J Breast Cancer.  2015 Jun;18(2):187-194. 10.4048/jbc.2015.18.2.187.

Magnetic Resonance Imaging Features of Adenosis in the Breast

• Gity M
• Arabkheradmand A
• Taheri E
• Shakiba M
• Khademi Y
• Bijan B
• Sadaghiani MS
• Jalali AH

• KMID: 2374535
• DOI: http://doi.org/10.4048/jbc.2015.18.2.187

Abstract

PURPOSE
Adenosis lesions of the breast, including sclerosing adenosis and adenosis tumors, are a group of benign proliferative disorders that may mimic the features of malignancy on imaging. In this study, we aim to describe the features of breast adenosis lesions with suspicious or borderline findings on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).
METHODS
In our database, we identified 49 pathologically proven breast adenosis lesions for which the final assessment of the breast MRI report was classified as either category 4 (n=45) or category 5 (n=4), according to the Breast Imaging Reporting and Data System (BI-RADS) published by the American College of Radiology (ACR). The lesions had a final diagnosis of either pure adenosis (n=33, 67.3%) or mixed adenosis associated with other benign pathologies (n=16, 32.7%).
RESULTS
Of the 49 adenosis lesions detected on DCE-MRI, 32 (65.3%) appeared as enhancing masses, 16 (32.7%) as nonmass enhancements, and one (2.1%) as a tiny enhancing focus. Analysis of the enhancing masses based on the ACR BI-RADS lexicon revealed that among the mass descriptors, the most common features were irregular shape in 12 (37.5%), noncircumscribed margin in 20 (62.5%), heterogeneous internal pattern in 16 (50.0%), rapid initial enhancement in 32 (100.0%), and wash-out delayed en-hancement pattern in 21 (65.6%). Of the 16 nonmass enhancing lesions, the most common descriptors included focal distribution in seven (43.8%), segmental distribution in six (37.5%), clumped internal pattern in nine (56.3%), rapid initial enhancement in 16 (100.0%), and wash-out delayed enhancement pattern in eight (50.0%).
CONCLUSION
Adenosis lesions of the breast may appear suspicious on breast MRI. Awareness of these suspi-cious-appearing features would be helpful in obviating unnecessary breast biopsies.

Keyword

Adenosis lesion; Breast; Magnetic resonance imaging

MeSH Terms

Biopsy
Breast*
Diagnosis
Fibrocystic Breast Disease
Information Systems
Magnetic Resonance Imaging*
Pathology
Subject Headings

Figure

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  Figure 1 A 33-year-old female with a palpable lump in the lower outer quadrant (LOQ) of the left breast. (A) T1-weighted image shows a poorly visualized hypointense mass in the posterior LOQ of the left breast, the white arrow indicate the nearly location. (B) T2-weighted fat-suppressed image shows an almost isointense lesion marked with white arrow. (C) Postcontrast fat suppressed subtracted first dynamic series, the white arrow shows a mass with an irregular shape and fine spiculated margin, heterogeneous internal pattern, rapid initial enhancement and type 3 dynamic curves. The mass was classified as Breast Imaging Reporting and Data System category 5 on magnetic resonance imaging. (D) In maximum intensity projection 3D reconstruction image, the white arrow shows location of the mass in the posterior LOQ of the left breast. No other enhancing mass was noted in either breast. Subsequent ultrasonography-guided core needle biopsy revealed pure sclerosing adenosis. (E) Axial computer aided detection, CADStream color-coded image.

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  Figure 2 A 37-year-old female with a palpable firm lump in the retroareolar region of the left breast. (A, B) Precontrast T1-weighted and fat saturated T2-weighted images, the white arrows show asymmetrical parenchymal thickening with minimal retraction in the left upper areolar region. (C) In postcontrast fat suppressed subtracted first dynamic series, the white arrow shows focal asymmetrical enhancement with clumped and stippled pattern, rapid initial enhancement and type 2 and 3 dynamic curves. The lesion was classified as Breast Imaging Reporting and Data System (BI-RADS) category 4. (D) In maximum intensity projection 3D reconstruction image, the white arrow shows location of the mass in the retroareolar region of the left breast. No other enhancing lesion was noted in either breast. (E) Sagittal CAD-Stream color-coded image. This magnetic resonance imaging was interpreted as BI-RADS category 5. On subsequent ultrasonography (US) exam, parenchymal distortion was noted and US-guided biopsy revealed extensive sclerosing adenosis. Due to suspicious image findings, excision was recommended and pure sclerosing adenosis without any evidence of malignancy was reported on the pathological specimen.

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  Figure 3 A 38-year-old female with palpable firmness in the upper outer quadrant (UOQ) of the right breast. (A) T1-weighted image shows ill-defined low signal intensity mass in the UOQ of the right breast. (B) In T2-weighted fat suppressed image, the white arrow shows a low signal intensity mass. (C) Postcontrast fat suppressed subtracted first dynamic series, the white arrow shows a 28-mm irregular shaped mass with irregular borders, heterogeneous internal pattern and rapid washout dynamic curve. This lesion was classified as Breast Imaging Reporting and Data System (BI-RADS) category 4. Ultrasonography-guided core needle biopsy (CNB) revealed fibrocystic changes, nonproliferative type, mixed with sclerosing adenosis. (D) In maximum intensity projection 3D reconstruction image, the thinner arrow shows location of the suspicious mass in the UOQ of the right breast. Besides, in the central aspect of the lower outer quadrant of the left breast, the thicker arrow shows a 12-mm lobulated enhancing mass with smooth borders, dark internal septum and rapid washout dynamic curves. This lesion was classified as BI-RADS category 3 lesion. Simultaneous CNB of this mass revealed sclerosing adenosis in a fibroadenoma, but it was not included in this study. (E) Axial CAD-Stream color-coded image. The thin arrow depicts the main lesion in the right breast to be a BI-RADS category 4 lesion and the thick arrow points to the second lesion on the left side.

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  Figure 4 A 60-year-old female with no palpable abnormality. (A, B) T1-weighted and fat suppressed T2-weighted images show no detectable abnormality in the dense fibroglandular breast parenchyma, the white arrows indicated the nearly location of the lesion,considering other imaging sequences. (C) Postcontrast fat suppressed subtracted first dynamic series shows asymmetrical segmental nonmass enhancing in a triangular area pointed toward the areola, located in the central aspect of the UIQ of the left breast (arrow). The internal pattern is heterogeneous and the predominant dynamic features are rapid initial rise with washout curves. (D) In maximum intensity projection 3D reconstruction image, there is segmental nonmass enhancing area in central aspect of left UIQ (arrow), no other significant enhancing lesion in either breast noted. (E) In sagittal CAD-Stream color-coded image, the white arrow shows the lesion in the central aspect of the UIQ of the left breast. This lesion was classified as Breast Imaging Reporting and Data System category 4. Ultrasonography-guided core needle biopsy revealed focal ductal hyperplasia without atypia and focal sclerosing adenos.

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