J Korean Soc Magn Reson Med.  2014 Mar;18(1):43-51. 10.13104/jksmrm.2014.18.1.43.

MR Findings of Papillary Neoplasms of the Breast

• Jo Y
• Kim SH
• Kang BJ
• Choi BG

• KMID: 1683779
• DOI: http://doi.org/10.13104/jksmrm.2014.18.1.43

Abstract

PURPOSE
To review MR imaging finding of papillary lesion identified as additional suspicious lesion on MR image in women with biopsy-proven breast cancer and to evaluate upgrading rates after subsequent surgical histopathological diagnosis.
MATERIALS AND METHODS
Among 1729 preoperative MR image of women with biopsy proven breast cancer, US-guided CNB-proven 22 papillary lesions from 21 patients, which showed additional suspicious contrast enhancement other than index cancer on MR image, were subjected to the study. Some of these lesions underwent surgery, thus the comparisons between the histopathologic results were able to be compared to the results of US guided CNB. Also retrospective analysis was done for MR findings of these lesions by BI-RADS MRI lexicon.
RESULTS
On MR imaging, 8 mass lesions, 7 non-mass lesions, 7 focus lesions were detected. All of the focus lesion (100%, 7/7) was diagnosed as benign lesion and showed plateau and washout pattern in dynamic MR image. After excisional biopsy, one of 9 benign papilloma (11.1%), 3 of 3 papillary neoplasm with atypia component (100%), 3 of 5 papillary neoplasm (60%) were upgraded to malignancy such as ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC).
CONCLUSION
The MR images of papillary lesions diagnosed by US-guided CNB exhibit no significant differences between malignancy and benign lesion. Also 41.2% of the lesion (7/17) was upgraded after subsequent surgery. Thus all of the papillary lesions require excisional biopsy for definite diagnosis and the MR imaging, it's just not enough by itself.

Keyword

Magnetic resonance imaging; Breast cancer; Papillary neoplasm; Upgrade

MeSH Terms

Biopsy
Breast Neoplasms
Breast*
Carcinoma, Ductal
Carcinoma, Intraductal, Noninfiltrating
Carcinoma, Lobular
Diagnosis
Female
Humans
Magnetic Resonance Imaging
Papilloma
Retrospective Studies

Figure

• 

  Fig. 1 A 68-year-old woman with left breast cancer. a. Axial fat saturated contrast-enhanced T1-weighted image shows a focus (arrow) in the left subareolar portion. b. The kinetic curve shows early rapid enhancement and delayed washout pattern. This lesion is categorized as BI-RADS 4A, low suspicion of malignancy. c. US guided core needle biopsy was done in the left subareolar mass and intraductal papilloma was diagnosed. Subsequent surgical exicision after US-guided localization shows no remnant papilloma.

• 

  Fig. 2 A 77-year-old woman with left breast cancer. a. Axial fat saturated contrast-enhanced T1-weighted image shows a 6 mm sized, smooth round mass with rim enhancement at the right breast. b. The kinetic curve shows early rapid enhancement and delayed washout pattern. This lesion is categorized as BI-RADS 4A, low suspicion of malignancy. c. US-guided core needle biopsy was done in the right breast mass and intraductal papilloma was diagnosed. Subsequent surgical excision revealed same histopathological result.

• 

  Fig. 3 A 47-year-old woman with left breast cancer. a. Maximal intensity projection (MIP) reconstruction image shows an index cancer, known invasive ductal carcinoma, in the left breast (arrow) and non-mass enhancement in the right breast (arrowheads). b. Axial fat saturated contrast-enhanced T1-weighted image shows a 48 mm sized, clumped, segmental non mass enhancement at the right breast. c. The kinetic curve shows delayed plateau pattern. This lesion is categorized as BI-RADS 4B, intermediate suspicion of malignancy. d. US-guided core needle biopsy is done in the right breast masses and intraductal papilloma is proved. This lesion is upgrade to ductal carcinoma in situ after surgical excision.

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