Diagnosis of a Malignant Intramammary Node Retrospectively Aided by Mastectomy Specimen MRI-Is the Search Worth It? A Case Report and Review of Current Literature

Metastases to intramammary nodes have been shown to be an independent predictor of poor outcome in patients with breast cancer, such as axillary lymph node metastases. The detection and accurate characterization of these nodes preoperatively is thus crucial for the staging and planning of treatment for breast carcinoma, particularly in cases with axillary lymph node negative disease as it upgrades the disease staging. We herein report the first case where we detected an intra-mammary node on specimen MRI after the primary pathological gross specimen evaluation failed to detect the node.     

MRI of the breast in patients with metastatic disease of unknown primary

The objective of this study was to assess the value of contrast-enhanced dynamic breast imaging in patients with carcinoma of unknown primary (CUP). Fourteen patients presenting with metastatic disease compatible with breast cancer (axillary lymph node metastasis: n = 6; supraclavicular lymph node metastasis: n = 1; bone metastasis: n = 3; liver metastasis: n = 3; lung metastasis: n = 1), who had no evidence of tumor in X-ray mammograms and ultrasound, underwent bilateral dynamic breast MR imaging. Suspicious lesions were localized preoperatively using a stereotactic device for MR-guided localization procedures. Magnetic resonance imaging revealed suspicious lesions in 9 of 14 patients. Histopathology revealed invasive carcinoma of the breast in 6 of these patients. Two enhancing lesions were fibroadenomas; one proved to be sclerosing adenosis. In 5 patients MR imaging showed no abnormality. Follow-ups performed up to 1 year after initial treatment revealed no breast cancers in these 5 patients. In patients with metastatic disease of unknown primary, MRI of the breast depicts the primary in a considerable number of cases with normal conventional evaluation. Received: 20 February 1998; Revision received: 2 June 1998; Accepted: 10 July 1998     

超声、钼靶X线联合MRI在乳腺癌术前评价中的应用

目的 探讨超声、钼靶X线联合MRI在乳腺癌术前评价中的作用.资料与方法 经超声、钼靶X线和MRI检查后拟诊为乳腺癌的58例患者,均经手术或穿刺病理证实,比较三种检查方法对癌灶检出率、癌灶大小符合率、淋巴结转移情况及手术方式的影响.结果 钼靶X线对癌灶的检出率及对浸润性导管癌(IDC)和浸润性小叶癌(LDC)的检出率最低(P＜0.05);超声、钼靶X线和MRI联合对癌灶的检出率和对导管内原位癌(DCIS)的检出率均高于超声(P＜ 0.05),对转移淋巴结的检出率高于钼靶X线、MRI(P＜0.05);癌灶影像学测值与病理测值的符合度:MRI最高,超声次之,钼靶X线最低(P=0.000).对手术方案的影响:拟行保乳术25例,最终实施16例,超声、钼靶X线、MRI和术中病理分别使2例(2/25,8.0％)、1例(1/25,4.0％)、5例(5/25,20.0％)、1例( 1/25,4.0％)改行根治术.结论 超声、钼靶X线联合MRI可进一步确诊乳腺癌,并对手术方案的确立提供更详细准确的依据.     

Breast cancer metastasis to intramammary lymph nodes

Metastatic disease to the intramammary lymph nodes from breast cancer may be seen mammographically. In the four cases reviewed, the affected intramammary lymph nodes were enlarged (1 cm or greater in diameter), homogeneous, and well circumscribed. All lacked the lucent center or hilar notch characteristic of benign intramammary nodes. Differentiation of malignant from benign causes of intramammary lymph node enlargement, such as inflammation or hyperplasia, is impossible by mammography. Biopsy is recommended for all intramammary lymph nodes of 1 cm or greater that are not fat infiltrated unless the patient clearly has an associated dermatitis or mastitis. Metastatic disease to the intramammary lymph nodes may be the first clinical and/or mammographic sign of breast cancer and may significantly affect prognosis.     

Focal breast lesions with benign appearances. Review of eight breast cancers with initial features of intramammary lymph node

PURPOSE: The aim of this study was to evaluate whether certain histological types of early breast cancer may share radiographic features with intramammary lymph nodes. MATERIALS AND METHODS: The previous mammograms of patients with histologically proven breast cancer and lesions displaying the morphological features of intramammary lymph nodes were retrospectively reviewed. RESULTS: Retrospective evaluation demonstrated eight breast cancers of varying histological nature--mostly ductal carcinomas not otherwise specified (NOS)--whose early radiographic features were similar to intramammary lymph nodes. CONCLUSIONS: Although uncommon, a lesion with the radiographic features of an intramammary lymph node may hide an early breast cancer. No significant relationship exists between histological type and the presence of such features.     

Imaging of tuberculous disease involving breast

The aim of our study was to evaluate radiologic findings of the tuberculosis involving breast. We evaluated the radiologic features of 17 patients (18 lesions) with tuberculous disease involving the breast. The radiologic examinations, including mammography (16 patients), ultrasonography (12 patients), and Gd-DTPA-enhanced dynamic MRI (6 patients), were analyzed. Mammographic findings included mass (12 of 17 lesions), calcification (3 of 17 lesions), asymmetric density with spiculated margin (5 of 17 lesions), and axillary lymph node enlargement (8 of 17 lesions). On ultrasonography, a smooth bordered mass (7 of 13 lesions) with thin boundary (7 of 13 lesions) and heterogeneous, intermediate internal echoes (9 of 13 lesions) were most commonly demonstrated. On Gd-DTPA-enhanced dynamic MRI, 3 lesions showed significant enhancement at the first minute after injection (3 of 7 lesions). The maximun enhancing amount was greater than 500 normalized units, and the enhancing pattern was smooth or irregular ring appearance. Breast involvement with tuberculosis is rare but should be considered in the differential diagnosis of a woman living in an endemic area or when extramammary foci of tuberculosis are present. A multimodality imaging approach with clinical evaluation will help to establish the diagnosis of tuberculosis involving breast. Received 26 May 1997: Revision received 4 September 1997; Accepted 19 January 1998     

The Role of Sonography in Patients with Breast Cancer Presenting as an Axillary Mass

Objective

To compare sonography and mammography in terms of their diagnostic value in breast cancer cases which initially presented as an axillary mass without a palpable mass or other clinical symptoms.

Materials and Methods

Seven patients with enlarged axillary lymph nodes who first presented with no evidence of palpable breast lesions and who underwent both mammography and sonography were enrolled in this study. In six of the seven, the presence of metastatic adenocarcinoma was confirmed preoperatively by axillary needle aspiration biopsy; in four, subsequent sonographically-guided breast core biopsy performed after careful examination of the primary site indicated that primary breast cancer was present. In each case, the radiologic findings were evaluated by both breast sonography and mammography.

Results

Breast lesions were detected mammographically in four of seven cases (57%); in three of the four, the lesion presented as a mass, and in one as microcalcification. In three of these four detected cases, fatty or scattered fibroglandular breast parenchyma was present; in one, the parenchyma was dense. In the three cases in which lesions were not detected, mammography revealed the presence of heterogeneously dense parenchyma. Breast sonography showed that lesions were present in six of seven cases (86%); in the remaining patient, malignant microcalcification was detected at mammography. Final pathologic examination indicated that all breast lesions except one, which was a ductal carcinoma in situ, with microinvasion, were infiltrating ductal carcinomas whose size ranged from microscopic to greater than 3 cm. At the time of this study, all seven patients were alive and well, having been disease free for up to 61 months after surgery.

Conclusion

In women with a palpable axillary mass confirmed as metastatic adenocarcinoma, breast sonography may be a valuable adjunct to mammography.     

Detection of primary breast cancer in women with known adenocarcinoma metastatic to the axilla: Use of MRI after negative clinical and mammographic examination

The purpose of this study was to evaluate the ability of MRI to identify a primary site of malignancy in the breast of patients who present clinically with ipsilateral lymph nodes containing metastatic carcinoma but whose physical and mammographic examination are negative. MRI of the breast was performed on four patients using a variety of imaging parameters, all with and without gadolinium contrast. All patients had biopsy-proven adenocarcinoma of the ipsilateral axilla, with negative physical and mammographic examinations. Foci of enhancement assessed visually on precontrast and postcontrast scans (n = 1) and on substraction studies (n = 3) were considered suspicious under the clinical circumstances defined for this study. Lesions identified on MRI were re-identified on ultrasound examination and either preoperative localization for excisional biopsy or tissue sampling was performed. Surgery was performed and histopathologic correlation was obtained in all cases. Primary sites of breast carcinoma were identified in all four patients, with multiple sites of malignancy identified in three of four patients. Breast conservation therapy was made possible for three of four patients based on the results of the MRI study showing sites of malignancy and no features of cancer elsewhere in the breast. Follow-up data of 1, 2, and 5 years of these patients show no evidence of recurrent disease. MRI of the breast is a useful technique for identifying primary sites of malignancy in patients presenting with ipsilateral lymph nodes positive for metastatic adenocarcinoma when the physical and mammographic examinations are negative.     

获得性免疫缺陷综合征相关消化道病变的影像学表现

目的：初步探讨艾滋病（AIDs）相关消化道病变的影像学表现。方法：回顾性分析11例AIDS相关消化道病变的影像学表现。行胸部平片检查11例,胸部CT扫描4例,腹部CT扫描9例,盆腔CT扫描2例,盆腔MRI检查1例,消化道内窥镜检查9例。结果：11例中消化道穿孔3例（食管穿孔2例,胃穿孔1例）、肠结核2例、巨细胞性肠炎1例、淋巴瘤4例、胃腺癌1例。食管穿孔的主要影像表现为食管一纵隔瘘伴纵隔淋巴结结核及双肺结核;胃穿孔主要表现为胃瘘伴肝左叶及肝胃间隙脓肿;肠结核主要表现为回盲部肠壁增厚;巨细胞性肠炎主要表现为乙状结肠末段及直肠管壁向心性增厚;淋巴瘤主要表现为受累消化道管壁肿块状增厚,肠腔狭窄或扩张,多伴溃疡及病变周围淋巴结增大;胃腺癌主要表现为胃壁增厚、僵硬及明显强化。结论：AIDS相关消化道病变可表现为多种机会性感染和恶性肿瘤,影像学检查对这些病变的诊断具有重要作用。     

乳腺MRI在X线检查乳腺阴性腋淋巴结转移癌阳性患者中的应用价值

目的 探讨乳腺MR检查对临床乳腺触诊和X线检查均为阴性的腋淋巴结转移癌患者寻找其乳腺内原发病灶的应用价值.方法 分析33例以腋淋巴结转移癌为首诊表现(临床乳腺触诊和X线检查均为阴性)患者的乳腺MR影像资料,依据美国放射学会的乳腺影像报告和数据系统MRI标准对所有病变进行分析,并将MRI诊断结果与病理进行对照.结果 33例腋淋巴结转移癌患者中,30例临床行乳腺根治术,其中17例经病理证实为乳腺癌,乳腺MRI检出其中的16例,包括10例肿块性病变和6例非肿块性病变,肿块性病变直径0.5～2.6 cm(平均1.5 cm),直径≤1.5 cm者6例;非肿块性病变包括4例导管性强化和2例段性强化;另1例病理切片发现乳腺癌但乳腺MRI为阴性.其余13例行乳腺根治术患者病理检查未发现乳腺癌灶,其中9例乳腺MRI亦呈阴性表现,另4例MRI提示可疑癌灶.余3例临床未行手术治疗的患者,乳腺MRI亦为阴性.以病理诊断为金标准,MR检出乳腺原发癌灶的敏感度、特异度和准确度分别为94.1%、69.2%和83.3%.结论 相对于一般乳腺癌而言,隐匿性乳腺癌MRI表现更以小灶性的肿块性病变和导管或段性强化的非肿块性病变为常见表现类型.乳腺MR检查对隐匿性乳腺癌的检出具有较高的敏感度和准确度,应作为这类患者的常规检查手段.     

乳腺MRI在X线检查乳腺阴性腋淋巴结转移癌阳性患者中的应用价值

目的 探讨乳腺MR检查对临床乳腺触诊和X线检查均为阴性的腋淋巴结转移癌患者寻找其乳腺内原发病灶的应用价值.方法 分析33例以腋淋巴结转移癌为首诊表现(临床乳腺触诊和X线检查均为阴性)患者的乳腺MR影像资料,依据美国放射学会的乳腺影像报告和数据系统MRI标准对所有病变进行分析,并将MRI诊断结果与病理进行对照.结果 33例腋淋巴结转移癌患者中,30例临床行乳腺根治术,其中17例经病理证实为乳腺癌,乳腺MRI检出其中的16例,包括10例肿块性病变和6例非肿块性病变,肿块性病变直径0.5～2.6 cm(平均1.5 cm),直径≤1.5 cm者6例;非肿块性病变包括4例导管性强化和2例段性强化;另1例病理切片发现乳腺癌但乳腺MRI为阴性.其余13例行乳腺根治术患者病理检查未发现乳腺癌灶,其中9例乳腺MRI亦呈阴性表现,另4例MRI提示可疑癌灶.余3例临床未行手术治疗的患者,乳腺MRI亦为阴性.以病理诊断为金标准,MR检出乳腺原发癌灶的敏感度、特异度和准确度分别为94.1%、69.2%和83.3%.结论 相对于一般乳腺癌而言,隐匿性乳腺癌MRI表现更以小灶性的肿块性病变和导管或段性强化的非肿块性病变为常见表现类型.乳腺MR检查对隐匿性乳腺癌的检出具有较高的敏感度和准确度,应作为这类患者的常规检查手段.     

Benign breast lesions that simulate malignancy: magnetic resonance imaging with radiologic-pathologic correlation

The typical appearance of benign breast conditions on magnetic resonance imaging (MRI) is well established and diagnosis is usually easy. However, cases of benign breast lesions that are extremely difficult to differentiate from malignant breast tumors are occasionally encountered in MRI of the breast because overlap between benign and malignant lesions characteristics is found. This article describes the MRI features of a variety of suspicious breast conditions that were confirmed to be benign in the histopathologic study. We evaluated both enhancement kinetics and lesion morphological information to differentiate malignant from benign lesions. We also correlated the MRI findings with clinical data, and mammographic, ultrasound, and pathologic findings. Lesions evaluated included benign proliferative breast disease, fibroadenoma, intraductal papilloma, granular cell tumor, pseudoangiomatous stromal hyperplasia, fat necrosis, mastitis, inflammatory granuloma, epidermal inclusion cyst, and benign intramammary lymph node.     

Bone metastases from head and neck paragangliomas: uncommon MR findings in an uncommon condition--report of three cases

Malignancy (defined as metastatic disease) has been reported in nearly 5% of head and neck paragangliomas. Metastases preferentially target the lymph nodes, lung, liver, or bone. We describe three patients with multiple silent bone metastases exhibiting a fatty halo at MRI that coexisted with expansive bone lesions. In all cases, (123)I-metaiodobenzylguanidine ((123)MIBG) scintigraphy showed no abnormal tracer uptake, whereas (111)In-pentetreotide scintigraphy visualized a few silent bone metastases. These findings indicate that MRI should be included in the staging of paraganglioma patients with risk factors for malignancy.     

Contrast enhancing lymph nodes in bladder cancer: a potential pitfall on CT.

We report three cases of bladder cancer in which contrast enhanced computed tomography (CT) demonstrated minimally enlarged lymph nodes. These showed uniform uptake of contrast medium to a similar degree as adjacent venous structures, making the distinction between vessels and lymph nodes difficult. Magnetic resonance imaging (MRI) examination resolved the problem in two of the three patients.     

乳腺癌术后患者胸部磁共振检查的评价

目的 探讨MRI在乳腺癌根治术后患者胸部复查中的价值和限度。材料与方法 搜集乳腺癌根治术后作胸部MRI检查的20例患者,均为女性,年龄39－70岁,平均51岁。观察分析MRI表现（包括胸壁、内乳淋巴结、腋下淋巴结、纵隔和肺门淋巴结、胸膜、骨、肺及肩部软组织等8个部位）,分别计算敏感性、特异性和准确性。另对12例同时有MRI和SPECT检查的患者进行初步比较。结果 MRI的总体敏感性为86．3％,特异性为99．5％,准确性为96．9％。尤其对胸壁和内乳区病变,上述三特性均达100％。对骨转移的敏感性为83．3％,特异性为100％,准确性为96．7％;MRI对扁平骨（如肋骨和肩胛骨）转移易漏诊,因而导致敏感性偏低。结论 胸部MRI检查对乳腺癌术后胸部复发是较好的影像学方法,有助于临床制定治疗方案。     

串珠征在周围型小细胞肺癌中的诊断价值

目的：探讨串珠征的形成机制,评价其在周围型小细胞肺癌(SCLC)、周围型肺腺癌及周围型肺鳞癌中的鉴别诊断意义。方法收集病理证实的周围型 SCLC 78例、周围型肺腺癌69例、周围型肺鳞癌33例,分别统计串珠征的阳性率、纵隔淋巴结的转移率及纵隔淋巴结大于肺原发灶的比例,对相关数据进行统计分析。结果78例周围型 SCLC中10例串珠征阳性(12.8%),且纵隔淋巴结均大于肺原发灶;78例中63例纵隔淋巴结转移(80.8%),42例纵隔淋巴结大于肺原发灶(53.8%)。69例周围型实性肺腺癌中,无1例出现串珠征,25例纵隔淋巴结转移(36.2%),2例纵隔淋巴结大于原发灶(2.9%)。33例周围型肺鳞癌中1例串珠征阳性(2.8%),该例肺门淋巴结明显小于肺原发灶,33例中13例纵隔淋巴结转移(39.4%),6例纵隔淋巴结大于原发灶(16.7%)。经统计分析,串珠征在周围型 SCLC与周围型肺鳞癌中差异无统计学意义,周围型 SCLC与周围型肺腺癌、肺鳞癌在纵隔淋巴结转移率及纵隔淋巴结大于肺原发灶的阳性率差异均有统计学意义。结论串珠征在一定程度上反映 SCLC 的生物学特性,在周围型SCLC与周围型肺腺癌、肺鳞癌的鉴别诊断中有重要价值,应结合纵隔淋巴结大小。     

超声诊断乳腺癌腋窝淋巴结转移的多因素分析

目的分析乳腺癌原发病灶与腋窝淋巴结的灰阶及彩色多普勒超声表现,探讨声像表现与腋窝淋巴结转移的相关性。资料与方法 120例乳腺癌患者及其132个腋窝淋巴结,观察原发病灶的血流分布、最大径、数目、微钙化及淋巴结的血流特征、横径/纵径和皮质厚度。采用单因素和logistic多因素回归分析检验观察指标与乳腺癌腋窝淋巴结转移的相关性。结果单因素分析结果显示,所有影像学观察指标与LNM有相关性,差异有统计学意义(P<0.05)。多因素logistic回归分析表明,原发病灶的最大径、数目、丰富血供和淋巴结的皮质厚度、血流分布与LNM有相关性(P<0.05)。结论依据乳腺癌原发病灶和腋窝淋巴结声像图特征评判腋窝淋巴结的性质,具有重要临床意义。     

Indeterminate or suspicious breast lesions detected initially with MR imaging: value of MRI-directed breast ultrasound

RATIONALE AND OBJECTIVES: To retrospectively determine the value of magnetic resonance imaging (MRI)-directed breast ultrasonography (US) in the evaluation of indeterminate or suspicious lesions identified on contrast-enhanced, breast MRI. MATERIALS AND METHODS: A total of 395 patients presenting for breast MRI during a 4-year period was retrospectively reviewed. Seventy-one patients were recommended for MRI-directed US for further characterization of indeterminate or suspicious breast lesions detected on MRI. Fifty-five patients (all female; age 31-80 years) had US. Their MRI and US were reviewed and tested for correlations with histologic results or long term follow-up. Logistic regression analyses were used to test for associations between MRI lesion characteristics and US detection rate. RESULTS: US identified 46 of 97 (47%) lesions depicted at MRI from 55 patients (47 [85%] of these patients had histories of breast malignancies). Twelve cancers were found from the 97 lesions (12%). Biopsy was avoidable in 10 lesions (10%). The detection rate with US was slightly higher with "mass" (55% [23/42]) lesions described in MRI than "non-mass" lesions or lymph nodes (42% [23/55]). There was a significant positive association (odd ratio = 1.23: 95% CI = 1.05-1.43, P = .01) between US detection rate and MRI mass lesion size. There was no statistical significance between US detection rate and the presence of malignancies; 42% (5/12) of MRI malignant lesions were not visualized with US. CONCLUSIONS: MRI-directed US reduced the number of biopsies required for indeterminate or suspicious MRI lesions. Nevertheless, the lesions which were biopsied had a low rate of malignancy.     

背景抑制扩散加权成像(DWIBS)在宫颈癌诊断与分期中的价值

目的：探讨背景抑制扩散加权成像（DWIBS）在宫颈癌术前诊断与分期中的价值。方法：39例宫颈癌患者术前行常规MRI与背景抑制扩散加权成像（DWIBS）检查,所得图像经最大强度投影（MIP）重建,并反相显示。结果：宫颈癌、宫颈周围浸润灶及盆腔转移灶呈明显高信号。MRI常规序列检出宫颈癌38例,DWIBS检出39例;MRI常规序列检出24枚盆腔转移性淋巴结,DWIBS检出32枚。MRI常规序列宫颈癌分期符合率87.2%（34/39例）,MRI常规序列结合DWIBS符合率97.4%（38/39例）。结论：背景抑制扩散加权成像（DWIBS）能直观、敏感地显示宫颈癌及其转移灶,结合MRI常规序列有利于肿瘤分期,应作为宫颈癌重要辅助检查序列。     

Imaging and clinical spectrum of rhabdomyosarcoma in children

We retrospectively analyzed the MRI findings of rhabdomyosarcoma (RMSA) in 23 patients to evaluate its role in staging and management. Heterogeneous signal abnormalities were noted in the sarcoma lesions with significant contrast enhancement. Seven head and neck cases showed direct bone invasion and destruction; only one had distant bony metastasis. Metastasis was noted in the lymph nodes, lung, bone, abdominoperitoneum, and head and neck soft tissue. MRI findings of RMSA are most helpful in staging and assessing therapeutic response.