MRI in patients with axillary metastases of occult breast carcinoma

Tilanus-Linthorst, Madeleine M.A.; Obdeijn, A.I.M.; Bontenbal, M.; Oudkerk, Matthijs

doi:10.1023/a:1005774009740

Cited by 50 publications

(22 citation statements)

References 16 publications

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“…In our patients with axillary lymph node metastases who presented with negative findings in mammographic and physical examinations, primary breast cancer was detected in 75-86% by MRI compared to the 80% detection rate reported by Tilanus-Linthorst et al [20] . Moreover, the incidence of an axillary lymph node manifestation from an occult primary breast cancer was low, with rates ranging from 0.3 to 0.8% of all patients with carcinoma of the breast at the time of presentation as reported by Solin et al [21] .…”

Section: Discussioncontrasting

confidence: 55%

Breast Magnetic Resonance Imaging: Initial Experience in Kuwait

Al-Khawari

Kovacs²,

Athyal³

et al. 2009

Med Princ Pract

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Objective: To report our initial experience of breast magnetic resonance imaging (MRI) in Kuwait in order to identify and characterize breast lesions. Subjects and Methods: In 58 patients ranging in age from 25 to 64 years, breast MRI was performed as a problem-solving tool (29); for suspicious local relapse of the treated breast (6); to search for a primary breast cancer in patients with metastatic axillary lymph nodes (5); for local staging of breast cancer (5); breast implants (6); screening in high-risk patients (3), and differentiation between inflammation and inflammatory carcinoma (4). Sagittal fat-saturated T₂ and axial T₁ images were obtained before, and axial fat-saturated T₁ and dynamic sagittal fat-saturated T₁-weighted images after contrast enhancement in a 1.5-tesla closed magnet. The diagnostic criteria were based on the morphology and kinetics of the lesion. Findings were validated by tissue sampling or radiological follow-up. Results: Seventy breast lesions (25 malignant, 38 benign and 7 lesions detected by MRI only) were identified in the 58 patients. The sensitivity, specificity, and positive and negative predictive values of MRI in diagnosing malignant breast lesions were 96, 67, 71 and 95%, respectively, while the accuracy was 80%. Conclusion: This initial experience is comparable to other published data. Future plans for improving image spatial resolution and MR-guided procedures have been taken into consideration.

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Section: Discussioncontrasting

confidence: 55%

Breast Magnetic Resonance Imaging: Initial Experience in Kuwait

Al-Khawari

Kovacs²,

Athyal³

et al. 2009

Med Princ Pract

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“…Aksillada metastaz olup memede mamografi ve US ile bir lezyon saptanamıyorsa, okult meme kanseri demeden önce tetkik olarak mutlaka MR eklenmeli ve tedavi ona göre yönlendirilmelidir (34,35 MR'ı her ne kadar yüksek derecede sensitif bir yöntem ise de, maliyetinin yüksek olması, hastaların bu yönteme uyumunda sorun olabilmesi ve spesifitesinin düşük olması (%30-95) gibi dezavantajları vardır (32,36). Dolayısıyla hatalı pozitif durumları azaltmak için biyopsi yapılması şarttır (30).…”

Section: Mrunclassified

Occult Breast Cancer

Kebudi¹

2013

J Breasth Health

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Breast carcinoma is the most common malignancy in women after skin cancer and, after lung cancer, the most frequent cause of cancer death in females. With advances in screening over the past 25 years, fewer than 10% of patients will present with metastatic breast carcinoma at the time of diagnosis. Occult breast carcinoma presenting axillary metastases is uncommon and accounts for less than 1% of newly diagnosed breast carcinoma. However, it continues to be a challenging diagnostic and therapeutic problem. In this review, the current approach to diagnosis and treatment of occult breast cancer is discussed. Okult primer meme kanserleri (OMK), T0N1 (evre II) olarak sınıf-landırılmaktadır. Aksiller metastazı olan OMK insidansı düşük-tür. Mamografi öncesi döneme ait üç geniş seride, bu oran tüm meme kanserleri içinde %0,30-1 (2-4) iken, mamografi dönemin-de dört geniş seride bu oran %0,34-0,88 olarak bulunmuştur (5-8) (Tablo 1).Mamografi, ultrasonografi (US) ve Manyetik Rezonanstaki (MR) gelişmelerle birlikte aksiller metastazlı OMK tanısında azalma söz konusudur. Curie Enstitüsü'nde 1960-1997 yılları arasında 59 hasta tedavi edilmiştir (9). Hastalarda medyan yaş 57 (36-79) idi. Otuz beş hasta (%58) postmenopozal dönemde ve iki hasta hormon replasman tedavisi görmekteydi. On beş hastada (%25) meme kanseri aile öyküsü saptandı. Ayrıca diğer çalışmalarda da, bu hasta grubunda ailesel meme kanseri öyküsü yüksek oranda bulunmuştur (6-8). Yirmi sekiz hastada (%47,5) sol aksiller nodlar ve 31 hastada da (%52,5) sağ aksiller nodlar ön plandaydı. TanıKlinik Muayene: OMK tanılı kadınların yaş ortalaması 45-55 arasıdır (10). Lenf nodlarının ortalama çapını Haagensen ve ekibi (11) ile Andrade ve ekibi (12) 4,7 cm, Curie Enstitüsü ise 3 cm olarak vermiştir (13). Nadiren, karşı memede kanser hikayesi olan hastalarda aksiller metastaz görülebilir (14,15). Bu durumda aksilladaki tutulumun nedeninin karşı taraftaki meme kanserinden mi, yoksa aynı taraftaki memedeki yeni, okult bir kanserden mi olduğunu söylemek zordur.Büyümüş aksiller lenf nodları genellikle selimdir, %70 oranında nonspesifik inflamatuvar veya hiperplastik değişikliklere bağlı, %7 oranında da granülomlara bağlı olarak gelişmektedir (16,17). Geriye kalan olgularda malign bir neden vardır. Kadınlarda en sık primer kanser, memenin adenokarsinomudur. Lenfoma ve metastatik kanserler de diğer sebeplerdir. Cilt melanomu, tiroid, akciğer, over, gastrointestinal ve böbrek hücreli kanserler, prostat kanseri meme bölgesine metastaz yapan kanserler olarak sayılabilir (18)(19)(20).Aksiller adenopatisi olan bir kadında tanı amacıyla yapılacak ilk iş, dikkatli bir anamnez alma ve iyi bir fizik muayenedir. Örneğin diğer lenf nodu bulunan bölgelerde yaygın lenfadenopati viral etyoloji

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“…Sensitivity is not impaired by dense parenchyma. Moreover, the technique is known to detect breast cancers that are undetected at mammography even when the breast tissue is not dense [37,38]. In addition, MRI does not employ ionizing radiation.…”

Section: Ce Mri Of Symptomatic Womenmentioning

confidence: 99%

MRI in familial breast cancer

Gilhuijs

Deurloo

2004

Breast Cancer Online

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Five to ten per cent of all breast cancers are associated with a proven genetic predisposition for the disease or a strong family history of breast cancer in which yet unknown genetic predisposition is suspected. Carriers of germline mutations in genes breast cancer 1 or 2 (BRCA1/2) have up to 85% chance of developing breast cancer during their lifetime. The majority of these women develop the disease before the age of 50 years. Consequently, breast-cancer screening programmes aimed at reducing mortality in this population may only be effective if they start at much younger age than the general breast-cancer screening programmes. Unfortunately, the efficacy of conventional X-ray mammography in premenopausal women is often limited by dense fibroglandular tissue that obscures suspicious lesions. As a result, more advanced breast-imaging techniques have been considered, such as contrast-enhanced (CE) magnetic resonance imaging (MRI). In symptomatic patients, the sensitivity of CE MRI to detect invasive breast cancer is known to be high, regardless of the density of the fibroglandular tissue. Conversely, the specificity of CE MRI to discriminate between benign and malignant lesions is variable, and depends on the indication of the examination. Low specificity could result in many recalls on benign lesions, thus negatively affecting the cost–benefit ratio of CE MRI as a screening technique. Several single- and multi-institutional studies have been performed to investigate the efficacy of CE MRI as a screening tool exclusively for asymptomatic women at increased lifetime risk of breast cancer. Mounting evidence suggests that the addition of CE MRI results in cost-effective detection of tumours at earlier stage in BRCA1/2 mutation carriers. The value of CE MRI in other populations at risk is currently uncertain, and it is unlikely that CE MRI will be cost efficient in the general screening population of women who are not at increased lifetime risk.

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MRI in patients with axillary metastases of occult breast carcinoma

Cited by 50 publications

References 16 publications

Breast Magnetic Resonance Imaging: Initial Experience in Kuwait

Breast Magnetic Resonance Imaging: Initial Experience in Kuwait

Occult Breast Cancer

MRI in familial breast cancer

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