Breast MR Imaging in Patients with Axillary Node Metastases and Unknown Primary Malignancy1
Susan G. Orel, MD,
Susan P. Weinstein, MD,
Mitchell D. Schnall, MD,
Carol A. Reynolds, MD,
Lynn M. Schuchter, MD,
Douglas L. Fraker, MD and
Lawrence J. Solin, MD
1 From the Departments of Radiology (S.G.O., S.P.W., M.D.S.), Surgery (D.L.F.), and Radiation Oncology (L.J.S.) and the Hematology-Oncology Division (L.M.S.), University of Pennsylvania Medical Center, 3400 Spruce St, Philadelphia, PA 19104; and the Department of Anatomic Pathology, Mayo Clinic, Rochester, Minn (C.A.R.). Received July 8, 1998; revision requested August 18; final revision received October 22; accepted February 10, 1999. Address reprint requests to S.G.O. (e-mail: orel@oasis.rad.upenn.edu).
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Figure 1a. (a) Sagittal fat-suppressed contrast-enhanced three-dimensional fast spoiled gradient-recalled-echo MR image (15/2.2) demonstrates an enhancing 1-cm mass (arrow) with spiculated margins. (b) Sagittal fat-suppressed contrast-enhanced three-dimensional fast spoiled gradient-recalled-echo MR images (9.2/2.2) obtained during MR imaging-guided localization. The arrow in the image on the left marks the lesion. The arrow in the image on the right marks the artifact from the needle. (c) Postlocalization mediolateral mammogram reveals the hook wire in the central part of the breast and a skin marker (metallic bead). Scattered calcifications adjacent to and distant from the wire were present in both breasts and were stable. Excisional biopsy revealed a 6-mm infiltrating ductal carcinoma with associated ductal carcinoma in situ and extensive lymphatic invasion. On the basis of the histopathologic features, mastectomy was recommended. At mastectomy, minimal residual invasive ductal carcinoma and ductal carcinoma in situ were identified near the biopsy site. No other tumor was found in the breast.
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Figure 1b. (a) Sagittal fat-suppressed contrast-enhanced three-dimensional fast spoiled gradient-recalled-echo MR image (15/2.2) demonstrates an enhancing 1-cm mass (arrow) with spiculated margins. (b) Sagittal fat-suppressed contrast-enhanced three-dimensional fast spoiled gradient-recalled-echo MR images (9.2/2.2) obtained during MR imaging-guided localization. The arrow in the image on the left marks the lesion. The arrow in the image on the right marks the artifact from the needle. (c) Postlocalization mediolateral mammogram reveals the hook wire in the central part of the breast and a skin marker (metallic bead). Scattered calcifications adjacent to and distant from the wire were present in both breasts and were stable. Excisional biopsy revealed a 6-mm infiltrating ductal carcinoma with associated ductal carcinoma in situ and extensive lymphatic invasion. On the basis of the histopathologic features, mastectomy was recommended. At mastectomy, minimal residual invasive ductal carcinoma and ductal carcinoma in situ were identified near the biopsy site. No other tumor was found in the breast.
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Figure 1c. (a) Sagittal fat-suppressed contrast-enhanced three-dimensional fast spoiled gradient-recalled-echo MR image (15/2.2) demonstrates an enhancing 1-cm mass (arrow) with spiculated margins. (b) Sagittal fat-suppressed contrast-enhanced three-dimensional fast spoiled gradient-recalled-echo MR images (9.2/2.2) obtained during MR imaging-guided localization. The arrow in the image on the left marks the lesion. The arrow in the image on the right marks the artifact from the needle. (c) Postlocalization mediolateral mammogram reveals the hook wire in the central part of the breast and a skin marker (metallic bead). Scattered calcifications adjacent to and distant from the wire were present in both breasts and were stable. Excisional biopsy revealed a 6-mm infiltrating ductal carcinoma with associated ductal carcinoma in situ and extensive lymphatic invasion. On the basis of the histopathologic features, mastectomy was recommended. At mastectomy, minimal residual invasive ductal carcinoma and ductal carcinoma in situ were identified near the biopsy site. No other tumor was found in the breast.
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Figure 2. Sagittal fat-suppressed contrast-enhanced three-dimensional fast spoiled gradient-recalled-echo MR image (9.2/2.2) demonstrates a 2-cm enhancing mass (arrow) with irregular margins deep in the breast. A 5-mm enhancing mass (arrowhead) with irregular borders is also identified in the subareolar breast. MR imaging-guided localization of both lesions was performed. At excisional biopsy, the lesion deep in the breast was identified as a 1.8-cm infiltrating ductal carcinoma. In the subareolar excisional specimen, apocrine metaplasia was identified. The patient subsequently underwent breast-conservation therapy.
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Figure 3a. Images in a patient with known axillary metastases and a palpable mass in the upper outer quadrant of the breast. (a) Mediolateral oblique mammogram reveals a mass (arrow) in the superior part of the breast near the skin marker. No other suspicious finding was identified. Ultrasonographic (US) examination of the palpable mass demonstrated a hypoechoic mass, which at core biopsy proved to be a metastatic intramammary node. (b) Sagittal fat-suppressed contrast-enhanced three-dimensional fast spoiled gradient-recalled-echo MR image (9.3/2.2) reveals an enhancing 1.5-cm mass (arrow) with irregular borders in the central part of the breast. At mastectomy, a 1.5-cm infiltrating ductal carcinoma was identified in a location corresponding to the MR imaging-detected lesion.
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Figure 3b. Images in a patient with known axillary metastases and a palpable mass in the upper outer quadrant of the breast. (a) Mediolateral oblique mammogram reveals a mass (arrow) in the superior part of the breast near the skin marker. No other suspicious finding was identified. Ultrasonographic (US) examination of the palpable mass demonstrated a hypoechoic mass, which at core biopsy proved to be a metastatic intramammary node. (b) Sagittal fat-suppressed contrast-enhanced three-dimensional fast spoiled gradient-recalled-echo MR image (9.3/2.2) reveals an enhancing 1.5-cm mass (arrow) with irregular borders in the central part of the breast. At mastectomy, a 1.5-cm infiltrating ductal carcinoma was identified in a location corresponding to the MR imaging-detected lesion.
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Figure 4. Sagittal fat-suppressed contrast-enhanced three-dimensional fast spoiled gradient-recalled-echo MR images (9.3/2.2) reveal multiple enhancing areas scattered throughout the breast. Mammography revealed dense tissue without a suspicious finding. At mastectomy, multifocal invasive lobular carcinoma was found in all quadrants of the breast.
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Figure 5a. (a) Mediolateral oblique mammogram reveals heterogeneously dense breast tissue. (b) Sagittal fat-suppressed contrast-enhanced three-dimensional fast spoiled gradient-recalled-echo MR image (9.3/2.2) demonstrates two areas (arrows) of ill-defined enhancement. At mastectomy, approximately 5-cm multifocal infiltrating lobular carcinoma was identified.
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Figure 5b. (a) Mediolateral oblique mammogram reveals heterogeneously dense breast tissue. (b) Sagittal fat-suppressed contrast-enhanced three-dimensional fast spoiled gradient-recalled-echo MR image (9.3/2.2) demonstrates two areas (arrows) of ill-defined enhancement. At mastectomy, approximately 5-cm multifocal infiltrating lobular carcinoma was identified.
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Figure 6a. Images in a patient with axillary node metastases and an MR imaging-detected suspicious mass that resolved during chemotherapy. Mammography revealed dense breast tissue without a suspicious finding. (a) Sagittal fat-suppressed contrast-enhanced three-dimensional fast spoiled gradient-recalled-echo MR image (11/2.2) shows a 1.5-cm, spiculated mass (arrow) deep in the breast. (b) Four-month follow-up sagittal fat-suppressed contrast-enhanced three-dimensional fast spoiled gradient-recalled-echo MR image (27.8/4) obtained during chemotherapy shows no substantial change in the size of the mass (arrow). (c) Seven-month follow-up sagittal fat-suppressed contrast-enhanced three-dimensional fast spoiled gradient-recalled-echo MR image (9.2/2.2) shows resolution of the mass. No surgical procedure was performed.
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Figure 6b. Images in a patient with axillary node metastases and an MR imaging-detected suspicious mass that resolved during chemotherapy. Mammography revealed dense breast tissue without a suspicious finding. (a) Sagittal fat-suppressed contrast-enhanced three-dimensional fast spoiled gradient-recalled-echo MR image (11/2.2) shows a 1.5-cm, spiculated mass (arrow) deep in the breast. (b) Four-month follow-up sagittal fat-suppressed contrast-enhanced three-dimensional fast spoiled gradient-recalled-echo MR image (27.8/4) obtained during chemotherapy shows no substantial change in the size of the mass (arrow). (c) Seven-month follow-up sagittal fat-suppressed contrast-enhanced three-dimensional fast spoiled gradient-recalled-echo MR image (9.2/2.2) shows resolution of the mass. No surgical procedure was performed.
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Figure 6c. Images in a patient with axillary node metastases and an MR imaging-detected suspicious mass that resolved during chemotherapy. Mammography revealed dense breast tissue without a suspicious finding. (a) Sagittal fat-suppressed contrast-enhanced three-dimensional fast spoiled gradient-recalled-echo MR image (11/2.2) shows a 1.5-cm, spiculated mass (arrow) deep in the breast. (b) Four-month follow-up sagittal fat-suppressed contrast-enhanced three-dimensional fast spoiled gradient-recalled-echo MR image (27.8/4) obtained during chemotherapy shows no substantial change in the size of the mass (arrow). (c) Seven-month follow-up sagittal fat-suppressed contrast-enhanced three-dimensional fast spoiled gradient-recalled-echo MR image (9.2/2.2) shows resolution of the mass. No surgical procedure was performed.
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Copyright © 1999 by the Radiological Society of North America.
