False-positive helical CT findings of multifocal and multicentric breast cancer: is attenuation of tumor useful for diagnosing enhanced lesions?

OBJECTIVE: To analyze helical CT false-positive multifocal breast cancers and to assess the relevance of the attenuation of tumors for diagnosing enhanced lesions. METHODS: Helical CT studies of 156 invasive breast cancers before breast conserving surgery were examined. A lesion was defined as positive if focal enhancement was detected by CT within 100 seconds after contrast material administration. The attenuation and enhancement percent ratio [(post-contrast value/pre-contrast value)%] were obtained. Attenuation of false-positive and malignant lesions was compared. RESULTS: Helical CT enabled the detection of all 156 invasive tumors with 95 intraductal tumor extensions. The sensitivity and specificity of multifocal/multicentric disease detection by helical CT were 69% and 90%, respectively. False-positive multifocal/multicentric findings were obtained in 11 (7%) of 156 cases. The mean value of the enhancement percent ratio of the index tumors was 237%. Significant differences in the attenuation on post-contrast enhanced scans between the enhanced lesions (index tumors; mean, 82 HU), the true-positive multifocal/multicentric lesions (mean, 73 HU), the false-positive multifocal/multicentric lesions (mean, 87 HU) and normal breast tissue (mean, 32 HU) were found (p<0.0001). The attenuation of the true-positive multifocal/multicentric lesions on post-contrast enhanced scans was significantly less than that of the false-positive multifocal/multicentric lesions (p=0.03). CONCLUSION: Attenuation of tumor is not useful for differential diagnosis of enhanced lesions on helical CT of the breast. The presence of enhancement alone does not always indicate a malignant lesion.     

Metastatic breast cancer from gastric and ovarian cancer,mimicking inflammatory breast cancer: report of two cases

Breast metastases from extra-mammary malignancies, especially those mimicking primary inflammatory breast carcinoma, are extremely rare. We report here two cases of inflammatory breast metastases from gastric or ovarian cancer. Both patients, who had prior advanced malignant disease, presented with unilateral breast redness and swelling with peau d’orange sign, resembling primary inflammatory breast cancer or acute mastitis. Breast biopsy revealed poorly differentiated adenocarcinoma with signet-ring cells or clear cell carcinoma in the lymphatic vessels and the parenchyma without an in situ lesion, similar to primary lesions of the stomach or ovary, respectively. Immunohistochemical staining for estrogen receptor, progesterone receptor, and gross cystic disease fluid protein 15 was of value for correct diagnosis. Since breast metastasis is a sign of poor prognosis of the primary malignant disease, the possibility of breast metastasis should be considered in appropriate patients to preclude unnecessary major surgery.     

Ultrasound characteristics of histologically proven grade 3 invasive ductal breast carcinoma

High‐grade invasive ductal carcinoma (IDC) may paradoxically display features similar to benign breast masses. This study analysed the ultrasound features of histologically proven cases of grade 3 IDC. At North Western BreastScreen Victoria, from 4 February 1993 to 30 September 2002, 181 cases of grade 3 IDC that had ultrasound evaluation were available for retrospective analysis. For each tumour, four features were assessed: margin, attenuation characteristics, echotexture and depth versus width ratio. Eighty‐seven per cent of tumours had an aggressive margin with an echogenic rind, microlobulation or angular margins. However, 11% had a well‐defined smooth margin. The classic sonographic malignant feature of posterior shadowing was present in only 30%, whereas the tissues posterior to the lesion remained isoechoic in 48% and showed posterior enhancement in 11%. Six per cent of the tumours were isoechoic and difficult to appreciate on ultrasound. The best feature to characterize lesions as malignant was the margin of the lesion. To ensure that malignant lesions are correctly categorized, it is important that interfaces between the tumour and adjacent breast parenchyma are meticulously evaluated in a real‐time fashion rather than viewed as a single still image.     

乳腺癌的影像学表现与诊断

目的：探讨影像学对乳腺癌的诊断价值。方法：搜集经钼靶X线，CT，超声，MRI等影像学检查、手术或穿刺病理证实的乳腺癌56例进行回顾性分析。结果：56例乳腺癌中，单发病灶40例，多发病灶16例。X线和CT多表现为不规则肿块（34／46例），伴有毛刺32例，与导管形态一致的密集钙化30例。CT对肿块或结节的边缘毛刺，尖角状或触须状突起及邻近皮肤局限增厚或凹陷，脂肪间隙与胸肌受侵，腋窝淋巴结肿大等恶性征象的显示比钼靶更清晰，彩超能初步筛查有无乳腺包块存在，并能根据乳腺肿块的形态特点、内部回声及血流情况判断乳腺肿快的性质，磁共振不但可以显示肿瘤的部位大小和边缘及腋窝淋巴结肿大，皮肤和胸壁侵犯。还可显示肿瘤内部的坏死（52／56例）和多中心病灶（16／56例）。结论：MRI动态增强扫描对乳腺癌的判定有重要意义；多种影像结合及影像与临床结合对乳腺癌的诊断有较大帮助。     

肾占位性病变的CT定性诊断

目的分析肾占位性病变的CT表现,探讨CT对该类疾病的定性诊断价值。方法对手术/病例证实的28例肾占位性病变进行回顾性分析,所有病例均行平扫和增强扫描。结果肾恶性肿瘤21例(75%),其中肾癌(RCC)16例,CT表现为肾实质内形态不规则的低密度软组织肿块,增强后不强化或轻度强化;肾盂癌2例,CT表现为肾盂内软组织肿块影,增强后不强化或轻度强化。肾母细胞瘤(Wilms瘤)3例,CT表现为较大不规则的分叶肿块,增强后不强化;肾良性肿瘤3例(11%),均为肾血管平滑肌脂肪瘤(ALL),两例CT表现为多种不同成分的混杂密度肿块,一例表现为均匀等密度肿块,增强后软组织部分强化,而脂肪成分不强化。其它4例(14%),3例肾囊肿,CT表现为典型的边界清楚的囊性病灶,增强后未见强化;1例肾脓肿,CT表现为实质性与囊性混杂密度的肿块,增强后实质性部分有轻度强化,囊性部分不强化。结论CT平扫及增强扫描,以及诊断过程中密切结合病史,对肾占位性病变有重要的鉴别诊断价值。     

肾占位性病变的CT定性诊断(英文)

目的分析肾占位性病变的 CT 表现,探讨 CT 对该类疾病的定性诊断价值。方法对手术/病例证实的28例肾占位性病变进行回顾性分析,所有病例均行平扫和增强扫描。结果肾恶性肿瘤21例(75%),其中肾癌(RCC)16例,CT 表现为肾实质内形态不规则的低密度软组织肿块,增强后不强化或轻度强化;肾盂癌2例,CT 表现为肾盂内软组织肿块影,增强后不强化或轻度强化。肾母细胞瘤(Wilms 瘤)3例,CT 表现为较大不规则的分叶肿块,增强后不强化;肾良性肿瘤3例(11%),均为肾血管平滑肌脂肪瘤(ALL),两例 CT 表现为多种不同成分的混杂密度肿块,一例表现为均匀等密度肿块,增强后软组织部分强化,而脂肪成分不强化。其它4例(14%),3例肾囊肿,CT 表现为典型的边界清楚的囊性病灶,增强后未见强化;1例肾脓肿,CT 表现为实质性与囊性混杂密度的肿块,增强后实质性部分有轻度强化,囊性部分不强化。结论 CT 平扫及增强扫描,以及诊断过程中密切结合病史,对肾占位性病变有重要的鉴别诊断价值。     

MRI features of space-occupying lesions in the breast

Our study evaluates the correlation between benign and malignant breast masses contrast enhancement, on the one hand, and the type of the vascular net and histological prognosis, on the other. We reviewed the preoperative images of 298 breast masses (benign--95 (32%), malignant--203 (68%)) after dynamic contrast enhancement as well as on the basis of pathomorphological data. Due to use of high-concentration paramagnetic contrast agents in ultra-fast sequences, benign and malignant tumors could be differentiated. The quantitative data on both intensive contrast and ring-shaped enhancement corresponded to the low capillary density in the center of carcinoma which correlated with poor prognosis.     

Radiofrequency ablation of invasive breast carcinoma followed by delayed surgical excision

BACKGROUND: Radiofrequency ablation (RFA) is gaining acceptance as a treatment modality for several tumor types. However, its use in patients with breast carcinoma remains investigational. The current study was undertaken to determine the feasibility of treating small breast malignancies with RFA and to evaluate the postablation magnetic resonance imaging scans (MRI) and histologic findings. METHODS: Patients with core-needle biopsy-proven invasive carcinoma (< 2 cm in greatest dimension) underwent ultrasound-guided RFA under local anesthesia. Surgical excision was undertaken 1-3 weeks later. All patients had breast MRI scans performed before ablation and repeated within 24 hours of surgery. RESULTS: Ten patients completed the treatment and experienced minimal or no discomfort. The mean tumor size was 1.2 cm (range, 0.8-1.6 cm). The mean time required for ablation was 13.8 minutes (range, 7-21 minutes). There were no treatment-related complications other than minimal breast ecchymosis. A pre-RFA MRI scan showed enhancing tumors in 9 of 10 (90%) patients. A post-RFA MRI scan revealed no residual lesion enhancement in 8 of these 9 patients (89%), and the zone of ablation was demonstrated in all patients. One patient had residual enhancement anteriorly consistent with residual tumor, which was confirmed histologically. Evaluation of the remaining ablated lesions revealed a spectrum of changes ranging from no residual tumor to coagulation necrosis with recognizable malignant cells. Immunostains for cytokeratin 8/18 were negative in these recognizable malignant cells. CONCLUSIONS: RFA of small breast malignancies can be performed under local anesthesia in an office-based setting. A postablation MRI scan appears to predict histologic findings, although tumor viability needs to be assessed in a long-term study.     

Obesity obscuring breast cancer: a case report.

There is normally a layer of fat in the breast between the parenchyma of the breast and the skin. This is frequently thin and does not preclude the palpation of a tumor mass which involves the breast parenchyma. In patients suffering from obesity this fat pad becomes much thicker and obscures any underlying masses arising from the breast parenchyma. A case is reported in which a woman who was markedly obese lost a significant amount of weight and presented a bulge which was found to be carcinoma. This situation, in which fat obscures underlying breast lesion, has been observed in a number of patients. Attention is called to the limited value of physical examination of the breast in markedly obese patients. If any suspicion exists or if the patient is a candidate for cancer from a familial standpoint, mammograms are indicated.     

Assessment of false-negative cases of breast MR imaging in women with a familial or genetic predisposition

In order to assess the characteristics of malignant breast lesions those were not detected during screening by MR imaging. In the Dutch MRI screening study (MRISC), a non-randomized prospective multicenter study, women with high familial risk or a genetic predisposition for breast cancer were screened once a year by mammography and MRI and every 6 months with a clinical breast examination (CBE). The false-negative MR examinations were subject of this study and were retrospectively reviewed by two experienced radiologists. From November 1999 until March 2006, 2,157 women were eligible for study analyses. Ninety-seven malignant breast tumors were detected, including 19 DCIS (20%). In 22 patients with a malignant lesion, the MRI was assessed as BI-RADS 1 or 2. One patient was excluded because the examinations were not available for review. Forty-three percent (9/21) of the false-negative MR cases concerned pure ductal carcinoma in situ (DCIS) or DCIS with invasive foci, in eight of them no enhancement was seen at the review. In six patients the features of malignancy were missed or misinterpreted. Small lesion size (n = 3), extensive diffuse contrast enhancement of the breast parenchyma (n = 2), and a technically inadequate examination (n = 1) were other causes of the missed diagnosis. A major part of the false-negative MR diagnoses concerned non-enhancing DCIS, underlining the necessity of screening not only with MRI but also with mammography. Improvement of MRI scanning protocols may increase the detection rate of DCIS. The missed and misinterpreted cases are reflecting the learning curve of a multicenter study.     

Comparison of technetium-99m methoxyisobutylisonitrile scintimammography and ultrasonography in the diagnosis of breast cancer in patients with mammographically dense breast

The main purpose of this study was to compare the utility of technetium-99m methoxyisobutylisonitrile (Tc-99m sestamibi) scintimammography with that of ultrasonography for diagnosis of breast cancer in 32 female patients with indeterminate mammographic probability of malignancy because of mammographically dense breast. All breast masses were removed and histopathological diagnosis was obtained in all cases. The results showed 20 of 24 cases of breast carcinoma detected on Tc-99m sestamibi scintimammography. Only one out of eight patients with benign breast lesion had abnormal scintimammographic finding. Ultrasonography diagnosed 22 of the 24 cases of breast carcinoma. However, five out of eight patients with benign breast lesion had positive ultrasonographic findings. In differentiating malignant and benign breast tumors in mammographically dense breast, the diagnostic sensitivities were 83 and 92%, specificities were 88 and 38%, and accuracies were 84 and 78% for Tc-99m sestamibi scintimammography and ultrasonography, respectively. Ultrasonography showed a nonsignificantly higher sensitivity (p < 0.05), but lower specificity, with more false-positive diagnoses made on ultrasonography. Due to its higher sensitivity, ultrasonography is more suitable for screening breast masses. However, Tc-99m sestamibi scintimammography exhibited significantly higher specificity (p < 0.05) and accuracy in detecting malignant breast tumors in the current study. We conclude that Tc-99m sestamibi scintimammography is a safe and useful diagnostic method for detection of breast cancer in patients with nondiagnostic mammogram because of mammographically dense breast.     

Primary Neuroendocrine Carcinoma of the Breast with Clinical Features of Inflammatory Breast Carcinoma: A Case Report and Literature Review

Primary neuroendocrine carcinoma of the breast (NECB) is a very rare type of invasive breast carcinoma. Most NECBs appear on breast imaging as solid masses of varied shapes and margins, and have worse clinical outcomes than does invasive ductal carcinoma, not otherwise specified. However, there have been no reports to date regarding NECB with features of inflammatory breast carcinoma. Here, we describe the clinical, radiol-ogic, and pathologic findings of the first reported case of primary NECB presenting as inflammatory breast carcinoma. The patient complained of diffuse right breast enlargement and erythema. Mammography identified severe breast edema and axillary lymphadenopathy. Ultrasound detected an irregular, angular, hypoechoic mass with dermal lymphatic dilatation. On magnetic resonance imaging, the mass had rim enhancement and the entire right breast showed heterogeneous enhancement with malignant kinetic features. Pathology identified the mass as a primary NECB with positive for synaptophysin, CD56, estrogen and progesterone receptors.     

Magnetic resonance imaging of induration in the irradiated breast.

BACKGROUND: The causes of induration (hardness) in the breast many years after tumour excision and whole breast radiotherapy for early stage breast cancer are not well established. The purpose of this study is to describe morphological magnetic resonance imaging (MRI) appearances and MRI-derived microvascular functional characteristics of the indurated breast several years post-treatment. PATIENTS AND METHODS: Fifteen women with moderate or marked induration at the electron boost site after breast preserving surgery and radiotherapy for early breast cancer (median 6 years; range, 2-15 years) underwent MRI, including 6/15 with very marked breast shrinkage and 8/15 with marked induration. Morphological T1- and T2-weighted and STIR images were obtained followed by a dynamic contrast medium enhanced sequence. The breast skin and underlying parenchyma of the irradiated breast were evaluated for thickening, oedema and the presence of enhancement compared to the contralateral breast. Particular note of boost site findings was made. RESULTS: No evidence of tumour recurrence was seen. Fat necrosis was seen in 2/15 cases. Skin thickening and skin oedema not evident clinically were seen in 11/15 patients. Increased parenchymal oedema at the electron boost site was seen in 12/15 patients. The parenchymal oedema was not confined to the electron boost site, but was strongest in this location in 9/12 patients. Post-contrast images in 12/14 patients showed persistent parenchymal enhancement in nine (marked in three, who also had severe breast shrinkage and marked induration), a finding consistent with, but not diagnostic of tissue fibrosis. CONCLUSIONS: Fat necrosis is not likely to contribute to breast induration several years after radiotherapy in more than a minority of patients. Increased fluid content in the breast parenchyma and skin oedema are likely to be more important contributors to palpable induration. Increased fluid content may be related to persistent capillary leakage even many years post-treatment, an expression of radiation-induced vascular injury. Fibrosis cannot be scored directly on MRI, but persistent parenchymal enhancement in a high proportion of post-contrast images is compatible with this pathology.     

超声造影在肝脏良恶性占位病变诊断中的应用价值

目的：探讨实时超声造影对腹部良恶性占位病变的诊断价值。方法：对207例肝脏占位性病变进行实时超声造影研究,所有病例均经手术或其它影像学检查方法证实。结果：92例肝细胞性肝癌中71例表现为典型“快进快退”,8例表现为“快进慢退”,9例表现为“慢进快退”,4例表现为“慢进慢出”;29例转移性肝癌病灶分为少血供转移癌组13例,表现为动脉相呈环形高增强,门脉相及延迟相呈低增强;多血管转移癌组16例表现为动脉相呈完全高增强,门脉相及延迟相呈低增强。37例肝血管瘤中25个动脉相表现为向心性环形结节状高增强;局造性结节增生表现为中央扩散型快速整体增强,部分病例显示为轮辐状高增强;肝硬化增生结节的造影增强特征与肝实质一致。结论：实时超声造影能显示肿瘤内微小血管的血流灌注情况,对肝脏良恶性占位病变的定性诊断具有重要的参考价值。     

肝恶性肿瘤的实时超声造影研究

目的　探讨实时灰阶超声造影在肝恶性肿瘤诊断中的价值。方法　对9例原发性肝癌,5例转移性肝癌病例进行实时灰阶超声造影检查,观察病灶内及肝实质的造影剂动态灌注过程。结果　超声造影后,原发性肝癌表现为动脉相快速增强,随后快速消退;转移性肝癌动脉相表现多样,实质相呈明显的低回声“缺损”区,并且于实质相发现了更多病灶。结论　实时灰阶超声造影对于提高肝恶性肿瘤的定性诊断及检出有较大帮助。     

钆贝酸葡甲胺与钆喷替酸葡甲胺在肝脏MRI增强扫描中的应用与评价

目的对钆贝酸葡甲胺（Gd—BOPTA）与钆喷替酸葡甲胺（Gd—DTPA）在肝脏MRI增强扫描中的安全性、耐受性及诊断性疗效进行临床研究与评价。方法经超声或CT检查怀疑为肝脏原发肿瘤或转移瘤而要求行MR检查的患者共42例。先进行MR平扫,然后随机经静脉注射Gd—BOPTA或Gd—DTPA中任1种试验药物,剂量0．1mmol／kg。在开始注射对比剂后15～45s、1～2min、2～3min、4～5min和8min时,进行早期动态增强T1FFE扫描;给药后40～120min,进行T1FFE和T1SE延迟扫描。将每一病例的全部影像资料分为3组：给药前与给药后早期成像组、给药前与给药后延迟成像组、给药前与给药后早期＋延迟成像组;并对每组资料从4个方面进行配对判读：（1）肝脏病变信号的增强程度;（2）检出或排除肝脏病变的准确性;（3）对病变内部形态的评估;（4）显示病变特点的可信度。将判读结果分别进行组内及组间比较,最后进行放射学应用价值评估。结果在Gd—DTPA组内,给药后早期成像组的增强效果明显优于给药前与给药后延迟成像组,差异有统计学意义（P〈0．01）。给药前与给药后延迟成像组内,Gd-BOPTA组优于Gd．DTPA组,两组间差异有统计学意义（P〈0．05）。Gd—BOPTA组与Gd—DTPA组分别有72．7％和70．0％的病例在用药后图像质量得到显著改善,两组间差异无统计学意义。结论Gd-DTPA给药后早期的增强效果明显优于延迟期;Gd—BOPTA给药后早期的增强效果与Gd—DTPA相仿,而延迟期明显优于Gd-DTPA。     

Synchronous bilateral medullary carcinoma of breast: is it metastasis or second primary?

Bilateral breast cancer is a rare event accounting for 2-5% of all breast malignancies. A second tumor in contralateral breast may be either synchronous or metachronous lesion. Synchronous bilateral invasive ductal carcinoma is known but medullary carcinoma is rare. The etiology of bilateral breast cancer is uncertain and prognosis in these cases once thought to be poor but recent data suggest a similar survival compared to unilateral disease. We report a case of triple negative synchronous bilateral medullary carcinoma in a 38-year-old female who presented with lump in both the breasts for three months. Multidetector computed tomography breast scan revealed bilateral heterogeneously enhancing well-defined lesion in both the breasts. Fine needle aspiration cytology from both the breast lump was suggestive of malignancy. Patient underwent bilateral modified radical mastectomy with axillary clearance in a single sitting. Histopathology showed synchronous bilateral medullary carcinoma of breast with ER, PR and HER- 2/ neu negativity. Patient was treated with chemoradiation and she is on regular follow up for one year without any recurrence or metastasis.     

在体和离体胰头癌的磁共振成像表现与病理对照

目的 分析在体和离体胰头癌磁共振成像(MRI)的信号特征,研究其与大体标本及组织病理特征的相关性.方法 16例胰头癌患者行MRI检查(包括2D FLASH T1WI平扫、动态增强和抑脂TSE T2WI序列扫描),行Whipple手术切除肿瘤.新鲜手术标本再行MRI检查,扫描结束后,即将肿瘤标本按MRI检查方向完整切开,制成连续切片,分析MRI表现与大体切片和组织病理的对应关系.结果 肿瘤大小1.5 cm×2.0 cm～4.8 cm×4.2 cm,平均3.6 cm×3.1 cm.在体MRI检查:T1WI序列上,14例肿瘤呈低信号,2例呈等信号;抑脂TSE T2WI序列上,3例肿瘤呈等信号,13例肿瘤呈混杂信号;胰腺实质期增强扫描,15例强化不明显呈低信号,其中11例肿瘤周围呈环形强化;肝脏期增强扫描,9例呈不规则中等强化;增强延迟期,4例延迟强化呈等或略高信号.离体MRI检查: T1WI序列上,16例肿瘤均为低信号;在抑脂TSE T2WI序列中,均为混杂信号.MRI表现和病理的相关性:各类肿瘤成分在T1WI序列上均可为低信号,等信号区以肿瘤组织及炎性细胞为主;T2WI序列上,等低信号以纤维成分为主,略高信号以肿瘤组织和慢性炎症为主,高信号为黏液变性和受压扩张的胰腺导管.增强胰腺期环形强化是多种病理成分共同作用的结果,无明显强化区为肿瘤组织及纤维组织.肝脏期和延迟期强化以纤维成分为主.结论 胰头癌肿瘤内由多种病理成分按不同比例混合而成,MRI可揭示胰头癌的病理特征.在可切除的胰头癌肿瘤内,未见明显出血坏死的病理改变.     

Outcome after treatment of patients with mammographically occult, magnetic resonance imaging-detected breast cancer presenting with axillary lymphadenopathy

Although magnetic resonance imaging (MRI) for patients with mammographically occult breast cancer with axillary lymphadenopathy has been accepted for staging, treatment outcome data in this patient group is lacking. In this study, 16 patients, median age of 45 years (range, 27-66 years), presented with malignant axillary lymphadenopathy, negative mammograms, negative breast physical examination, and abnormal breast MRI. All 16 patients were found to have >/= 1 suspicious lesions on breast MRI. Ten patients had a solitary enhancing lesion; 1 patient had 2 enhancing lesions; 3 patients had 3 enhancing lesions; 1 patient had a mass lesion and diffuse patchy enhancement in the breast; and 1 patient had regional enhancement but no discrete lesion on MRI. Six patients underwent breast-conservation surgery using MRI-guided wire localization and 10 patients had modified radical mastectomy. Fourteen patients received adjuvant chemotherapy and the remaining 2 patients received neoadjuvant chemotherapy. With a median follow-up of 5 years (range, 1.2-7.6 years), the 5-year actuarial local control was 100%, relapse-free survival was 74%, and overall survival was 87%. Three patients developed distant metastases. Two patients died from distant metastases, and 1 patient is alive with metastatic disease. One patient had a relapse in the contralateral axilla and was treated with paclitaxel and is disease free. Although the patient population is small, the outcome after treatment for this group of patients with a mammographically occult, MRI-detected breast cancer presenting with axillary adenopathy is similar to the expected outcome for patients with breast cancer with positive axillary lymph nodes.