Keywords:
Breast, Oncology, MR, MR-Diffusion/Perfusion, Diagnostic procedure, Contrast agent-intravenous, Dysplasias, Neoplasia
Authors:
M. Nadrljanski, N. Gusic, Z. Milovanovic, V. Plesinac - Karapandzic, O. Radulovic, Z. C. Milosevich; Belgrade/RS
DOI:
10.1594/ecr2013/C-0868
Purpose
Fibrocystic changes (FCCs) are the most frequent benign lesions that occur in the breast of premenopausal women between 20 and 50 years of age.
Pathogenesis of FCCs is related to the response of the breast tissue to fluctuations of estrogen and progesterone levels during menstrual cycle.
Clinically,
FCCs are present in more than 50% of women without breast disease,
usually in the form of cyclic,
multifocal and bilateral breast pain or tender nodularities [1].
Histologically,
FCCs are observed in up to 90% of women,
as a heterogeneous group of disorders that includes cysts (macro- and microcysts) and solid lesions (adenosis,
epithelial hyperplasia with or without atypia,
apocrine metaplasia,
radial scar,
and papilloma) [2].
Significance of this benign condition is defined by at least three facts:
- FCCs may simulate a malignant lesion by physical examination or imaging studies that lead to the unnecessary surgical procedures.
- The coexistence of FCCs can be a reason for the false negative findings on mammography,
especially in women with dense breasts.
- Some histologic subtypes of FCCs are associated with an increased risk for subsequent development of breast cancer [3,
4].
In 1985,
Dupont and Page first proposed a practical classification system for FCCs with three categories: nonproliferative lesions,
proliferative lesions without atypia,
and proliferative lesions with atypia (atypical ductal or lobular hyperplasia) [5].
In each of these lesions,
the subsequent risk for breast cancer is associated with the histologic appearance of the lesion.
Compared with the general population,
women with nonproliferative lesions on breast biopsy have no risk for breast cancer,
whereas women having proliferative disease without atypia and women with atypical ductal or lobular hyperplasia have a greater breast cancer risk,
with relative risks 1.3–1.9 and 3.9–13.0,
respectively [6].
The purposes of our paper are:
- To analyze morphologic characteristics,
kinetic enhancement patterns and apparent diffusion coefficient (ADC) of histologically confirmed FCCs at dynamic contrast-enhanced (DCE-MRI) and diffusion-weighted MR images (DWI);
- To assess the possibilities of breast MRI in differentiation of nonproliferative lesions from other two categories of FCCs at risk of developing breast cancer.