Correlation of Lesion Appearance and Histologic Findings for the Nodes of a Breast MR Imaging Interpretation Model

Abstract

An interpretation model for evaluating magnetic resonance (MR) images of the breast was constructed that allowed differentiation of benign from malignant palpable or mammographically visible abnormalities. Architectural features define each node of the model. Investigation was subsequently made of the histologic findings in individuals within each node and of the frequency with which each histologic finding manifested as a particular architectural feature to determine whether nodal location and specific histologic findings are mutually predictive. The strongest associations were found between fibrocystic change and smooth masses, fibroadenoma and lobulated masses with nonenhancing internal septations, invasive ductal carcinoma (with or without ductal carcinoma in situ [DCIS]) and enhancing irregular or spiculated masses, invasive tubular carcinoma or radial scar and spiculated masses, medullary or colloid carcinoma and enhancing lobulated masses, invasive lobular carcinoma and the absence of a focal mass, DCIS and ductal enhancement, and DCIS (with or without invasive ductal carcinoma) and regional enhancement. Nodal location and histologic findings proved to be mutually predictive within the model; that is, the nodal location of MR imaging features within the model can be used to predict histologic findings and vice versa.

Something as Simple and as Complex as Fibrocystic Masthopathy Review of MRI Findings in a Case Report

“…In fact, the MR presentation can be very similar to mammographic, with small well defined and grouped cysts, or we can see after administration of contrast a dotted striking patchy pattern and diffuse, even as in our case, a regional enhancement or even a heterogeneous mass [6]. Proliferative changes may also be arranged as a mass effect by the compressive effect on the stroma, altering the configuration and arrangement of the glandular component, which is indistinguishable from DCIS or invasive carcinoma [6].…”

Optimal post‐contrast timing of breast MR image acquisition for architectural feature analysis

“…However, both high spatial resolution architectural imaging data and high temporal resolution contrast kinetic data could ideally be obtained in a single MR examination, and perhaps used in combination for greater diagnostic accuracy. Some investigators (21) have been evaluating single pulse sequences to try to allow this occurrence, but their spatial resolution does not yet equal that of studies designed to maximize spatial resolution (2)(3)(4)22,23). Although pulse sequences have been reported that can obtain both high spatial and high temporal resolution concurrently, their efficacy has not yet been clinically tested (24).…”

Clinically Practical Magnetic Resonance Protocol for Improved Specificity in Breast Cancer Diagnosis

“…Although the results of investigation to date have varied greatly, the sensitivity of breast DCE, T1-weighted MRI for malignancy has consistently been reported to be excellent (88-100%) (7)(8)(9)(10)(11)(12)(13)(14)(15). Qualitative analyses of the temporal changes in signal intensity following bolus CR injection have shown that malignant tissues generally enhance early, with rapid, large increase in signal intensity as compared with benign tissues.…”

“…This is presumably due to the inherent leakiness of the tumor vasculature and/or increased vascularization. However, the specificity of DCE MRI has been rather variable, ranging from 37-97% (7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Recently, T2 * -weighted perfusion MRI (17)(18)(19), as well as the technique of 1 H MR spectroscopy (MRS) (20)(21)(22) have also been examined as promising tool for improving the specificity of breast malignancy detection.…”