Magnetic Resonance Imaging Assessment of Radial Scars/complex Sclerosing Lesions of the Breast

Abstract

Purpose: To describe the magnetic resonance characteristics of radial scars/complex sclerosing lesions (RS/CSL) of the breast using the current BI-RADS lexicon. To investigate the value of diffusion weighted imaging to predict malignancy. Patients and methods: From 2010 to 2017 we have found 25 women with architectural distortion at mammography who underwent surgical resection with a final hystopathologic report of RS/CSL. For description of MRI findings we adhered to BI-RADS classification (5th edition). Results: The final pathological diagnosis was: “pure” RS/CSL in 7 cases (28%), RS/CSL with associated high risk lesions in 12 (48%) and 6 cases (24%) were associated with malignancy. Magnetic resonance findings: four of 25 negative or focus. Five of 25 mass enhancement: irregular, non circumscribed spiculated mass with heterogeneous or rim enhancement and most with type II curves. Sixteen of 25 non mass enhancement: focal or linear distribution and heterogeneous internal enhancement most with type I curves. Six of 25 had cancer associated with the complex sclerosing lesion. All six showed non-mass, focal and clustering-ring enhancement. Two cases with invasive breast carcinoma had ADC values under 1.15 x10−3 mm/s while most of the rest had values above. Conclusion: Most RS/CSL showed enhancement at MR. The predominant pattern was a non-mass, focal, heterogeneous internal enhancement with type 1 curves. All cases with associated cancer showed non mass enhancement. Invasive breast cancers had ADC values < 1.15 10-3 s/mm2.

Distance of Biopsy-Confirmed High-Risk Breast Lesion from Concurrently Identified Breast Malignancy Associated with Risk of Carcinoma at the High-Risk Lesion Site

“…One approach to the stratification of risk conferred by these high-risk lesions has been the study of imaging features on MRI, as many of these lesions are diagnosed by this modality. Some authors have reported modestly increased risk of upgrade with ALH, LCIS, CSL and IPA lesions that are large in size, have clumped non-mass enhancement (NME) with mixed kinetics or NME with regional/segmental distribution [ 29 , 30 , 31 ]. Other authors have not found any imaging features predictive of upgrade.…”