This page contains a Flash digital edition of a book.
Breast Cancer


Breast Magnetic Resonance Imaging of Multicentric, Multifocal and Bilateral Cancer – A Case-based Review


Virginia Pérez Dueñas,1


María Ruíz de Gopegui Andreu,2 Asunción Suárez Manrique4


Sara Morón Hodge3 and


1. Radiology Consultant, Department of Radiology, Hospital Universitario Madrid Sanchinarro; 2. Radiology Consultant, Department of Radiology, Hospital Infanta Elena, Hospital Universitario La Paz; 3. Doctor, Hospital Universitario La Paz; 4. Pathology Consultant, Hospital Universitario La Paz


Abstract


Multifocal or multicentric breast cancer can be difficult to detect on mammography or ultrasound, particularly in patients with dense breast tissue. A multimodality approach that includes breast magnetic resonance imaging (MRI) is indicated, particularly when conservative surgery is being considered as it is the most sensitive technique for identifying additional sites of disease. However, its influence on recurrence and survival rates has yet not been clearly established, and false-positive cases may lead to more aggressive management and treatment. Radiologists should therefore be aware of relevant breast MRI findings. Infiltrating carcinomas, contralateral unsuspected carcinomas, occult carcinomas, false-positive cases and post-chemotherapy changes. Several cases of multiple-site breast carcinomas and their corresponding mammographic, ultrasound and MRI features have been reviewed for this article, in which the definition and differences between multifocal, multicentric and contralateral breast carcinoma are explained and the most relevant imaging findings on MRI are illustrated and correlated with mammogram and ultrasound findings. Finally, the role of breast MRI in the pre-operative assessment of breast cancer is discussed.


Keywords


Breast neoplasm, invasive lobular/ductal carcinoma, multifocal/multicentric extent, magnetic resonance imaging, pre-operative staging, false-positive, local recurrence rate, survival rate


Disclosure: The authors have no conflicts of interest to declare. Received: 3 July 2010 Accepted: 23 January 2011 Citation: European Oncology & Haematology, 2011;7(1):24–30 Correspondence: Virginia Pérez Dueñas, Department of Radiology, Hospital Universitario Madrid Sanchinarro, C/ Oña 13, 28050 Madrid, Spain. E: virpedue@gmail.com


Breast cancer is an important public health problem, as it is the leading cause of death from cancer in women and the leading cause of death in 35–55-year-old women in the EU. Well-known risk factors are a previous breast carcinoma, atypical ductal hyperplasia, atypical columnar hyperplasia, lobular lesion in situ, papillomatosis or atypical papillary lesion, mediastinal radiotherapy and family history of breast cancer, especially the positive genes BRCA 1 and 2.1


Invasive breast carcinoma includes a wide range of tumours. The most frequent is invasive ductal carcinoma not otherwise specified ([NOS] 60–80%), followed by invasive lobular carcinoma (about 15%), which is often multicentric or bilateral. The remaining most frequent subtypes are medullary, mucinous, papillary and tubular carcinomas, each of which occurs with a frequency of approximately 2–4%.1


It is important to establish the classification of breast cancer according to its local extent. Multifocal carcinoma refers to two or more tumour areas in a unique quadrant or a distance of <4–5cm (although in breasts of small volume it can involve several quadrants, see Figure 1). Multicentric carcinoma refers to two or more tumour areas in different quadrants of the same breast/to a distance >4–5cm (see Figures 2–3). Contralateral cancer can be synchronous, when the detection of a contralateral tumour occurs in the first six months following diagnosis of the primary tumour, or metachronous, when


24


the recurrence is later.1


Multifocal or multicentric carcinomas are


more frequent in young patients or peri-menopausal women with large tumours (>5cm) and high-density fibroglandular parenchyma, women with a family history of breast cancer and in cases of invasive lobular carcinoma.1


Imaging Techniques in Breast Cancer Breast cancer detection requires a multimodality approach and several imaging modalities must be adequately employed by the radiologist. For this reason we will include a short review of mammography and breast ultrasounds findings and indications before explaining the role of breast magnetic resonance imaging (MRI).


Mammography


Mammography is the primary diagnostic imaging modality in the evaluation of any mammary pathology because it is accessible, rapid, reproducible, relatively cheap and useful. The sensitivity and specificity for screening of breast cancer depend on the quality of the images, the experience of the radiologist and the reason for the imaging: screening versus diagnostic mammogram in symptomatic patients. It has been demonstrated that the likelihood of death from breast cancer is 50% lower in women who regularly participate in screening mammography programmes than in women who do not, with a similar death rate in the latter group to those obtained prior to


© TOUCH BRIEFINGS 2011


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92