Evaluation of Residual Disease Using Breast MRI After Excisional Biopsy for Breast Cancer

Chae, Eun Young; Hee, Joo; Kim, Hak Hee; Shin, Hee Jung; Kim, Hyunji; Lee, Jung Bok; Cheung, Joo Yeon

doi:10.2214/ajr.12.9275

Cited by 22 publications

(27 citation statements)

References 30 publications

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“…Previous studies have investigated breast MRI findings in patients who have undergone both surgery and radiation. 11,12,17 To the best of our knowledge, our study is the first to report, as a separate group, patients who underwent surgical excisional biopsy but not radiation treatment. We observed that postoperative enhancement developed significantly less often in patients who had undergone surgery alone, compared with patients who had undergone both surgery and radiation.…”

Section: Resultsmentioning

confidence: 85%

“…Radiation treatment also plays an important role in the histopathologic changes of the postconservation breast. Previous studies have investigated breast MRI findings in patients who have undergone both surgery and radiation . To the best of our knowledge, our study is the first to report, as a separate group, patients who underwent surgical excisional biopsy but not radiation treatment.…”

Section: Discussionmentioning

confidence: 87%

“…Given the findings of enhancement during the later postoperative periods in our patients, its mere presence should not be a cause for concern, but must be evaluated in the context of both the morphologic pattern and the kinetics of enhancement. While others have suggested that the pattern of enhancement be characterized descriptively (thin, thick, nodular), we believe that a physiological description of the enhancement pattern (cavity, scar, mass, fat necrosis) may be more useful and have suggested it herein.…”

Section: Discussionmentioning

confidence: 93%

“…15 Given the findings of enhancement during the later postoperative periods in our patients, its mere presence should not be a cause for concern, but must be evaluated in the context of both the morphologic pattern and the kinetics of enhancement. While others have suggested that the pattern of enhancement be characterized descriptively (thin, thick, nodular), 17 Radiation treatment also plays an important role in the histopathologic changes of the postconservation breast. Previous studies have investigated breast MRI findings in patients who have undergone both surgery and radiation.…”

Section: Resultsmentioning

confidence: 99%

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Postoperative enhancement on breast MRI: Time course and pattern of changes

Mahoney

Sharda²

2018

Breast J

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Expected postoperative enhancement on breast MRI can appear similar to enhancement seen in recurrent or residual malignancy. Our aim was to assess the time course and patterns of enhancement at the surgical site, thereby helping to distinguish between benign and malignant postoperative enhancement. In 200 MRI scans performed in 153 patients after breast conservation treatment, 43 after surgical excision of atypia, and 4 patients after benign excisional biopsy were categorized by postoperative time interval. We defined 4 patterns of morphologic enhancement on MRI: cavity wall/seroma (Pattern I); thin linear (Pattern II); mass (Pattern III); and fat necrosis (Pattern IV). Of 200 MRI scans, 66 (33%) demonstrated enhancement at the surgical site. Enhancement typically decreased through the postoperative follow-up period. Enhancement was observed in 41% (28/68) of cases beyond the 18-month interval but was uncommon after 5 years. Pattern III enhancement was the morphologic pattern seen most commonly with malignancy (5/19 cases, 26%). When associated with delayed washout kinetics, it was even more strongly predictive of malignancy (4/5 cases, 80%). In patients with a history of excisional biopsy and no prior radiation treatment, the percentage of MRI scans showing enhancement was significantly lower than (21% vs 49% with P-value .0027) in patients who had undergone radiation. Enhancement at the surgical site occurred in one-third of cases up to 5 years after surgery, particularly in patients who underwent both radiation and surgery. Mass enhancement, particularly in conjunction with delayed washout kinetics, is most predictive of malignancy and should prompt biopsy or re-excision.

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Section: Resultsmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 93%

Section: Resultsmentioning

confidence: 99%

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Postoperative enhancement on breast MRI: Time course and pattern of changes

Mahoney

Sharda²

2018

Breast J

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“…It makes valuable contributions in high-risk screening; evaluating the extent of disease, positive surgical margins, and response to neoadjuvant chemotherapy; as well as distinguishing postoperative scar from recurrent disease. [1][2][3][4][5][6] Although the examination is focused on the breast, portions of the neck, thorax, and upper abdomen are also visualized. Just as in computed tomography, the issue of the incidental or unexpected finding must be addressed by the reader.…”

mentioning

confidence: 99%

Breast Magnetic Resonance Imaging Incidental Findings

Szabo

2014

Topics in Magnetic Resonance Imaging

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B reast magnetic resonance imaging (MRI) is now an integral part of breast imaging. It makes valuable contributions in high-risk screening; evaluating the extent of disease, positive surgical margins, and response to neoadjuvant chemotherapy; as well as distinguishing postoperative scar from recurrent disease. [1][2][3][4][5][6] Although the examination is focused on the breast, portions of the neck, thorax, and upper abdomen are also visualized. Just as in computed tomography, the issue of the incidental or unexpected finding must be addressed by the reader.The detection of these findings during diagnosis and surveillance often results in additional testing, economic burden, and anxiety for the patient. Most incidentally detected lesions are benign; however, the reader must consider the potential of these findings to be metastases or additional primary tumors. Approximately 5% to 10% of breast cancers are metastatic at the time of diagnosis. 7 Even with significant advances in breast cancer treatment, up to 70% of node-positive breast cancers will relapse and 20% to 30% of women with stage I and II disease will develop distant metastases, occurring approximately 15 years after radiation therapy. 7,8 Therefore, all detected findings must be carefully considered. A recent study demonstrated the bone, lung, and liver to be the most common anatomical sites of distant metastases in patients with breast cancer, with 21.9% presenting with multisite involvement. 9 The exception to this pattern is the basal-like and triple-negative breast cancers, which have a predilection for visceral and central nervous system metastases and infrequently involve bone. 10 Although lesion detection occurs on potentially any sequence, the 3-dimensional fast spoiled gradient echo axial sequence is reported to be superior to the short tau inversion recovery sequence in incidental finding detection (82.8% vs 76.5%). 11 As in computed tomography, the addition of intravenous contrast enhances lesion detection. Rinaldi et al 11 demonstrated the enhanced 3-dimensional fast spoiled gradient echo axial fat-suppressed axial sequence to have greater sensitivity compared with unenhanced images in detecting metastatic lesions, especially those smaller than 10 mm (98.3% vs 79.3%). These lesions are often on the edge of the field of view and require window manipulation for identification. BREASTDuring the initial extent of disease evaluation, it is not uncommon to discover additional breast lesions. Management of ipsilateral breast findings is directed by their morphology, enhancement characteristics, and proximity to the index tumor. Masses found in the contralateral breast during the extent of disease evaluation raise the issue of an additional primary tumor.Studies have reported an incidence of contralateral synchronous malignancy detected by preoperative MRI to be in the range of 3% to 5 %. 12-14 A contralateral metachronous cancer has been reported to develop in 5% to 10% of patients with breast cancer within a 10-year follow-up. 12 This is especia...

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