Clustered Breast Microcalcifications: Evaluation by Dynamic Contrast-Enhanced Subtraction MRI

Gilles, R.; Meunier, Martine; Lucidarme, Olivier; Zafrani, B; Jm, Guinebretière; Aa, Tardivon; M, Le Gal; Vanel, D.; Neuenschwander, S.; Arriagada, R.

doi:10.1097/00004728-199601000-00003

Cited by 70 publications

(42 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Because DCIS is the earliest stage of breast cancer and has the best prognosis, it is likely that further improvements in the detection of breast cancers at a preinvasive stage may improve patient outcomes. Some reports have shown decreased diagnostic accuracy of DCE MR imaging for DCIS (2,3), while others have shown comparable or even higher performance compared with that of x-ray mammography (4,5). The sensitivity of DCE MR imaging for detection of DCIS may be compromised if the lesion does not exhibit sufficient gadolinium uptake or if it is obscured by strongly enhancing parenchyma (6,7).…”

Section: C3mentioning

confidence: 99%

Ductal Carcinoma in Situ: X-ray Fluorescence Microscopy and Dynamic Contrast-enhanced MR Imaging Reveals Gadolinium Uptake within Neoplastic Mammary Ducts in a Murine Model

Jansen¹,

Paunesku²,

Fan³

et al. 2009

Radiology

View full text Add to dashboard Cite

Purpose:To combine dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging with x-ray fluorescence microscopy (XFM) of mammary gland tissue samples from mice to identify the spatial distribution of gadolinium after intravenous injection. Materials and Methods:C3(1) Sv-40 large T antigen transgenic mice (n ϭ 23) were studied with institutional animal care and use committee approval. Twelve mice underwent DCE MR imaging after injection of gadodiamide, and gadolinium concentrationtime curves were fit to a two-compartment pharmacokinetic model with the following parameters: transfer constant (K trans ) and volume of extravascular extracellular space per unit volume of tissue (v e ). Eleven mice received gadodiamide before XFM. These mice were sacrificed 2 minutes after injection, and frozen slices containing ducts distended with murine ductal carcinoma in situ (DCIS) were prepared for XFM. One mouse received saline and served as the control animal. Elemental gadolinium concentrations were measured in and around the ducts with DCIS. Hematoxylin-eosin-stained slices of mammary tissues were obtained after DCE MR imaging and XFM. Results:Ducts containing DCIS were unambiguously identified on MR images. DCE MR imaging revealed gadolinium uptake along the length of ducts with DCIS, with an average K trans of 0.21 min Ϫ1 Ϯ 0.14 (standard deviation) and an average v e of 0.40 Ϯ 0.16. XFM revealed gadolinium uptake inside ducts with DCIS, with an average concentration of 0.475 mmol/L Ϯ 0.380; the corresponding value for DCE MR imaging was 0.30 mmol/L Ϯ 0.13. Conclusion:These results provide insight into the physiologic basis of contrast enhancement of DCIS lesions on DCE MR images: Gadolinium penetrates and collects inside neoplastic ducts. RSNA, 2009 Note: This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, use the Radiology Reprints form at the end of this article.T he sensitivity and specificity of dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging in the early detection of invasive cancers have been shown to be equal or superior to those of x-ray mammography (1). However, this has not been consistently demonstrated for ductal carcinoma in situ (DCIS), which is a nonobligate precursor to invasive breast cancer, in which cancer cells are still confined by the basement membrane of mammary ducts. Because DCIS is the earliest stage of breast cancer and has the best prognosis, it is likely that further improvements in the detection of breast cancers at a preinvasive stage may improve patient outcomes. Some reports have shown decreased diagnostic accuracy of DCE MR imaging for DCIS (2,3), while others have shown comparable or even higher performance compared with that of x-ray mammography (4,5). The sensitivity of DCE MR imaging for detection of DCIS may be compromised if the lesion does not exhibit sufficient gadolinium uptake or if it is obscured by strongly enhancing parenchyma (6,7). Even when D...

show abstract

Section: C3mentioning

confidence: 99%

Ductal Carcinoma in Situ: X-ray Fluorescence Microscopy and Dynamic Contrast-enhanced MR Imaging Reveals Gadolinium Uptake within Neoplastic Mammary Ducts in a Murine Model

Jansen¹,

Paunesku²,

Fan³

et al. 2009

Radiology

View full text Add to dashboard Cite

show abstract

“…Dynamic enhancement rates of DCIS are extremely variable [16], but morphological criteria such as segmental or linear enhancement have been reported to be the imaging hallmarks of DCIS on breast MRI [15,[17][18][19][20][21][22][23]. However, the positive predictive value of this enhancement pattern is still unknown.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic usefulness of segmental and linear enhancement in dynamic breast MRI

et al. 2005

View full text Add to dashboard Cite

The aim of this study was the evaluation of the diagnostic usefulness of ductal or segmental enhancement in dynamic breast MRI. Segmental and ductal enhancement have been established as the breast MRI hallmarks of intraductal breast cancer (DCIS); however, the positive predictive value of this imaging finding is still unknown. In our study, we analysed the overall prevalence of a segmental or a linear enhancement pattern on breast MRI for an unselected cohort of patients. The aim was to evaluate the diagnostic usefulness of segmental or linear enhancement. Second, we asked whether biopsy was necessary also in the absence of mammographic findings suggestive of DCIS. Prospective, consecutive evaluation of 1,003 patients undergoing bilateral dynamic breast MRI. Studies were interpreted by two experienced breast radiologists. A diagnostic or screening two-view mammogram was available for all patients. Biopsy or short-term breast MRI follow-up was recommended for patients showing a segmental or a linear enhancement pattern on breast MRI. The patients' final diagnoses were established by imaging guided excisional or core biopsy or by clinical plus conventional imaging follow-up for a period of 2 years. The prevalence of segmental or linear enhancement was determined for patients with a final diagnosis of benign breast disease compared with those with a diagnosis of breast cancer. One hundred twenty patients had invasive breast cancer, 24 patients had DCIS and 859 patients had unsuspicious breast MRI or benign breast disease. A segmental or a linear enhancement pattern was found for 50/1,003 (5%) patients (17 DCIS, 33 benign breast diseases). Accordingly, the positive predictive value of segmental and linear enhancement is 34% (17/50); the specificity of this criterion is 96% (826/859). For 4/24 (17%) patients, DCIS was visible as segmental or linear enhancement on dynamic breast MRI, whereas no abnormalities were visible on the corresponding mammogram. The overall prevalence of a ductal or a segmental enhancement pattern on breast MRI is low. But this finding has a high specificity and a moderate positive predictive value for intraductal neoplastic changes. We conclude that if segmental or linear enhancement is identified on breast MRI further work-up is necessary. We recommend either direct MR-guided vacuum-assisted core biopsy or short-term follow-up breast MRI within 3 months. If ductal enhancement then persists, MR-guided biopsy should be recommended even in the absence of mammographically visible signs of DCIS.

show abstract

“…Westerhof et al (1998), investigating mammographically suspicious microcalcifications, reported a sensitivity of 45%, specificity of 72%, positive predictive value of 71%, negative predictive value 46% and an accuracy of 56%, and in a further study, Gilles et al observed a sensitivity of 95% and a specificity of 51%. Their specificity was impaired because the presence or absence of contrast uptake in the breast was the only parameter used to decide if the area of microcalcification was associated with malignancy or not (Gilles et al, 1996).…”

Section: Dcismentioning

confidence: 99%

Current applications and future direction of MR mammography

2003

View full text Add to dashboard Cite

Compared with triple assessment for symptomatic and occult breast disease, magnetic resonance mammography (MRM) offers higher sensitivity for the detection of multifocal cancer, which is important in selecting patients appropriately for breast-conserving surgery. It is an ideal tool for the screening of patients with a high risk of breast cancer or where there is axillary disease or nipple discharge and conventional imaging has not revealed the primary focus. Techniques are now available to biopsy lesions only apparent on MRM. MRM can differentiate scar tissue from tumour; therefore, it is useful in patients in which there is possible recurrent disease. Clinical and X-ray mammographic assessment of response to neoadjuvant chemotherapy may be unreliable because of replacement of the tumour with scar tissue. MRM can identify responders and nonresponders with more accuracy. It is the modality of choice for the assessment of breast implants for rupture with accuracy higher than X-ray mammography and ultrasound. Advances in both spatial and temporal resolutions, the imaging sequences employed, pharmacokinetic modelling of contrast uptake, the use of dedicated and now phased-array breast coils, and gadolinium-based contrast agents have all played their part in the advancement of this imaging technique. Despite the limitations of patient compliance, scan-time and cost, this review describes how MRM has become a valuable tool in breast disease, especially in cases of diagnostic uncertainty. However, MRM must make the transition from research institutions into routine clinical practice.

show abstract

Clustered Breast Microcalcifications: Evaluation by Dynamic Contrast-Enhanced Subtraction MRI

Abstract: Poor specificity limits the diagnostic accuracy of dynamic contrast-enhanced subtraction MRI in distinguishing benign from malignant microcalcifications on mammography.

Cited by 70 publications

References 7 publications

Ductal Carcinoma in Situ: X-ray Fluorescence Microscopy and Dynamic Contrast-enhanced MR Imaging Reveals Gadolinium Uptake within Neoplastic Mammary Ducts in a Murine Model

Ductal Carcinoma in Situ: X-ray Fluorescence Microscopy and Dynamic Contrast-enhanced MR Imaging Reveals Gadolinium Uptake within Neoplastic Mammary Ducts in a Murine Model

Diagnostic usefulness of segmental and linear enhancement in dynamic breast MRI

Current applications and future direction of MR mammography

Contact Info

Product

Resources

About