Breast-specific gamma imaging with 99mTc-Sestamibi and magnetic resonance imaging in the diagnosis of breast cancer--a comparative study

The purpose of this study was to compare the sensitivity and specificity of breast-specific gamma imaging (BSGI) using a high-resolution breast-specific gamma camera and magnetic resonance imaging (MRI) in patients with indeterminate breast findings. Twenty-three women with an indeterminate breast finding that required BSGI and MRI as deemed necessary by the interpreting radiologist or referring physician were included. MRI was performed on a GE 1.5T scanner and BSGI was performed on a Dilon high-resolution breast-specific gamma camera. All imaging findings were correlated with pathologic diagnosis. Thirty-three indeterminate lesions were evaluated in the study. There were a total of nine pathologically confirmed cancers. There was no statistically significant difference in sensitivity of cancer detection between BSGI and MRI. BSGI demonstrated a greater specificity than MRI, 71% and 25%, respectively. BSGI has equal sensitivity and greater specificity than MRI for the detection of breast cancer.     

Correlation of magnetic resonance imaging and pathologic size of infiltrating lobular carcinoma of the breast

BACKGROUND: Determining the extent of infiltrating lobular carcinoma (ILCA) in the breast is difficult. This study was designed to determine if the size of ILCA on magnetic resonance imaging (MRI) correlated with final pathology. METHODS: Retrospective study of patients between 1998 and 2004, who were evaluated for extent of ILCA prior to definitive treatment, was conducted. Demographic data and radiology and pathology results were obtained. Spearman correlation coefficient was used. RESULTS: Twenty-nine patients (median age 62 years) had MRI of breast. Fourteen patients (48%) had contralateral MRIs; 13 (45%) normal; 1 (8%) prompted core biopsy; 6 of 13 patients underwent contralateral mastectomies, which were benign. The distribution of tumor size was: T1 = 15 (52%); T2 = 7 (24%); T3 = 5 (17%); T4 = 2 (7%). Spearman correlation coefficient between tumor size on ultrasound and MRI with pathology was .19 (P = .5) and .88 (P < .001), respectively. CONCLUSION: MRI provided superior correlation between tumor size and pathology.     

The effect of magnetic resonance imaging in the workup of breast cancer

Background

Breast magnetic resonance imaging (MRI) is becoming an often-utilized examination in the preoperative planning for breast cancer. However, it is not yet accepted as a routine examination for all breast cancer patients due to the lack of data regarding whether breast MRI has any effect on recurrence or survival.

Methods

The charts of 76 patients referred by their surgeons for breast MRI during breast cancer workup were reviewed to determine if the breast MRI changed the preoperative clinical staging, the operative plan, or prompted additional testing.

Results

Thirty-eight of 76 patients (50%) received follow-up imaging and 22/76 (29%) received additional biopsies. The breast MRI upstaged the cancer in 14/76 patients (18%). There was a change in the surgical plan in 19 of 76 (25%) patients, all of whom received more extensive surgery than previously planned.

Conclusion

Breast MRI contributed significantly to the workup and management of breast cancer at our institution, suggesting a higher stage in 18% of the patients and changing the surgical plan in 25% of the patients.     

Increased ipsilateral whole breast vascularity as measured by contrast-enhanced magnetic resonance imaging in patients with breast cancer

BACKGROUND: Tumor-induced neovessel formation identified by gadolinium-enhanced magnetic resonance imaging (MRI) is a commonly used marker for breast malignancy. The purpose of this study was to assess possible differences in whole-breast vascularity as measured by contrast-enhanced MRI in the ipsilateral and contralateral breasts of patients with unilateral breast malignancies. METHODS: Gadolinium-enhanced MRI of the breast using a Siemens 1.0-T scanner with dedicated breast coil was performed on 22 consecutive patients with histologically confirmed unilateral breast carcinoma. Whole-breast vascularity of the breast containing the carcinoma was estimated as increased, decreased, or similar compared with the contralateral unaffected breast. Breast vascularity was then correlated to clinical factors including tumor size, histology, multifocality, nodal involvement, and patient age and menopausal status. RESULTS: Twenty patients had infiltrating carcinomas, and 2 patients had ductal carcinoma in situ. Four were multifocal. Fifteen of 22 patients demonstrated clear evidence of increased whole-breast vascularity in the ipsilateral breast containing the primary breast cancer compared with the contralateral breast. Although there was no clear correlation between the presence of increased whole-breast vascularity in the cancer-bearing breast with tumor size, histology, grade, mammographic appearance, or patient age and menopausal status, increased vascularity was present in 3 of 4 patients with multifocal disease and in 4 of 5 patients with metastatic disease in the axillary nodes. CONCLUSIONS: Measurable increases in whole-breast vascularity can be identified by contrast-enhanced MRI and appear with increased frequency in the cancer-bearing breast. These findings suggest that factors other than tumor size and histology may influence development of macroscopic vessels during tumor progression and may be indicative of angiogenic tumor biology.     

A comparison of the diagnostic accuracy of magnetic resonance imaging to axillary ultrasound in the detection of axillary nodal metastases in newly diagnosed breast cancer

Patients with a diagnosis of invasive breast cancer are increasingly undergoing breast magnetic resonance imaging (MRI) for preoperative staging including evaluation of axillary lymph node metastases (ALNM). This retrospective study aims to evaluate the utility of adding axillary ultrasound (AUS) in the preoperative setting when an MRI is planned or has already been performed. This IRB approved, HIPAA compliant study reviewed a total of 271 patients with a new diagnosis of invasive breast cancer at a single institution, between June 1, 2010 and June 30, 2013. The study included patients who received both AUS and MRI for preoperative staging. Data were divided into two cohorts, patients who underwent MRI prior to AUS and those who underwent AUS prior to MRI. AUS and MRI reports were categorized according to BI‐RADS criteria as “suspicious” or “not suspicious” for ALNM. In the setting of a negative MRI and subsequent positive AUS, only one out of 25 cases (4%) were positive for metastases after correlating with histologic pathology. MRI detected metastatic disease in four out of 27 (15%) patients who had false‐negative AUS performed prior to MRI. Our results indicate the addition of AUS after preoperative MRI does not contribute significantly to increased detection of missed disease. MRI could serve as the initial staging imaging method of the axilla in the setting that AUS is not initially performed and may be valuable in identification of lymph nodes not identified on AUS.     

Background parenchymal enhancement in breast magnetic resonance imaging: A review of current evidences and future trends

Background parenchymal enhancement (BPE) on breast magnetic resonance imaging (MRI) is a dynamic process, which varies among women and within the same woman over time due to different factors. BPE has profound implications for women with or at risk of breast cancer. Breast radiologist should be aware of factors that could potentially influence BPE and have to be familiar with its typical appearance. Marked BPE could indeed affect the diagnostic accuracy of breast MRI, but this shortcoming can be minimized through evaluation by dedicated radiologists, in order to correctly interpret and properly manage the additional findings. BPE shows promise as an imaging biomarker but many issues need to be addressed before it can be used either to determine screening strategy or the value of risk-reducing interventions. This review analyzes the clinical influence of BPE on breast MRI interpretation, breast cancer staging and surgical outcome and discusses current available evidences about BPE as an imaging biomarker.     

Technique for a hybrid system of real‐time transrectal ultrasound with preoperative magnetic resonance imaging in the guidance of targeted prostate biopsy

Diagnostic magnetic resonance imaging (MRI) for prostate has achieved increasingly higher levels of accuracy. Because real‐time MR‐guided targeted biopsy is still a complicated and expensive procedure, there is considerable interest in a technique of MR/transrectal ultrasound (TRUS) hybridized image‐guided biopsy. However, because the 3‐D shapes of the prostate at the time of image‐acquisition at preoperative MRI are likely to be different from the intra‐operative TRUS images, the precise registration of each 3‐D volume data is critical. To reduce the potential errors in registration of TRUS with MRI, we introduce new procedural techniques in a rigid image fusion technique. First, preoperative MR images were obtained with a specifically‐made plastic outer‐frame, with exactly the same shape as the real TRUS probe, placed in the rectum, in order to simulate the deformation of the prostate caused by the absence or presence of a TRUS probe during the acquisition of MR or TRUS images. Second, instead of using a single plane of longitudinal image, we applied biplane TRUS images to be shown in parallel on a multiplanar display with corresponding reconstructed MRI, in order to register both horizontal and longitudinal images of the prostate simultaneously, thereby achieving improved 3‐D anatomical matching.     

Routine screening for local recurrence following breast-conserving therapy for cancer with dynamic contrast-enhanced magnetic resonance imaging of the breast

Background: Dynamic contrast-enhanced magnetic resonance imaging (MRI) of the breast is highly sensitive for the diagnosis of primary breast malignancy. We investigated the clinical application of dedicated dynamic breast MR for routine screening for local recurrence following breast-conserving therapy. Methods: Patients underwent a single dynamic MR of the breast routinely in the period 1 to 2 years following treatment, or earlier if recurrence was suspected. A biopsy was performed if there was suspicion of recurrence on MR. Results: One hundred and five patients with a median age of 58 years (range 50 to 65 years) were recruited for the study. Sixteen biopsies were performed and nine recurrences were confirmed histologically. Patients not undergoing biopsy have been followed up for a median of 341 days (range 168 to 451 days) following the MR. The sensitivity for clinical examination, mammography, examination combined with mammography, and MRI alone for the detection of recurrent cancer were 89%, 67%, 100%, and 100%, respectively, and the specificity was 76%, 85%, 67%, and 93%. Conclusion: Combined clinical examination and mammography are as sensitive as dedicated dynamic MR of the breast for the detection of locoregional recurrence, but breast MRI is associated with a far greater specificity. Therefore, dedicated dynamic breast MRI should be used when there is clinical or mammographic suspicion of recurrence to confirm or refute its presence.Presented at the 50th Annual Cancer Symposium of The Society of Surgical Oncology, Chicago, Illinois, March 20–23, 1997.     

Comparison of breast magnetic resonance imaging clinical tumor size with pathologic tumor size in patients status post-neoadjuvant chemotherapy

Background

Neoadjuvant chemotherapy (NACT) is used in breast cancer to evaluate the response to treatment. We examined the usefulness of breast magnetic resonance imaging (MRI) in the evaluation of tumor response after NACT.

Methods

Breast MRIs of 87 women with MRI after NACT were reviewed. The Spearman coefficient was used for estimating the correlation between MRI and pathologic tumor sizes (ypTs).

Results

The median age was 50 years (range 25 to 83 years). The median MRI size was 1.25 cm (range 0 to 10 cm). The median ypT was 1.20 cm (range 0 to 10.4 cm). The Spearman coefficient between MRI and ypT was .78 (95% confidence interval, .67 to .85; P < .0001). MRI was found to have a positive predictive value of 92% and a negative predictive value of 64% for residual in-breast disease. The sensitivity and specificity of MRI were 86% and 77%, respectively.

Conclusions

MRI correlates well with the final pathology and can be a useful modality to predict residual disease after NACT and aid in surgical planning.     

Effect of 0.5 Tesla magnetic resonance imaging on the surgical management of breast cancer patients

BACKGROUND: This trial examines the utility of breast magnetic resonance imaging (MRI) for detection of occult breast disease and its effect on surgical treatment. METHODS: Between October 2000 and March 2002, 76 of 1289 patients underwent bilateral breast MRI within 4 months of a mammogram. The MRI scan, mammogram, pathology reports, and physicians' notes were reviewed to determine impact of MRI on surgical treatment. RESULTS: Magnetic resonance imaging detected 23 additional lesions in 19 patients not detected by mammogram. Cancer occult to mammography was detected by MRI in 6 women, constituting 7.9%. Magnetic resonance imaging impacted surgical treatment plans in 10 of 76 (13.2%) patients. CONCLUSIONS: Magnetic resonance imaging is effective at identifying new subclinical breast disease not seen on mammography. Ten of 76 patients (13.2%) who underwent MRI had their surgical management altered due to MRI findings. Specific criteria should be studied to know which subgroups would benefit most from breast MRI.     

fMRI(磁共振功能成像)对乳腺癌新辅助化疗评估的研究进展

【摘要】〓能够早期评估乳腺癌新辅助化疗疗效的方法很大程度上有助于病人治疗方案的制定,所以对于找寻精准且无创的方法的需求则日益上升。目前,MRI技术能够根据肿瘤大小、形态及强化程度等形态学变化对疗效进行评估,而且已有越来越多新兴技术能够从微观分子层面早期反映新辅助化疗后肿瘤变化,这些技术包括动态对比增强(DCE-MRI)、磁共振波谱(MRS)、磁共振弥散加权成像(DWI)、体素内不相干运动(IVIM)。作者综述MRI新技术在评估乳腺癌新辅助化疗疗效中的应用。     

Correlation of endorectal coil magnetic resonance imaging of the prostate with pathologic stage

The aim was to evaluate the pretreatment efficacy of endorectal coil (ERC) MRI in accurately predicting extracapsular extension in a group of intermediate risk patients. A total of 40 intermediate risk patients were identified who underwent pretreatment ERC MRI and subsequent radical prostatectomy (RP). Imaging studies and pathologic analysis were compared with respect to presence of extracapsular extension (ECE), involvement of seminal vesicles, and appearance of regional nodes. Mean age was 62 years, PSA 14.8, and most common stage was cT2a/pT2c and Gleason 6. ERC MRI has a positive predictive value of 81%, specificity 89%, and odds ratio 6.47 in determining extracapsular extension. Conversely, its sensitivity is only 43%, with a negative predictive value of 59%. ERC MRI may be useful as an adjunctive study for intermediate risk patients due to its high specificity and positive predictive value, thereby adding information to the clinical decision-making process.     

Breast magnetic resonance imaging for preoperative locoregional staging

BACKGROUND: Breast magnetic resonance imaging (MRI) has been recommended increasingly in the preoperative setting for patients newly diagnosed with malignancy to evaluate tumor extent, multicentricity, and contralateral disease. METHODS: Results of conventional imaging, breast MRI, and pathology were analyzed from 603 consecutive breast cancer patients who underwent MRI preoperatively. The focus of this retrospective study was imaging-histologic correlation. RESULTS: Reoperation for positive margins after lumpectomy occurred in 8.8% of patients. Multicentricity was identified by MRI alone in 7.7% of patients, whereas 3.7% were found to have contralateral cancer by MRI. The sensitivity of MRI was 93% in detecting multicentric disease and 88% for contralateral disease, whereas sensitivity for conventional imaging was 46% and 19%, respectively. Unsuspected disease was identified by MRI equally for invasive ductal and ductal carcinoma in situ histology, whereas multicentricity was found more frequently with invasive lobular carcinoma. CONCLUSIONS: Breast MRI is recommended for preoperative evaluation of the newly diagnosed breast cancer patient.     

Influence of preoperative magnetic resonance imaging on the surgical management of breast cancer patients

Background

Magnetic resonance imaging (MRI) is gaining popularity in the preoperative management of breast cancer patients. However, the role of this modality remains controversial. We aimed to study the impact of preoperative MRI (pMRI) on the surgical management of breast cancer patients.

Methods

This retrospective study included 766 subjects with breast cancer treated operatively at the specialized academic center.

Results

Between those who underwent pMRI (MRI group, n = 307) and those who did not (no-MRI group, n = 458), there were no significant differences (P = .254) in the proportions of either total mastectomies (20.5% vs 17.2%, respectively) or segmental mastectomies (79.5% vs 82.8%). Patients in the MRI group were significantly more likely (P = .002) to undergo contralateral surgery (11.7% vs 5.5%). Similar results were obtained in multivariate analysis adjusting for age, with the proportions of contralateral breast operations significantly higher in the MRI group (Odds Ratio = 2.25, P = .007). pMRI had no significant effect (P = .54) on the proportion of total re-excisions (7.5% vs 8.7%) or the type of re-excision (total vs segmental mastectomy) between the groups.

Conclusions

pMRI does not have a significant impact on the type of operative intervention on the ipsilateral breast but is associated with an increase in contralateral operations. Similarly, pMRI does not change the proportion of re-excisions or the type of the re-excision performed. This study demonstrates that pMRI has little impact on the surgical management of breast cancer, and its value as a routine adjunct in the preoperative work-up of recently diagnosed breast cancer patients needs to be re-examined.     

磁共振成像在乳腺癌保乳手术中的应用价值

目的 探讨磁共振成像在乳腺癌保乳手术中的应用价值.方法 对2004年5月至2007年12月通过常规影像学检查符合保乳手术指征的52例乳腺癌患者术前进行乳腺磁共振检查,以检出多中心性乳腺癌病例,同时在增强扫描联合脂肪抑制成像中对肿瘤大小以及周围浸润范围进行准确测定,以确定手术切除的最小范围.结果 根据52例乳腺癌患者的磁共振诊断,多中心性乳腺癌3例,单发乳腺癌49例,并且发现单发乳腺癌中有3例存在较广泛的乳管内浸润.本组行保乳手术47例,首次切缘阴性率为93.6%(44/47).结论 磁共振成像对多中心性乳腺癌的检出及乳腺癌乳管内浸润的判断具有明显优势,对于明确乳腺癌保乳适应证以及准确把握保乳手术的切除范围具有较高的临床应用价值.     

The utility of magnetic resonance imaging in early‐stage breast cancer survivors—An institutional experience and literature review

The role of breast magnetic resonance imaging (MRI) in the screening of breast cancer survivors with remaining breast tissue is not well studied. We sought to evaluate the outcomes of screening breast MRI in a cohort of breast cancer survivors. A population of patients with history of stage I‐IIIa breast cancer and ≥1 MRI a year or later from diagnosis between 2006‐2008 were identified using the National Comprehensive Cancer Network data base from two large Boston‐area cancer centers. Patient and disease characteristics were obtained from the data base, and medical records were reviewed to identify the index MRI (first eligible), indications, and two‐year outcomes. Overall, 647 patients had breast MRI scans during the study period including 342 eligible patients whose index MRIs were done for breast screening purposes. 47/342 (13.7%) were abnormal, and 3.8% (13/342) underwent biopsy, resulting in the detection of 3 cases of locoregional recurrence or new primary breast cancer (0.9%, 95% CI = 0.2%‐2.5%). Of 295 patients with a normal index screening MRI, 12 had a breast cancer recurrence diagnosed within 2 years (4.1% 95%CI = 2.1%‐7.0%), and 5 of these recurrences were limited to MRI‐screened breast tissue. No statistically significant difference in the rate of 2‐year locoregional or distant recurrence was observed between patients with an abnormal screening MRI and those with a normal scan. Adjunct single breast MRI surveillance in a general population of breast cancer survivors one year after diagnosis detected few recurrences, and its effect on short‐term outcomes was unclear.     

Correlation between imaging and molecular classification of breast cancers

The histological type of tumour according to the WHO: ductal, lobular, rare forms, is correlated with specific aspects of the imaging based on each type. This morphological classification was improved by knowledge of the molecular anomalies of breast cancers, resulting in the definition of cancer sub-groups with distinct prognoses and different responses to treatment: luminal A, luminal B, HER2 positive, basal-like, triple-negative. Studies are beginning to deal with the appearance of each sub-type in the imaging. It is now important for the radiologist to be familiar with them.