Non-lactational mastitis is an inflammatory process in the breast tissue that is not associated with lactation. The detection of a malignant transformation during inflammation process is often difficult, because it has similar clinical manifestations. Medical approach depends on the characteristics of the processes which are received from the data obtained from radiation diagnostic methods: whether or not there is a nodular formation or infiltrate, cystic cavities, dilatation of the ducts, how the axillary lymph nodes are changed. Diagnostic errors in inflammatory breast diseases are quite common; according to the literature, errors in the interpretation of clinical, mammographic, and ultrasound signs of cancer during inflammation account for up to 53.1% of cases. Inflammation, as well as cancer, in majority of cases is accompanied by a visually detectable increase in blood flow due to proliferation and neoangiogenesis. Magnetic resonance imaging with dynamic contrast enhancement (MRI) is highly sensitive in detecting areas with increased vascularization and makes it possible to assess their nature with a high degree of probability during any changes in the structure of the breast tissue, including edema and inflammatory infiltration.MR signs that allow to make differential diagnosis are a combination of pathological accumulation and lymphadenopathy, which are coded by the BIRADS system as category 4 and only the absence of contrast agent accumulation may suggest an inflammatory nature of the changes. According to the literature, MRI-DCE is a highly sensitive diagnostic method of identifying cancer during inflammation processes. The results of 85 MR studies with clinical manifestations of non-lactational mastitis were analyzed.The purpose of study: is to evaluate the possibilities of magnetic resonance mammography in making a differential diagnosis of non-lactational mastitis and breast cancer.
Purpose: to evaluate retrospectively the MR data of the breast phyllodes tumors and to perform comparative analysis of the MR signs and the histological grade of the phyllodes tumors.Materials and methods. The analyses enrolled 27 pathologically confirmed phyllodes tumors (mean age of patient 37.8 y.o.). Following features were evaluated: tumor shape and structure, margins, size, type of contrast enhancement, foci of high signal intensity on the T1-WI, foci of hypo- or isointense signal on the T2-WI comparing with intact breast tissue, presence of cystic inclusions and the type of their margins.Results. The study included 18 benign, 4 borderline and 5 malignant phyllodes tumors. The following features showed significant correlation with the tumor grade: irregular margins of the cystic foci (p = 0.003), foci of hypo- or isointense signal on the T2-WI compared with intact breast tissue (p = 0.005). Foci of high signal intensity on the T1-WI were often revealed in the malignant (3/5) and borderline tumors (2/4), but this dependence was not significant (p = 0.021). According to pathomorphological correlation the foci of the high signal intensity on the T1-WI corresponded to hemorrhages, while cystic foci with irregular margins were revealed to be foci of necrosis. The foci of hypo- or isointense signal on the T2-WI compared with intact breast tissue corresponded to the hypercellular stroma.Conclusion. Specific features of phyllodes tumors are useful in differentiation of their histological types; furthermore the MR mammography provides accurate data for planning the point of biopsy.
The improvement of methods of radiation diagnostics has led to an increase in the frequency of detection of breast cancer in the early stages. According to our study (a retrospective analysis of data from 195 MRM with DKU), the results of studies of women with a histologically verified diagnosis of intra-ductal carcinoma in situ (DCIS). For formations of more than 5 mm in 60 %, we obtained reliable criteria for the malignant process (contrast capture of more than 100 % for type II-III, the presence of feeding arteries). Various contrast zones without / or with the presence of less than 5 mm formation in 10–20 % of in situ carcinomas had a pattern of accumulation similar to benign proliferative changes, a statistically significant criterion was the strengthening of the vasculature on MIP reconstruction around the contrast zone, which in 31 % of cases coincided with the areas of accumulation of atypical microcalcinates detected in mammography (BI-RADS 4). MR mammography with dynamic contrast enhancement, having a high sensitivity in detecting vascularized areas, allows us to assess their nature with a high degree of probability against the background of any types of breast tissue structure.
Magnetic resonance imaging (MRI) is the most effective method of diagnosing breast pathology due to its high resolution in the study of soft tissues and high sensitivity based on the contrast effect. There is still no consensus on the choice of the optimal method of examination of patients after mastectomy and breast reconstruction. Changes in breast tissue that are associated with surgery and radiation therapy cause difficulties in interpreting mammographic and ultrasound images. MRI using a high-field tomograph (> 1 T), a specialized coil and a paramagnetic contrast agent is highly informative in the detection and differential diagnosis of recurrent formations against the background of infiltrative and scarring changes.
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