乳腺MRI在X线检查乳腺阴性腋淋巴结转移癌阳性患者中的应用价值

目的 探讨乳腺MR检查对临床乳腺触诊和X线检查均为阴性的腋淋巴结转移癌患者寻找其乳腺内原发病灶的应用价值.方法 分析33例以腋淋巴结转移癌为首诊表现(临床乳腺触诊和X线检查均为阴性)患者的乳腺MR影像资料,依据美国放射学会的乳腺影像报告和数据系统MRI标准对所有病变进行分析,并将MRI诊断结果与病理进行对照.结果 33例腋淋巴结转移癌患者中,30例临床行乳腺根治术,其中17例经病理证实为乳腺癌,乳腺MRI检出其中的16例,包括10例肿块性病变和6例非肿块性病变,肿块性病变直径0.5～2.6 cm(平均1.5 cm),直径≤1.5 cm者6例;非肿块性病变包括4例导管性强化和2例段性强化;另1例病理切片发现乳腺癌但乳腺MRI为阴性.其余13例行乳腺根治术患者病理检查未发现乳腺癌灶,其中9例乳腺MRI亦呈阴性表现,另4例MRI提示可疑癌灶.余3例临床未行手术治疗的患者,乳腺MRI亦为阴性.以病理诊断为金标准,MR检出乳腺原发癌灶的敏感度、特异度和准确度分别为94.1%、69.2%和83.3%.结论 相对于一般乳腺癌而言,隐匿性乳腺癌MRI表现更以小灶性的肿块性病变和导管或段性强化的非肿块性病变为常见表现类型.乳腺MR检查对隐匿性乳腺癌的检出具有较高的敏感度和准确度,应作为这类患者的常规检查手段.     

乳腺MRI在X线检查乳腺阴性腋淋巴结转移癌阳性患者中的应用价值

目的 探讨乳腺MR检查对临床乳腺触诊和X线检查均为阴性的腋淋巴结转移癌患者寻找其乳腺内原发病灶的应用价值.方法 分析33例以腋淋巴结转移癌为首诊表现(临床乳腺触诊和X线检查均为阴性)患者的乳腺MR影像资料,依据美国放射学会的乳腺影像报告和数据系统MRI标准对所有病变进行分析,并将MRI诊断结果与病理进行对照.结果 33例腋淋巴结转移癌患者中,30例临床行乳腺根治术,其中17例经病理证实为乳腺癌,乳腺MRI检出其中的16例,包括10例肿块性病变和6例非肿块性病变,肿块性病变直径0.5～2.6 cm(平均1.5 cm),直径≤1.5 cm者6例;非肿块性病变包括4例导管性强化和2例段性强化;另1例病理切片发现乳腺癌但乳腺MRI为阴性.其余13例行乳腺根治术患者病理检查未发现乳腺癌灶,其中9例乳腺MRI亦呈阴性表现,另4例MRI提示可疑癌灶.余3例临床未行手术治疗的患者,乳腺MRI亦为阴性.以病理诊断为金标准,MR检出乳腺原发癌灶的敏感度、特异度和准确度分别为94.1%、69.2%和83.3%.结论 相对于一般乳腺癌而言,隐匿性乳腺癌MRI表现更以小灶性的肿块性病变和导管或段性强化的非肿块性病变为常见表现类型.乳腺MR检查对隐匿性乳腺癌的检出具有较高的敏感度和准确度,应作为这类患者的常规检查手段.

Abstract：

Objective To evaluate the role of breast MRI in detecting the primary malignancy in patients presenting solely with axillary lymph node metastases. Methods Thirty-three patients with axillary lynph node metastases but negative findings on either physical examination or mammography underwent breast MRI to identify occult breast carcinoma. MRI of the breast was assessed according to BI-RADS criteria. The pathologic diagnosis was made according to the standard criteria by the WHO Classification of Tumor. Results Among 33 patients presenting solely with axillary metastases, 30 patients underwent modified radical mastectomy. Primary breast carcinoma was proven in 17 patients. MRI detected lesions in 16 patients, including 10 masses and 6 non-mass lesions. Size of the masses ranged from 0. 5 to 2. 6 cm (mean 1.5 cm). Six lesions were smaller than 1.5 cm in size. Non-mass lesions showed ductal enhancement in 4 cases and segmental enhancement in 2 cases. One patient with tumor detected by histopathology showed no abnormal enhancement on MRI. No tumor was found at mastectomy in the other 13 womeu, and negative MR findings were revealed in 9. Four cases with suspicious enhancement on MRI had no corresponding primary foci on pathology. Three patients didn't undergo surgical procedure. The sensitivity, specificity, and accuracy of MRI in the diagnosis of the primary malignancy were 94. 1%,69. 2%, and 83.3%, respectively. Conclusions Small size of mass and ductal or segmental enhancement of non-mass lesion were common MR features of occult malignancy. MRI showed high sensitivity and accuracy in diagnosing occult breast carcinoma. Breast MRI should be taken in search of occult malignancy in patients with axillary metastases.     

MR乳腺线圈对腋窝淋巴结的评价

目的　研究正常与异常乳腺腋窝淋巴结的MRI表现 ,探讨MR乳腺线圈对术前乳腺癌腋窝淋巴结转移的评估。方法　应用MR乳腺线圈对 2 4例健康志愿者、2 3例乳腺良性疾病患者和 43例乳腺癌患者共 119个腋窝进行扫描 ,对比分析MRI片内各组腋窝淋巴结的形态、边缘、大小、数目和信号变化 ,并将乳腺癌组淋巴结表现与组织病理学结果进行对照。结果　 3 1.2 5 %的正常健康人腋窝可以检出淋巴结 ,乳腺良性疾病、乳腺癌腋窝淋巴结无转移者 (LN -)淋巴结的形态、边缘、大小、数目和信号变化与正常健康人无显著差异 ,乳腺癌腋窝淋巴结转移者 (LN + )淋巴结的形态、边缘、大小和强化方式与前三者有显著差异。结论　MRI是术前评估腋窝淋巴结状态的有效检查方法 ,为临床手术和治疗提供有价值的依据     

乳腺DR在农村地区对触诊阴性乳腺癌的诊断价值

目的：探讨乳腺 DR 检查在农村地区触诊阴性乳腺癌检出中的作用。方法随机选取2012年本院13700例来院检查的当地妇女中的6754例,不论临床医生是否触及肿块(年龄30~83岁),均进行乳腺 X 线检查。结果6754例 X 线检查报告中,考虑乳腺癌72例(72/6754),其中临床触诊阳性乳腺癌患者59例(59/72),临床触诊阴性乳腺癌患者13例(13/72),年龄在35~77岁之间(临床触诊阴性患者)。临床触诊阴性乳腺癌病理所见原位癌6例、导管内癌3例、浸润性导管癌4例。结论乳腺 X 线检查利于较早发现临床触诊阴性乳腺癌,提高乳腺癌的早期诊断率。     

99Tcm标记抗粘蛋白McAb乳腺癌放射免疫显像的临床研究

目的　评价99Tcm 标记抗乳腺癌粘蛋白单克隆抗体 (McAb)放射免疫显像 (RII)诊断乳腺癌的临床价值。方法　选择 17例乳腺肿瘤患者进行RII。结果　 9例原发性乳腺癌中 8例RII阳性 ,灵敏度 88 89% ;5例原发性乳腺癌伴腋淋巴结转移及 1例右乳腺浸润性导管癌根治术 5a后出现右腋淋巴结转移 ,RII发现其中 5例出现淋巴结转移 ;而 6例乳腺良性病变和 1例右乳腺单纯癌根治术7a后随访 ,RII阴性。结论　99Tcm 标记抗粘蛋白McAbRII可作为乳腺癌特异性诊断的重要辅助手段 ,并对淋巴结转移、术后复发等具有一定的诊断价值。     

乳腺癌MRI诊断的临床应用价值

目的 评价MRI在乳腺癌临床诊断中的应用价值。资料与方法 30例临床或乳腺X线摄影诊断有困难的患者行乳腺和腋窝MRI检查，17例经组织病理证实为乳腺癌，分析MRI显示乳腺癌病灶和胸肌浸润以及淋巴结转移的敏感性，所有结果均与病理对照。结果 17例乳腺癌患者共检出35个病灶，包括6例多中心性乳腺癌、4例多灶性乳腺癌和7例单发病灶(包括2例隐匿性乳腺癌)。6例(35．3％)出现胸肌浸润；腋窝淋巴结转移11例，其中9例病理证实，其敏感性为81．8％。结论乳腺MRI对检出隐匿性乳腺癌，多灶性和多中心性乳腺癌，评估胸肌有无浸润以及腋窝淋巴结有无转移具有重要价值。     

彩色多普勒超声对良恶性乳腺肿瘤的研究

目的：探讨彩色多普勒超声(Colour Doppler Ultrasonography,CDU)在判断乳腺肿物良恶性和腋淋巴结转移的价值。材料和方法：作者分析了58例乳腺实性肿物的彩色多普勒超声和临床怀疑乳腺癌且CDU为阳性的30例病人的腋淋巴结CDU扫查结果。结果：发现34例乳腺癌中26例CDU有阳性表现，而24例良性肿物则均无阳性结果。得出CDU对乳腺癌的敏感性为77％，特异性100%，阳性符合率100%，肿癌直径小于1cm和浸润性小叶癌的CDU阳性率最低。对照术后病理，10例腋淋巴结CDU阳性者均已有淋巴结浸润，另有4例已受累的淋巴结CDU为阴性。CDU对腋淋巴结受累敏感性为71％，特异性100%，阳性符合率100%。结论：CDU对乳腺肿物良恶性以及腋淋巴结转移的判断上有重要的应用价值。     

乳腺浸润性小叶癌的MRI表现及对比超声对多发病灶检出价值的研究

【摘要】目的：分析乳腺浸润性小叶癌(ILC)的MRI表现,并与超声对照,对比两种方法对多发病灶的检出价值。方法：回顾性研究经手术病理证实的19例乳腺ILC的MRI及超声表现,并分析两种方法对多发病灶的检出情况。结果：19例乳腺ILC在MRI上表现为肿块强化15例,非肿块强化2例,两种强化类型均有的混合型1例,另有1例患者MRI结果阴性（B超、钼靶结果均为阴性）。15例肿块强化中,边缘毛刺状的不规则形肿块11例;2例非肿块强化中,局灶性、多区域性分布各1例;1例混合型表现为多区域性分布。18例阳性乳腺ILC动态增强后,TIC早期缓慢强化1例,中度强化3例,快速强化14例;延迟期上升型8例,平台型4例,流出型6例。18例行超声检查的浸润性小叶癌中,检出阳性者17例,其中12例ILC在超声上表现为不规则的不均匀低回声肿块。18例阳性乳腺ILC中,MRI诊断多灶及多中心均为4例且经病理证实,超声诊断单发4例、多灶3例、多中心1例,两种方法对病变多灶及多中心性的检出率差异具有统计学意义（P=0.026,P<0.05）。2例同侧乳房其他病灶均经MRI、超声检出,1例对侧乳房其他病变仅通过MRI检出。结论：乳腺ILC的MRI表现具有一定特征性,且对多发病灶的检出较超声有一定优势。     

年轻女性(≤40岁)乳腺癌的X线摄影与MRI对照研究

目的 分析年轻女性乳腺癌乳腺X线摄影(mammography,MG)及磁共振成像(magnetic resonance imaging,MRI)影像学特点,以期提高年轻女性乳腺癌病灶的检出和评估.方法 收集经手术病理证实的121例乳腺癌患者,均于术前接受乳腺MRI检查,年轻组(≤40岁)患者29例,中老年组(>40岁)患者92例,其中共81例患者行MG检查.比较2组病例的MG特点、MRI形态学、信号强度、ADC值及血流动力学特点,以及淋巴结转移与否.采用SPSS13.0统计软件,P值≤0.05为差异有统计学意义.结果 年轻女性表现为致密型乳腺23例(79.3%),浸润性导管癌24例(82.8%),病灶平均直径为3.6 cm,肿块型病灶中表现为非毛刺状边缘14例(73.7%),不均匀强化病灶21例(72.4%),病灶伴导管内成分(extensive intraductal component,EIC)16例(55.2%),18例病灶发生腋淋巴结转移病灶(62.1%).年轻女性与中老年女性癌灶出现钙化的几率无明显差异(P=0.159),乳腺X线摄影对年轻女性组患者病灶检出的敏感性(62.5%)低于中老年女性组(87.7%)(P=0.006).结论 MRI对于年轻女性致密型乳腺中乳腺癌病灶的检出及术前评估具有极其重要的作用.     

伴乳头溢液乳腺癌的乳腺导管造影表现与病理对照研究

目的:分析伴有乳头溢液乳腺癌的乳腺导管造影表现,并分析其病理基础,以提高诊断水平。方法:临床表现有乳头溢液并经手术、病理证实的乳腺癌23例,回顾性分析其乳腺导管造影的影像表现,并与手术病理结果进行对比分析。结果:23例中原位癌8例,浸润性导管癌10例(包括单纯癌6例、乳头状癌4例),导管癌早期浸润3例,乳头状瘤病恶变2例。病理上诊断早期癌13例(56.5%),其中8例临床未触及乳腺肿块。乳腺导管造影主要表现:导管内充盈缺损并伴有不同程度的导管扩张12例;乳腺肿瘤侵蚀导管形成潭湖征5例;溢液导管受乳腺肿块推挤,导管变形3例;导管持续显影、管壁不规则伴广泛微钙化灶1例。本组中乳腺导管造影诊断乳腺癌的符合率为82.6%。结论:乳腺导管造影对伴有乳头溢液乳腺癌的检出是一项安全、有效的检查方法,能准确观察到肿块与溢液导管的位置关系、溢液导管受侵蚀程度,而且还能检测出临床触诊阴性的早期乳腺癌。     

Breast MRI for evaluating patients with metastatic axillary lymph node and initially negative mammography and sonography.

OBJECTIVE: We wanted to investigate the ability of breast MR imaging to identify the primary malignancy in patients with axillary lymph node metastases and initially negative mammography and sonography, and we correlated those results with the conventional imaging. MATERIALS AND METHODS: From September 2001 to April 2006, 12 patients with axillary lymph node metastases and initially negative mammography and sonography underwent breast MR imaging to identify occult breast carcinoma. We analyzed the findings of the MR imaging, the MR-correlated mammography and the second-look sonography. We followed up both the MR-positive and MR-negative patients. RESULTS: MR imaging detected occult breast carcinoma in 10 of 12 (83%) patients. Two MR-negative patients were free of carcinoma in the ipsilateral breast during their follow-up period (39 and 44 months, respectively). In nine out of 10 patients, the MR-correlated mammography and second-look sonography localized lesions that were not detected on the initial exam. All the non-MR-correlated sonographic abnormalities were benign. CONCLUSION: Breast MR imaging can identify otherwise occult breast cancer in patients with metastatic axillary lymph nodes. Localization of the lesions through MR-correlated mammography and second-look sonography is practically feasible in most cases.     

Breast MR imaging in patients with axillary node metastases and unknown primary malignancy.

PURPOSE: To assess the usefulness of magnetic resonance (MR) imaging of the breast in patients with malignant axillary adenopathy and unknown primary malignancy. MATERIALS AND METHODS: Between October 1993 and December 1997, 38 women with malignant axillary adenopathy and negative mammographic and physical examination findings underwent contrast material-enhanced MR imaging. Sixteen patients were excluded due to axillary tail cancer (n = 7), lack of follow-up (n = 4), second primary malignancy (n = 3), or chemotherapy before MR imaging (n = 2). The study population comprised the remaining 22 patients. Histopathologic findings were available in 20 patients; follow-up MR imaging findings were available in two patients. RESULTS: MR imaging depicted a primary breast cancer in 19 patients (86%; identified at excisional biopsy or mastectomy in 17, resolved on follow-up MR images during treatment in two). MR imaging depicted 4-30-mm cancers (mean, 17 mm), which correlated closely with histopathologic size. Two patients (9%) had false-negative findings: (a) One had a 2-mm invasive ductal carcinoma, and (b) one had 17- and 20-mm invasive ductal carcinomas. Of the 19 patients, 11 underwent mastectomy, seven underwent breast-conservation therapy, and one did not undergo a surgical procedure. CONCLUSION: MR imaging is very sensitive for the detection of mammographically and clinically occult breast cancer in patients with malignant axillary adenopathy. In these patients, MR imaging offers potential not only for cancer detection but also for staging the cancer within the breast, which may be useful for treatment planning.     

MR imaging-guided sonography followed by fine-needle aspiration cytology in occult carcinoma of the breast

OBJECTIVE: In patients with axillary metastases as clinical evidence of possible occult breast cancer, a combined approach of MR imaging, sonography, and aspiration biopsy cytology was evaluated. SUBJECTS AND METHODS: Thirty-one women with metastatic adenocarcinoma in their axillary lymph nodes originating from an unknown primary site underwent MR imaging of the breast because physical examination and mammography findings were normal. Twenty of the 31 women had no history of malignancy, 10 had been previously treated for contralateral breast cancer, and one patient had nodal metastases in the contralateral axilla at the time breast cancer was detected. When a contrast-enhancing lesion was revealed on MR imaging of the breast, sonography and fine-needle aspiration cytology were also performed. RESULTS: MR imaging revealed the primary breast cancer in eight (40%) of the 20 patients without a history of malignancy. MR imaging of the breast revealed a second primary cancer in three (27%) of the 11 patients with previous or simultaneous breast cancer. All lesions were identified with sonography and verified by cytology and histology. CONCLUSION: In women with axillary lymph node metastases from adenocarcinoma, MR imaging of the breast should be added to clinical examination and mammography before defining the breast cancer as occult. The combined approach of MR imaging, sonography, and aspiration fine-needle cytology is a good alternative to the MR imaging-guided biopsy.     

Breast lesions detected on MR imaging: features and positive predictive value

OBJECTIVE: The purpose of this study was to analyze features of breast lesions detected on MR imaging that had subsequent biopsy and to determine the positive predictive value (PPV) of these features. MATERIALS AND METHODS: Retrospective review was performed of 100 consecutive solitary MR imaging-detected breast lesions that had MR imaging-guided needle localization and surgical excision. We described lesions, using terms found in a proposed breast MR imaging lexicon. Histologic findings were reviewed. RESULTS: Carcinoma was identified in 25 lesions (25%), including ductal carcinoma in situ (DCIS) in 13 (52%) and infiltrating carcinoma in 12 (48%). Carcinoma was found in 15 (25%) of 60 masses versus 10 (25%) of 40 nonmass lesions; most malignant masses (73%) were infiltrating carcinoma, whereas most malignant nonmass lesions (90%) were DCIS. The features with the highest PPV were spiculated margin (80% carcinoma), rim enhancement (40% carcinoma), and irregular shape (32% carcinoma) for mass lesions and segmental (67% carcinoma) or clumped linear and ductal enhancement (31% carcinoma) for nonmass lesions. Visually assessed kinetic patterns were not significant predictors of carcinoma, but washout was present in 70% of infiltrating carcinomas versus 9% of DCIS lesions (p < 0.01). Carcinoma was present in 17 (19%) of 88 lesions classified as suspicious versus eight (67%) of 12 lesions classified as highly suggestive of malignancy (p = 0.001). CONCLUSION: Among MR imaging-detected breast lesions referred for biopsy, carcinoma was found in 25%, of which half were DCIS. Features with the highest PPV were spiculated margin, rim enhancement, and irregular shape for mass lesions and segmental or clumped linear and ductal enhancement for nonmass lesions. Final assessment categories were significant predictors of carcinoma.     

Invasive Micropapillary Carcinoma of the Breast: MR Imaging Findings

Objective

To analyze the magnetic resonance (MR) imaging findings of invasive micropapillary carcinoma of the breast.

Materials and Methods

MR images were retrospectively evaluated in 14 patients (age range: 37-67, mean age: 49 years) with pathologically confirmed invasive micropapillary carcinoma of the breast. The enhancement type (mass/non-mass), shape, margin, contrast enhancement, and time-intensity curve pattern on the dynamic study were correlated with the histopathologic features. Associated findings, such as edema, nipple change, skin change and enlarged axillary lymph nodes were also studied.

Results

The most common features of the masses were irregular shape (12 of 14 patients, 85.8%) and irregular or spiculated margin (11 of 14 patients, 78.7%). The contrast enhancement was heterogeneous in 11 patients (78.7%), rim enhancement in 2 cases (14.2%), and homogeneous in one patient (7.1%). The predominant kinetic pattern was rapid increase (14 of 14, 100%) in the initial phase and washout (11 of 14, 78.7%) in the delayed phase. Associated non-mass like enhancement was shown in 4 patients, representing ductal carcinoma in situ. MR imaging helped detect additional sites of cancer other than the index lesion in 3 patients (21.4%). Enlarged axillary lymphadenopathy was identified in 7 of the 14 patients (50%).

Conclusion

Invasive micropapillary carcinoma appears as a mass with an irregular shape, irregular or spiculated margin and heterogeneous enhancement on MR imaging. Though these findings are not specific and are also observed with other breast malignancies, invasive micropapillary carcinoma frequently showed multiple lesions, accompanying non-mass enhancement and axillary lymph node enlargement.     

False-negative MR imaging of malignant breast tumors

In this study we analyze MR-negative malignant lesions of the breast. A total of 204 patients with palpable and/or mammographic lesions were studied. The MR technique consisted of the turbo FLASH and MP-RAGE subtraction techniques. All patients underwent surgical biopsy and/or mastectomy and all specimens were examined by the correlative radiologic-histologic mapping technique. A total of 208 lesions were evaluated; 145 turned out to be malignant and 63 proved to be benign. Six malignant lesions were misinterpreted as benign on MR imaging; thus, suspicious contrast enhancement was present in 96 % of the lesions detected by mammography, US, or clinical examination. Especially 4 of the 17 ductal carcinoma in situ (DCIS) lesions were misinterpreted (23.5 %). Despite optimal technique, 6 malignant lesions were not identified by MR imaging. The highest prevalence of these MR occult lesions was in the group of DCIS. Although MR imaging has an important role in the evaluation of breast lesions and, primarily, in ruling out malignancy, one should be aware of the fact that false-negative MR findings do occur. Received 8 July 1996; Revision received 7 October 1996; Accepted 6 February 1997     

<Superscript>18</Superscript>F-FDG PET/CT detects Metastatic Renal Cell Carcinoma Masquerading as Primary Breast Malignancy

We present the case of a 36-year-old woman who underwent ¹⁸F-FDG PET/CT with suspicion of a primary breast malignancy. However, PET/CT detected an occult renal cell carcinoma with metastases to the thyroid, breast, lungs and lymph nodes. Thyroid and breast metastases are atypical metastatic sites of renal cell carcinoma. Breast metastases from extra mammary tissue are extremely rare, more so from renal cell carcinoma. Histopathologic confirmation of the breast lesions is imperative to avoid unnecessary mastectomy and imaging can help in raising the suspicion of metastatic involvement versus primary breast malignancy.     

Unusual presentation of tubular breast carcinoma as non-mass enhancement

A tubular carcinoma is a rare and well-differentiated histological subtype of invasive ductal carcinoma. Its lesion is generally presented as a spiculated, solid mass on mammography, ultrasonography (US), and magnetic resonance imaging (MRI) with posterior acoustic shadowing on US. Here, we describe unusual MRI findings of focal-type clumped non-mass enhancement and type 2 kinetic curve. This tumour should be included as a differential diagnosis with focal-type clumped non-mass enhancement on MRI, because this finding can refer benign lesions like as fibrocystic changes of breast.