J Breast Cancer.  2010 Dec;13(4):357-365. 10.4048/jbc.2010.13.4.357.

The Clinical Use of Low-Dose Multidetector Row Computed Tomography for Breast Cancer Patients in the Prone Position

• Lee WJ
• Seo BK
• Cho PK
• Yie A
• Cho KR
• Woo OH
• Cha SH
• Son GS
• Lee GY

• KMID: 2286523
• DOI: http://doi.org/10.4048/jbc.2010.13.4.357

Abstract

PURPOSE
To investigate the clinical use of low-dose multidetector row computed tomography (MDCT) for staging of invasive breast cancers with patients in the prone position.
METHODS
Three hundred twenty-two patients with 334 pathologically-verified breast cancers had low-dose MDCT breast imaging in the prone position for tumor staging before treatment between May 2006 and June 2010. We designed an additional computed tomography table pad with a hole for prone positioning. Patients lay prone on the table pad and the breasts were positioned within the rectangular hole. We obtained dynamic breast imaging from the lower neck to the lung base with the following parameters: 120 kVp, 50 mAs, and 3-mm reconstruction intervals. We evaluated the extent of the primary tumor, lymph nodal status, and distant metastasis in lung or bone, then assessed tumor staging based on the TNM classification of breast cancer. The assessed staging compared to the pathologic results for diagnostic accuracy.
RESULTS
Among the 334 invasive breast cancers, the overall diagnostic accuracy of tumor staging was 88.3% and the accuracy values of each tumor stage were 89.6% in T1, 90.8% in T2, 81.0% in T3, and 89.3% in T4. The overall diagnostic accuracy of lymph nodal staging was 86.3% and the accuracy values in each nodal stage were 82.9% in N0, 88.0% in N1, 89.7% in N2, and 93.3% in N3. Based on breast computed tomography scans, we detected distant metastases in 30 cases (7 lungs, 10 bones, 7 lungs and bones, and 6 livers).
CONCLUSION
Low-dose MDCT scanning for invasive breast cancer patients in the prone position is a feasible imaging technique for tumor staging before treatment to evaluate primary breast tumors, lymph nodes, lungs, or thoracic bones with reduced radiation doses.

Keyword

Breast; Carcinoma; Multi-detector row computed tomography

MeSH Terms

Breast
Breast Neoplasms
Humans
Lung
Lymph Nodes
Multidetector Computed Tomography
Neck
Neoplasm Metastasis
Neoplasm Staging
Prone Position

Figure

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  Figure 1 The additional computed tomography (CT) table pad and patient positioning. (A) A specially designed CT table pad is placed on the standard CT table for breast scanning in the prone position. The additional table pad is made with high-density polyfoam and has a rectangular hole for positioning of the breast. (B) The patient lies prone on the table pad and the breasts are positioned within the rectangular hole. The patient raises both arms and turns their head to the side.

• 

  Figure 2 A 47-yr-old woman with a left invasive ductal carcinoma. Dynamic computed tomography (CT) images are obtained precontrast (A) and after a 90-sec (B) and 300-sec delay (C) following contrast injection. The CT images show the presence of an indistinct irregular mass (arrows). The mass shows peak enhancement on the 90-sec delayed image (B) and washout on the 300-sec delayed image (C). On the pathologic examination, the size of the tumor measured 11 mm and the lymph nodes were negative for metastases.

• 

  Figure 3 A 40-yr-old woman with a right inflammatory carcinoma. A 90-sec delayed computed tomography image shows that the right breast is enlarged and has multiple enhancing tumors (arrows). The overlying skin is thickened (arrowheads) and the pectoralis muscle is swollen (curved arrows) due to tumor infiltration.

• 

  Figure 4 A 52-yr-old woman who underwent a mastectomy of the left breast for an invasive ductal carcinoma. An indistinct, irregular-shaped mass (arrow) is seen at the mastectomy site. The mass was pathologically-verified as a recurrent carcinoma.

• 

  Figure 5 A 58-yr-old woman with an invasive ductal carcinoma who received chemotherapy. (A) The initial computed tomography (CT) image shows that an advanced tumor (arrows) of the left breast has invaded the skin and chest wall. Axillary and mediastinal lymph nodes (arrowheads) are enlarged and the sternum (curved arrows) is destroyed from metastases. (B) A follow-up CT image obtained 3 months after chemotherapy demonstrates that the primary tumor, metastatic nodes, and sternum were much improved.

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