Abstract
Background: Breast cancer is the most common cancer in women all over India and accounts for 25% to 31% of all cancers in women in Indian cities. No preventive method for breast cancer has yet been defined. Special attention and control can so far only be planned among the known hereditary cancers. Therefore, to improve survival rate early detection is needed. The application of MRI for diagnosis of breast lesions is increasing rapidly. MRI imaging technique that employs time signal intensity curve, obtained by performing MRI scan after injection of contrast agent has emanated as amicable tool for screening of breast cancer, owing to its high sensitivity for detection of abnormalities.
Materials and Methods: Study was conducted at Department of Radio-diagnosis in Andhra Medical College, Visakhapatnam. Study population is 54 patients over duration of 2 years referred from OPD or IPD with clinically palpable breast lesions; non-palpable lesions with inconclusive findings on screening mammogram or screening ultrasonography; and high-risk patients who presented for screening MRI evaluation.
Results: The mean age of the patients was found to be 52.3 years. The range was found to be between 26 to 78 years. 11 patients (Approx. 21 %) with almost entirely fat type of fibro glandular tissue had malignant lesions. 32 cases i.e. 61% of patients showed mild background parenchymal enhancement, out of which 24 lesions were found to be malignant and 8 lesions were found to benign. 23 patients (48 %) had masses with irregular margin and 17 patients (35%) had masses with speculated margins, 8 cases (17%) had circumscribed margins.
Conclusion: DCE MRI of breast has been found to be an excellent diagnostic and screening tool for detecting and characterizing breast lesions. Evaluation is done based on morphology and enhancement pattern of the margin and an enhancement pattern of washout. Amongst these two, evaluation of morphology has emerged as the most useful and reliable parameter.
References
- Joe BN, Sickles EA. The evolution of breast imaging: past to present. Radiology. 2014 Nov;273(2 Suppl):S23-44.
- Aggrawal G, Su MY, NalciogluO , Feig, SA, Chen JH Significance of breast lesion descriptors in the ACR BI-RADS MRI lexicon. Cancer. 2009 April 115(7): 1363–1380.
- Ian Gardiner, MD, UrveKuusk, MD, FRCPC, Bruce B. Forster, MD, MSc, FRCPC, Audrey Spielmann, MD, FRCPC. Breast magnetic resonance imaging. BCMJ, Vol. 47, No. 10, December, 2005, page(s) 543-548.
- Kuhl CK, Mielcareck P, Klaschik S, Leutner C, Wardelmann E, Gieseke J, Schild HH. Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions? Radiology. 1999 Apr;211(1):101-10.
- Schnall MD, Rosten S, Englander S, Orel SG, Nunes LW. A combined architectural and kinetic interpretation model for breast MR images. Acad Radiol. 2001 Jul;8(7):591-7.
- Saslow D, Boetes C, Burke W, Harms S, Leach MO, Lehman CD, Morris E, Pisano E, Schnall M, Sener S, Smith RA, Warner E, Yaffe M, Andrews KS, Russell CA; American Cancer Society Breast Cancer Advisory Group. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin.2007 Mar-Apr;57(2):75-89. Erratum in: CA Cancer J Clin. 2007 May-Jun;57(3):185.
- Mann RM, Kuhl CK, Kinkel K, Boetes C. Breast MRI: guidelines from the European Society of Breast Imaging. Eur Radiol. 2008 Jul;18(7):1307-18.
- Warner E, Plewes DB, Hill KA, Causer PA, Zubovits JT, Jong RA, Cutrara MR, DeBoer G, Yaffe MJ, Messner SJ, Meschino WS, Piron CA, Narod SA. Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination. JAMA. 2004 Sep 15;292(11):1317-25.
- D’Orsi CJ, Sickles EA, Mendelson EB, Morris EA, et al. ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. Reston, VA, American College of Radiology; 2013
- Rausch DR, Hendrick RE. How to optimize clinical breast MR imaging practices and techniques on your 1.5-T system. Radiographics. 2006 Sep-Oct;26(5):1469-84.
- Grimm LJ, Anderson AL, Baker JA, Johnson KS, Walsh R, Yoon SC, Ghate SV. Interobserver Variability Between Breast Imagers Using the Fifth Edition of the BI-RADS MRI Lexicon. AJR Am J Roentgenol. 2015 May;204(5):1120-4.
- O'Connor JP, Tofts PS, Miles KA, Parkes LM, Thompson G, Jackson A. Dynamic contrast- enhanced imaging techniques: CT and MRI. Br J Radiol. 2011 Dec;84 Spec No 2:S112-20.
- King V, Brooks JD, Bernstein JL, Reiner AS, Pike MC, Morris EA. Background parenchymal enhancement at breast MR imaging and breast cancer risk. Radiology 2011 Jul;260(1):50-60.
- Telegrafo M, Rella L, Stabile Ianora AA, Angelelli G, Moschetta M. Breast MRI background parenchymal enhancement (BPE) correlates with the risk of breast cancer. MagnReson Imaging. 2016 Feb;34(2):173-6.
- Bennani-Baiti B, Dietzel M, Baltzer PA. Correction: MRI Background Parenchymal Enhancement Is Not Associated with Breast Cancer. PLoS One. 2016 Sep 8;11(9):e0162936.
- Flickinger FW, Allison JD, Sherry RM, Wright JC. Differentiation of benign from malignant breast masses by time-intensity evaluation of contrast enhanced MRI. MagnReson Imaging. 1993;11(5):617-20.
- Nunes LW, Schnall MD, Siegelman ES, Langlotz CP, Orel SG, Sullivan D, Muenz LA, Reynolds CA, Torosian MH. Diagnostic performance characteristics of architectural features revealed by high spatial-resolution MR imaging of the breast. AJR Am J Roentgenol. 1997 Aug; 169(2):409-15.
Corresponding Author
Dr N. Radha MD (RD)
Department of Radio-Diagnosis, Andhra Medical College, Visakhapatnam, India