performing modified radical mastectomy (Fig. 5).

Bottom Line: Two MR-negative patients were free of carcinoma in the ipsilateral breast during their follow-up period (39 and 44 months, respectively).All the non-MR-correlated sonographic abnormalities were benign.Breast MR imaging can identify otherwise occult breast cancer in patients with metastatic axillary lymph nodes.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and the Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Objective: We wanted to investigate the ability of breast MR imaging to identify the primary malignancy in patients with axillary lymph node metastases and initially negative mammography and sonography, and we correlated those results with the conventional imaging.

Materials and methods: From September 2001 to April 2006, 12 patients with axillary lymph node metastases and initially negative mammography and sonography underwent breast MR imaging to identify occult breast carcinoma. We analyzed the findings of the MR imaging, the MR-correlated mammography and the second-look sonography. We followed up both the MR-positive and MR-negative patients.

Results: MR imaging detected occult breast carcinoma in 10 of 12 (83%) patients. Two MR-negative patients were free of carcinoma in the ipsilateral breast during their follow-up period (39 and 44 months, respectively). In nine out of 10 patients, the MR-correlated mammography and second-look sonography localized lesions that were not detected on the initial exam. All the non-MR-correlated sonographic abnormalities were benign.

Conclusion: Breast MR imaging can identify otherwise occult breast cancer in patients with metastatic axillary lymph nodes. Localization of the lesions through MR-correlated mammography and second-look sonography is practically feasible in most cases.

Show MeSH
Related in: MedlinePlus