Nonmasslike Enhancement Research Articles

Subcategorization of suspicious non-mass-like enhancement lesions(BI-RADS-MRI Category4)

BackgroundThis study aims to providing a reliable method that has good compliance and is easy to master to improve the accuracy of NMLE diagnosis.MethodsThis study retrospectively analyzed 122 cases of breast non-mass-like enhancement (NMLE) lesions confirmed by postoperative histology. MRI features and clinical features of benign and malignant non-mass enhancement breast lesions were compared by using independent sample t test, χ2test and Fisher exact test. P < 0.05 was considered statistically significant. Statistically significant parameters were then included in logistic regression analysis to build a multiparameter differential diagnosis modelto subdivide the BI-RADS Category 4.ResultsThe distribution (odds ratio (OR) = 8.70), internal enhancement pattern (OR = 6.29), ADC value (OR = 5.56), and vascular sign (OR = 2.84) of the lesions were closely related to the benignity and malignancy of the lesions. These signs were used to build the MRI multiparameter model for differentiating benign and malignant non-mass enhancement breast lesions. ROC analysis revealed that its optimal diagnostic cut-off value was 5. The diagnostic specificity and sensitivity were 87.01% and 82.22%, respectively. Lesions with 1–6 points were considered BI-RADS category 4 lesions, and the positive predictive values of subtypes 4a, 4b, and 4c lesions were15.79%, 31.25%, and 77.78%, respectively.ConclusionsComprehensively analyzing the features of MRI of non-mass enhancement breast lesions and building the multiparameter differential diagnosis model could improve the differential diagnostic performance of benign and malignant lesions.

Preoperative Evaluation of Non-Mass-Like Enhancement on Magnetic Resonance Imaging for Measuring Tumor Extent and Affecting Surgical Margin Status in Breast Cancer Patients

Purpose: This study investigated the correlation between non-mass-like enhancement (NME) observed on preoperative breast magnetic resonance imaging (MRI) and the actual pathological size of breast cancer. We further examined the effect of NME on the positive resection margins during partial mastectomy.Methods: We retrospectively collected data from breast cancer patients who underwent surgery between January 2018 and September 2020. Patients were divided into two groups based on their MRI findings: NME and no-NME (mass-like lesion only) groups. The medical records, including MRI findings and clinicopathological information of patients, were collected retrospectively, and correlations with pathologic results were analyzed. Propensity score matching was applied to develop comparable cohorts of the NME group and no-NME group.Results: This study included a total of 317 patients, with 66 and 251 patients in the NME and no-NME groups, respectively. The mean pathologic size of invasive lesion was significantly smaller than the mean lesion size in the NME group (1.55±1.39 cm vs. 3.45±1.81 cm, p&lt;0.001). The mean pathologic size of ductal carcinoma in situ (DCIS) lesions was larger than that in the NME group but without statistical significance (3.91±2.67 cm vs. 3.50±1.79 cm, p=0.326). In the NME group, NME estimated DCIS size to within 1 cm in 20 patients (30.3%) and overestimated invasive lesion size by more than 1 cm in 31 patients (46.9%). NME (vs. no-NME; odds ratio [OR], 2.967; 95% confidence interval [CI], 0.878-10.025) showed a tendency to predict positive resection margins, but this was not statistically significant (p=0.080).Conclusion: NME findings on MRI showed a similar extent of DCIS lesions. NME findings on preoperative MRI should be considered an important factor for measuring the extent of tumors, especially in DCIS patients.

Diagnostic performance of DCE-MRI, multiparametric MRI and multimodality imaging for discrimination of breast non-mass-like enhancement lesions.

The aim of this study was to investigate and compare the diagnostic performance of dynamic contrast-enhanced (DCE)-MRI, multiparametric MRI (mpMRI), and multimodality imaging (MMI) combining mpMRI and mammography (MG) for discriminating breast non-mass-like enhancement (NME) lesions. This retrospective study enrolled 193 patients with 199 lesions who underwent 3.0 T MRI and MG from January 2017 to December 2019. The features of DCE-MRI, turbo inversion recovery magnitude (TIRM), and diffusion-weighted imaging (DWI) were assessed by two breast radiologists. Then, all lesions were divided into microcalcification and non-microcalcification groups to assess the features of MG. Comparisons were performed between groups using univariate analyses. Then, multivariate analyses were performed to construct diagnostic models for distinguishing NME lesions. Diagnostic performance was evaluated by using the area under the curve (AUC) and the differences between AUCs were evaluated by using the DeLong test. Overall (n = 199), mpMRI outperformed DCE-MRI alone (AUCmpMRI = 0.924 vs. AUCDCE-MRI = 0.884; p = 0.007). Furthermore, MMI outperformed both mpMRI and MG (the microcalcification group [n = 140]: AUCMMI = 0.997 vs. AUCmpMRI = 0.978, p = 0.018 and AUCMMI = 0.997 vs. AUCMG = 0.912, p < 0.001; the non-microcalcification group [n = 59]: AUCMMI = 0.857 vs. AUCmpMRI = 0.768, p = 0.044 and AUCMMI = 0.857 vs. AUCMG = 0.759, p = 0.039). DCE-MRI combined with DWI and TIRM information could improve the diagnostic performance for discriminating NME lesions compared with DCE-MRI alone. Furthermore, MMI combining mpMRI and MG showed better discrimination than both mpMRI and MG.

Interreader reproducibility of the Neck Imaging Reporting and Data system (NI-RADS) lexicon for the detection of residual/recurrent disease in treated head and neck squamous cell carcinoma (HNSCC)

BackgroundTo evaluate the inter- and intrareader agreement and reproducibility of the NI-RADS scoring system and lexicon with contrast-enhanced computed tomography (CECT) and contrast-enhanced magnetic resonance imaging (CEMRI).MethodsThis retrospective study included 97 CECT and CEMRI scans from 58 treated cases of head and neck squamous cell carcinoma (HNSCC) after the exclusion of head and neck cancers (HNCs) other than SCC and noncontrast and poor quality CT and MRI scans, with a total of 111 primary targets and 124 lymph node (LN) targets. Two experienced readers independently scored the likelihood of residual/recurrence for these targets based on the NI-RADS criteria and filled in report templates for NI-RADS lexicon diagnostic features. Inter- and intraobserver reproducibility was assessed with Cohen’s kappa, and the percent agreement was calculated.ResultsAlmost perfect interreader agreement was found for the final NI-RADS category of the primary lesions and LNs, with K = 0.808 and 0.806, respectively. Better agreement was found for CT than for MRI (K = 0.843 and 0.77, respectively, P value 0.001). There was almost perfect agreement for excluding tissue enhancement (K = 0.826, 95% CI = 0.658–0.993, P value 0.001), with a percent agreement of 96.4%, and substantial agreement for discrete nodular and diffuse mucosal enhancement (K = 0.826, 95% CI = 0.658–0.993, P value 0.001), with a percent agreement of 96.4%. There was fair agreement for focal mucosal nonmass and deep ill-defined enhancement. The intrareader agreement was almost perfect for most of the rated features (K ranging from 0.802 to 1), with the exception of enlarging discrete nodule/mass and focal mucosal nonmass-like enhancement, which had substantial intraobserver agreement (K ranging from 0.768 to 0.786).ConclusionThe individual features of NI-RADS show variable degrees of confidence; however, the overall NI-RADS category was not significantly affected.

Combined application of pharamcokinetic DCE-MRI and IVIM-DWI could improve detection efficiency in early diagnosis of ductal carcinoma in situ.

PurposeDuctal carcinoma in situ (DCIS) is a precursor of invasive ductal breast carcinoma (IDC). This study aimed to use pharamcokinetic dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI) and intravoxel incoherent motion diffusion‐weighted imaging (IVIM‐DWI) for the early diagnosis of DCIS.MethodsForty‐seven patients, including 25 with DCIS (age: 28–70 yr, mean age: 48.7 yr) and 22 with benign disease (age: 25–67 yr, mean age: 43.1 yr) confirmed by pathology, underwent pharamcokinetic DCE‐MRI and IVIM‐DWI in this study. The quantitative parameters Ktrans, Kep, Ve, Vp, and D, f, D* were obtained by processing of DCE‐MRI and IVIM‐DWI images with Omni‐Kinetics and MITK‐Diffusion softwares, respectively. Parameters were analyzed statistically using GraphPad Prism and MedCalc softwares.ResultsAll low‐grade DCIS lesions demonstrated mass enhancement with clear boundaries, while most middle‐grade and high‐grade DCIS lesions showed non‐mass‐like enhancement (NMLE). DCIS lesions were significantly different from benign lesions in terms of Ktrans, Kep, and D (t = 5.959, P < 0.0001; t = 5.679, P < 0.0001; and t = 5.629, P < 0.0001, respectively). The AUC of Ktrans, Kep, D and the combined indicator of Ktrans, Kep, and D were 0.936, 0.902, 0.860, and 0.976, respectively. There was a significant difference in diagnostic efficacy only between D and the combined indicator (Z = 2.408, P = 0.016).ConclusionDCE‐MRI and IVIM‐DWI could make for the early diagnosis of DCIS, and reduce the misdiagnosis of DCIS and over‐treatment of benign lesions.

Ductal carcinoma in situ of the breast: Evaluation of main presentations on magnetic resonance imaging compared with findings on mammogram and histology.

The purpose of this study was to evaluate the various morphologies and kinetic characteristics of the ductal carcinoma in situ (DCIS) on breast magnetic resonance imaging (MRI) exam, to establish which are the most prevalent and to determine the effectiveness of the method in the detection of DCIS. A prospective observational study, starting in May 2014. We evaluated 25 consecutive patients with suspicious or highly suspicious microcalcifications on mammography screening, BI-RADS categories 4 and 5, who underwent breast MRI and then surgery with proven diagnosis of pure DCIS. Surgery was considered the gold standard for correlation between histologic findings and radiological findings obtained on MRI. The most frequent morphological characteristic of DCIS on MRI was non-mass-like enhancement (NMLE), p<0.001, observed in 22/25 (88%) patients (95CI 72.5-100). Of these, segmental distribution was the most prevalent, represented by 9/22 (40.91%) cases (95CI 17.4-64.4), p=0.306, and a clumped internal enhancement pattern was most commonly characterized in DCIS, observed in 13/22 (50.09%) cases. DCIS has a wide variety of imaging features on MRI and being able to recognize these lesions is crucial. Its most common morphological presentation is non-mass-like enhancement, while segmental distribution and a clumped internal enhancement pattern are the most common presentations. Faced with the combined analysis of these findings, percutaneous core needle biopsy (core biopsy) or vacuum-assisted biopsy (VAB) should be encouraged.

Enhancing patterns of breast cancer on preoperative dynamic contrast-enhanced magnetic resonance imaging and resection margin in breast conserving therapy.

The association between enhancing patterns of preoperative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and resection margins after BCS has not been studied in detail before. We investigated the association between surgical outcomes and enhancing patterns observed on DCE-MRI. 269 enhancing patterns on DCE-MRI scans were selected, and subdivided into the following groups: (1) a single mass-like enhancement, (2) a single non-mass-like enhancement (NME), (3) mass-like enhancing breast cancer with other mass-like enhancing lesions, and (4) mass-like enhancing breast cancer with additional NMEs. Associations between enhancing patterns on DCE-MRI and re-excision rate, size of specimen, and ratio of tumor/specimen were evaluated retrospectively. The conversion rate from breast conserving therapy (BCT) to mastectomy as a result of MRI findings was 13.4%, re-excision rate during BCT was 8.2% and excision rate of another suspicious lesion was 7.4%. The single NME group had the highest re-excision rate after BCT (22.2%) (p = 0.02). The ratio of tumor/specimen (p = 0.61) and mean specimen size (p = 0.38) were not influenced by enhancement patterns. The false positive rate and positive predictive values of using DCE-MRI for defining the extension of breast cancer was 22.2% and 71.4%, respectively. Enhancement patterns on DCE- MRI, especially NME, could increase re-excision rates.

Magnetic resonance imaging evaluation of residual tumors in breast cancer after neoadjuvant chemotherapy: surgical implications.

Magnetic resonance imaging (MRI) can be used to guide breast cancer surgery with breast conservation for large tumors with a substantially reduced size after neoadjuvant chemotherapy (NAC). To evaluate the value of dynamic contrast-enhanced MRI (DCE-MRI) for measuring residual tumor size and enhancement patterns following preoperative NAC. Eighty-nine patients with breast cancer underwent breast DCE-MRI; 38 patients (39 lesions) were treated with NAC and examined for residual disease following therapy. Two patients were excluded because surgery had been performed >2 weeks after the final MR examination. Thus, we correlated the DCE-MRI results of 36 patients (37 lesions) with postoperative histopathological findings. Residual disease was confirmed by more enhancement compared to normal glandular tissue at the initial tumor site. Residual tumor size on DCE-MRI was compared with postoperative pathology findings. Tumor enhancement patterns on DCE-MRI were analyzed and correlated with pathological classification. MRI revealed 34 cases of residual tumors, with two false positives and one false negative. Pathological and MR measurements were correlated (r = 0.793). The correlation of mass enhancement size (r = 0.87, n = 14) with pathology and DCE-MRI was higher than for non-mass-like enhancement (NME) (r = 0.735, n = 23). The distribution of pathologic classification was significantly different between different MRI enhancement patterns (P = 0.006). Mass enhancement had higher cellularity than NME. MRI is useful for evaluating residual carcinoma following NAC. Mass enhancement with higher cellularity after NAC can be evaluated more accurately, which is suitable for evaluating lumpectomy. However, other approaches are required for NME, which has lower cellularity.

Diagnostic performance of apparent diffusion coefficient and quantitative kinetic parameters for predicting additional malignancy in patients with newly diagnosed breast cancer

PurposeTo evaluate the diagnostic performance of an apparent diffusion coefficient (ADC) and quantitative kinetic parameters in patients with newly diagnosed breast cancer. Materials and MethodsWe enrolled 169 lesions in 89 patients with breast cancer who underwent dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI). Comparisons between benign and malignant lesions were performed for lesion type (mass or nonmass-like enhancement), size (≥1cm or<1cm), ADC, kinetic parameters and the presence of a US correlate. ResultsThere were 63 benign and 106 malignant lesions. The mean size and initial peak enhancement of the benign lesions were significantly lower than those of malignant lesions (P<0.001 for both). The ADC of the benign lesions was significantly higher than that of malignant lesions (1.42×10−3mm2/sec vs. 1.04×10−3mm2/sec; P<0.001). The area under the receiver operating characteristic curve (AUC) for predicting malignancy was 0.87 for the combined parameters of size, ADC, and initial peak enhancement, which was higher than those of each parameter. ConclusionsCombination of quantitative kinetic parameters and ADC showed higher diagnostic performance for predicting malignancy than each parameter alone for the evaluation of patients with breast cancer.

The Effects of Applying Breast Compression in Dynamic Contrast Material–enhanced MR Imaging

To evaluate the effects of breast compression on breast cancer masses, contrast material enhancement of glandular tissue, and quality of magnetic resonance (MR) images in the identification and characterization of breast lesions. This was a HIPAA-compliant, institutional review board-approved retrospective study, with waiver of informed consent. Images from 300 MR imaging examinations in 149 women (mean age ± standard deviation, 51.5 years ± 10.9; age range, 22-76 years) were evaluated. The women underwent diagnostic MR imaging (no compression) and MR-guided biopsy (with compression) between June 2008 and February 2013. Breast compression was expressed as a percentage relative to the noncompressed breast. Percentage enhancement difference was calculated between noncompressed- and compressed-breast images obtained in early and delayed contrast-enhanced phases. Breast density, lesion type (mass vs non-masslike enhancement [NMLE]), lesion size, percentage compression, and kinetic curve type were evaluated. Linear regression, receiver operating characteristic (ROC) curve analysis, and κ test were performed. Mean percentage compression was 31.3% ± 9.2 (range, 5.8%-53.2%). Percentage enhancement was higher in noncompressed- versus compressed-breast studies in early (146% ± 66 vs 107% ± 42, respectively; P < .001) and delayed (158% ± 68 vs 107% ± 42, respectively; P = .1) phases. Among breast lesions, 12% (seven of 59) were significantly smaller when compressed, which led to underestimation of TNM classification (P < .001). Breast masses (n = 35) showed significantly higher early percentage enhancement (157% ± 71) than lesions with NMLE (n = 15, 120% ± 40; P = .02) and a percentage enhancement difference (47.5% ± 64 vs 17% ± 28, respectively; P = .023). Kinetic curve performance for identifying invasive cancer decreased after compression (area under ROC curve = 0.53 vs 0.71, respectively; P = .02). Breast compression resulted in complete loss of enhancement of nine of 210 lesions (4%). Breast compression during biopsy affected breast lesion detection, lesion size, and dynamic contrast-enhanced MR imaging interpretation and performance. Limiting the application of breast compression is recommended, except when clinically necessary.

Apparent diffusion coefficient values as an adjunct to dynamic contrast enhanced MRI for discriminating benign and malignant breast lesions presenting as mass and non-mass like enhancement

PurposeThe purpose of our study was to evaluate the diagnostic value of an imaging protocol that combines dynamic contrast-enhanced MRI (DCE-MRI) and apparent diffusion coefficient (ADC), measured by diffusion weighted MRI, in discriminating benign and malignant breast lesions presenting as mass and non mass like enhancement (NMLE). Methods and materials80 patients with 110 breast lesions identified with dynamic contrast MRI. Diffusion-weighted images were obtained at b values of 0 and 750S/mm2, differences in the apparent diffusion coefficients (ADCs) are included in the study and malignant lesions were compared by lesion type (mass or NMLE), and the analysis was performed to evaluate diagnostic performance based on ADC thresholds. All lesions have pathological results. The study has been done retrospectively 50 patients underwent surgical excision with preoperative localization, while the 30 cases underwent stereotactic biopsies either US or mammographically guided techniques specially if associated with micro calcifications. ResultsThe mean ADC value of all benign lesions is 1.41±0.36×10−3mm2/s, which is higher than the mean ADC of all malignant lesions (1.05±0.30×10−3mm2/s, p<0.05). In the MASS type, the mean ADC is higher in the benign group (1.34±0.30×10−3mm2/s) than in the malignant group (1.02±0.29×10−3mm2/s, p<0.01). In the NMLE type, the mean ADC is also higher in the benign group (1.54±0.45×10−3mm2/s) than in the malignant group (1.11±0.32×10−3mm2/s, p<0.01). Therefore, benign lesions have higher ADC values than malignant lesions, regardless of the lesion morphology. ConclusionDiffusion-weighted MRI shows adequate help in differentiation of benign and malignant masses and lesions with non-mass like enhancement found at breast MRI.

Radiopathological correlations: Masses, non-masslike enhancements and MRI-guided biopsy

MRI-guided biopsy is a recent interventional breast technique. Validating the procedure poses a new problem because the signal targeted is created by the injection of a paramagnetic contrast agent and is thus transitory. In the first instance, the procedure is validated by the radiologist, who checks that targeting is accurate and inserts a clip at the end of the procedure, and secondly by analysis of the histopathological results, which should be representative of the lesion. The pathologist needs to know the nature of the image, i.e. whether it is of mass or non-masslike enhancement, and its BI-RADS classification. The objective is that the image and the pathological result should concur. If the result is non-specific and benign, a follow-up MRI is required six months later.

Magnetic Resonance Imaging Factors Predicting Re-excision in Breast Cancer Patients Having Undergone Conserving Therapy

Purpose : The aim of this study was to determine the magnetic resonance imaging (MRI) features associated with re-excision due to the presence of a positive margin after breast conserving therapy (BCT) in breast cancer patients. Materials and Methods: We reviewed the records of 286 consecutive breast cancer patients who received BCT between January 2006 and December 2007. Among 246 patients who had undergone BCT, 38 (15.4%) underwent immediate further surgery due to positive margin status. We analyzed the MRI findings using χ 2 test, Fisher’s exact test and t tests. Multivariate logistic regression was conducted for prediction of re-excision. Results: Tumor size (p < 0.001), lesion multiplicity (p = 0.003), and non-mass-like enhancement (NMLE) type on MRI (p < 0.001) were associated with margin involvement in BCT. On preoperative MRI, larger size (≥ 5 cm) (odds ratio = 2.96), NMLE (odds ratio = 3.81), and multifocal lesions (odds ratio = 2.54) were positively associated with re-excision. In cases involving NMLE, segmental distribution was associated with a greater likelihood of immediate re-excision. Conclusion: Larger size, multiplicity, and NMLE on MRI are significantly associated with re-excision after BCT in breast

Abstract P2-02-13: The clinical significance of breast MRI in the management of ductal carcinoma in situ diagnosed on needle biopsy

Abstract Background: About 10-40% of ductal carcinoma in situ (DCIS) cases diagnosed on needle biopsy have invasive disease in the surgical specimens, which require surgical axillary staging. However, there is controversy regarding which subgroups should be indicated for sentinel lymph node biopsy (SLNB) because of the upstage on final diagnosis. Therefore, our aim is to identify the associated factors with invasive disease in DCIS diagnosed on needle biopsy by analyzing breast MRI findings with the histopathological factors of biopsy specimens. Methods: Seventy-five consecutive DCIS patients diagnosed on needle-biopsy in our institution who underwent preoperative MRI were retrospectively reviewed. The morphological features and kinetic curves were assessed using the ACR BI-RADS MRI lexicon. We measured the signal intensity (SI) of detected breast lesions and surrounding normal breast tissue on dynamic MRI and calculated the SI ratio as the SI of detected lesion divided by that of surrounding normal breast tissue. The MRI and histopathological variables were assessed between pure DCIS and invasive breast cancer (IBC) diagnosed on surgical specimens. Multivariable-analyses were performed to determine the independent factors for invasion using logistic-regression-model. Results: On dynamic MRI, 60 cases of 75 (80%) were classified as non-mass-like enhancement (NMLE) type and 15/75 (20%) were Mass type. In NMLE, 11/60 (18%) were ultimately diagnosed as IBC. Lesion size (P = 0.027), signal intensity (SI) ratios (calculated as the SI of detected lesions divided by the SI of surrounding normal breast tissue) (P = 0.032) on MRI and the number of biopsy-cores containing cancer nests (cancer-cores) (P = 0.012) were each independently associated with invasion. Table 1. Comparison of MRI findings and clinicopathological factors between pure DCIS and IBC groups in NMLE type.VariablesDCIS (n = 49)IDC (n = 11)P value (univariate)P value (multivariate)Age (years) 0.0480.067Median5544 Range34-7639-66 Lesion size on MRI (mm) 0.0180.027Median1634 Range5-606-59 Signal intensity ratio 0.0010.032Median1.352.01 Range1.04-2.891.56-2.55 The number of Cancer-cores 0.0050.012Median32 Range1-101-7 According to the ROC and statistical analyses performed for these independent factors, the area under the curve (AUC) was 0.72 for lesion size on MRI, 0.92 for the SI ratio and 0.80 for the number of cancer-cores (Table 2). Among these three factors, the SI ratio was the most accurately correlated with the presence of invasive disease. Table 2. The statistical results of the predictive factors in multivariate analysis for NMLE type.VariablesAUCCut-off valueSensitivitySpecificityPPVNPVLesion size on MRI (mm)0.723164%84%47%92%Signal intensity ratio0.921.7691%88%63%98%The number of Cancer-cores0.80282%80%47%95% In Mass type, there were no statistically significant differences between the DCIS and IBC cases. Conclusion: Our study demonstrated that needle biopsy-proven DCIS cases of NMLE type might be sufficiently managed using breast MRI features such as enhanced lesion size and signal intensity, incorporating the number of cancer-cores at needle biopsy specimen in the clinical setting. (Jpn J Clin Oncol. 2013 Epub ahead of print). Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-02-13.

Breast Sarcoma After Breast-Conserving Therapy for Breast Cancer in a Patient With Li-Fraumeni Syndrome Presenting as Focal Nonmasslike Enhancement on MRI

Breast Sarcoma After Breast-Conserving Therapy for Breast Cancer in a Patient With Li-Fraumeni Syndrome Presenting as Focal Nonmasslike Enhancement on MRISimon Sun1, Francine Tremblay1 and Benoît Mesurolle1Audio Available | Share

Invasive ductolobular carcinoma of the breast: spectrum of mammographic, ultrasound and magnetic resonance imaging findings correlated with proportion of the lobular component

PurposeThe aim of this study was to describe the imaging features of patients with invasive ductolobular carcinoma of the breast in comparison with the proportion of the lobular component.Materials and methodsWe retrospectively reviewed mammographic, sonographic and MRI records of 113 patients with proven ductolobular carcinoma diagnosed between January 2008 and October 2012 according to the BI-RADS ® lexicon, and correlated these to the proportion of the lobular component.ResultsAt mammography the most common finding (62.9%) for invasive ductolobular carcinoma was an irregular, spiculated and isodense mass. On ultrasound an irregular and hypoechoic mass, with spiculated margins and posterior acoustic shadowing was observed in 46.8% of cases. Isolated mass and mass associated with non-mass like enhancement (NMLE) were the most common findings by MRI (89.4%). Washout pattern in delayed phase was seen in 61.2% and plateau curve was more frequently observed in patients with larger lobular component. Additional malignant findings (multifocality, multicentricity and contralateral disease) did not correlate significantly with the proportion of the lobular component.ConclusionInvasive ductolobular carcinoma mainly presents as an irregular, spiculated mass, isodense on mammography and hypoechoic with posterior acoustic shadowing. On MRI it is usually seen as an isolated mass or as a dominant mass surrounded by smaller masses or NMLE. Washout is the most ordinary kinetic pattern of these tumors. In general, the imaging characteristics did not vary significantly with the proportion of the lobular component.

Breast Cancer Detected on an Incident (Second or Subsequent) Round of Screening MRI: MRI Features of False-Negative Cases

The purpose of this article is to evaluate the nature of breast cancers detected in the incident round of screening MRI to determine MRI features of early breast cancer. From 2003 to 2012, there were 16 incident breast cancers in 15 patients on screening MRI, including nine cancers that were retrospectively identifiable on the prior MRI (false-negative [FN] cancers at prior screening examination). We evaluated the BI-RADS features of these incident cancers in previous and current MRI scans. Of 16 incident cancers, there were 11 mass lesions (69%), three foci (19%), and two nonmasslike enhancement lesions (13%). Of the nine FN cancers (five foci, two masses, and two nonmasslike enhancement lesions), all showed increases in size on the current examination (median, 80% increase); four lesions showed rapid uptake kinetics on prior examinations, and five lesions showed a change in kinetic pattern from slow to rapid uptake. Among the five foci, one focus was isolated and four foci were in a background of other foci, where two foci could be distinguished for their higher signal intensity. On screening MRI, any lesion that increases in size, has rapid uptake kinetics or a change in kinetic pattern, or is an isolated focus or focus showing more enhancement than other foci should be viewed with a high degree of suspicion, and a biopsy should be considered.

Patterns of Nonmasslike Enhancement at Screening Breast MR Imaging of High-Risk Premenopausal Women

Current U.S. recommendations for breast cancer screening of women with at least a 20%-25% lifetime risk of developing breast cancer include contrast material-enhanced magnetic resonance (MR) imaging of the breasts. The cancer detection rate in high-risk women undergoing screening MR imaging is approximately 10 times higher than that in normal-risk women undergoing screening mammography. Many of these high-risk women commence MR imaging screening while they are premenopausal, when the breasts are most influenced by cyclical hormonal changes. Healthy premenopausal breast tissue enhances in a cyclical and variable manner. This enhancement is described as background enhancement. Typically, enhancement of normal breast tissue occurs in a symmetric and diffuse pattern, and there is little diagnostic difficulty in classifying it as normal background parenchymal enhancement. However, sometimes the pattern is more focal, asymmetric, or regional. It may then be described as nonmasslike enhancement, an observation associated with both benign and malignant breast pathologic conditions. A review of the morphologic features and internal enhancement patterns in normal but nondiffuse background enhancement and abnormal nonmasslike enhancement in high-risk premenopausal women can help improve interpretive specificity and decrease false-positive interpretations. MR imaging pitfalls and interpretation strategies for localized background enhancement and pathologic nonmasslike enhancement in this high-risk population are highlighted. In evaluating nonmasslike enhancement, the use of the Breast Imaging Reporting and Data System (BI-RADS) lexicon to perform careful analysis of morphologic features, along with an understanding of the role and limitations of kinetic information, will help balance early breast cancer detection against false-positive interpretation.

Breast MRI of pure ductal carcinoma in situ: Sensitivity of diagnosis and influence of lesion characteristics

ObjectivesThe purpose of the study was to evaluate the sensitivity of breast MRI in the detection of pure DCIS and to analyze the influence of lesion type and nuclear grade. Methods58 consecutive patients with pathologically proven pure DCIS and preoperatively performed breast MRI were retrospectively reviewed and analyzed. Sensitivities in the detection of DCIS were calculated for MRI and mammography (Mx). Influence of MRI lesion type and nuclear grading on DCIS diagnosis was evaluated. ResultsMRI detected pure DCIS with a sensitivity of 79.3%. The sensitivity of Mx was lower (69%), but the difference was not statistically significant (p=0.345). 46.2% of the DCIS presented as enhancing mass and 53.8% as non-mass-like enhancement (NMLE). None of the masses but 21.4% (n=6) of the NMLE were underestimated as probably benign (BI-RADS® 3). MRI measured lesion sizes showed a moderate correlation (r=0.74) with histopathologically measured lesion sizes. MRI detection rate of DCIS decreased significantly (p=0.0458) with increasing nuclear grade. Calculated sensitivities were 100% for low-grade DCIS, 84.6% for intermediate-grade DCIS, and 66.7% for high-grade DCIS. ConclusionsIn this study MRI could detect pure DCIS more sensitively than Mx. Despite of missing statistically significance preoperative MRI seems to be helpful in patients with DCIS who are eligible for breast conservation. This applies in particular to patients with non-high-grade DCIS because those were significantly more often positive on MRI and significantly more often negative on Mx. Misinterpretation occurs especially in cases of NMLE and high-grade DCIS and therefore a correlation with Mx is also recommended.

Is there different correlation with prognostic factors between “non-mass” and “mass” type invasive ductal breast cancers?

PurposeTo investigate the association between non-mass type breast cancer and common clinical–pathological prognostic factors, compared with mass type breast cancer. Materials and methodsAfter institutional review board approval, retrospective blind review of contrast-enhanced breast MRI was carried out for 88 histologically proven breast invasive ductal carcinoma (IDC) patients, presenting from January 2008 to December 2011. Two radiologists assessed the images of each lesion for the morphologic enhancement type [mass enhancement or non-mass-like enhancement (NMLE)] and the distribution/internal enhancement of NMLE. Two pathologists evaluated the histological grade of IDC, presence or absence of ductal carcinoma in situ (DCIS), lymph node status, presence or absence of vascular invasion, and expression status of estrogen receptor (ER)/progesterone receptor (PR)/HER-2/p53 tumor suppressor gene (p53)/Ki-67. Inter-observer agreement was assessed with kappa test. Chi-square test and Spearman rank correlation were performed to explore the associations of morphologic enhancement type with the age, lesion size and the above pathological prognostic factors ResultsInter-observer agreement was excellent, with kappa>0.75. Morphologic enhancement type was significantly correlated with age (P=0.02), with NMLE more commonly seen in women less than 50 y/o. The size of NMLE was larger than that of mass and, with the increase of lesion size, proportion of NMLE among the cases increased (P=0.001). NMLE was also significantly correlated with low histologic grade of IDC (P=0.003) and presence of DCIS (P<0.001). There was no significant correlation between morphologic enhancement type and lymph node status, vascular invasion, ER/PR/HER-2/p53/Ki-67 status. The histological grade was higher in clumped enhancement than non-clumped (P=0.011). There was no correlation between enhancement distribution and prognostic factors ConclusionsNon-mass type breast cancer may not necessarily have worse prognosis than the mass type, due to lower histological grade and closely related to DCIS component, although it may has larger tumor size. Clumped enhancement may have worse prognosis than non-clumped enhancement.