Type:
Educational Exhibit
Keywords:
Pathology, Neoplasia, Cancer, Education, Diagnostic procedure, Comparative studies, Ultrasound, MR, Mammography, Oncology, Management, Breast
Authors:
N. Rotaru, I. Gavrilasenco; Chisinau/MD
DOI:
10.1594/ecr2013/C-2223
Background
One hundred equivocal mammographic abnormalities from 93 consecutive patients included in the study.Patients had been selected and referred because of the presence of breast lesions detected by palpation and/or mammography and/or sonography.
The highest detection rate for multifocal invasive disease was seen with MRM,
which identified 72.5% out confirmed multifocal invasive cancers,
whereas mammography identified 20.5% (p=0.003).
Breast density was estimated visually with quantitative measures,
that is,
the percentage of the area of the breast encompassed by fibroglandular tissue dense enough to obscure a cancer was estimated.
MRM was performed in women with suspicious or equivocal results in conventional mammography and ultrasonography because of either dense parenchyma or heterogeneous echogenicity with dorsal shadowing with a purpose to exclude multifocal disease or contralateral breast cancer.
Definition of multifocal carcinoma required a distance <3 cm and for multicentric carcinoma a distance >3 cm between various lesions.
Interpretation of the various diagnostic procedures was compared with the histological examination with regard to sensitivity,
specificity,
accuracy,
positive (PPV) and negative predictive value (NPV).
All lesions were analyzed regarding their qualitative characteristics.
Lesions were divided into two groups: small (≤ 10 mm) and large (> 10 mm).
Clinically,
the mean estimated size of the lesion was 8.5 cm (range 4-13 cm),
by mammography 8.5 cm (range 4-13 cm) and by MRM 7 cm (range 3.5-12 cm).
Additionally,
the following lesions’ characteristics were investigated separately on the first and last contrast-enhanced series: lesions’ shape,
characterized as regular (oval,
round,
or polygonal),
or as irregular (linear,
branching,
or stellate); margin type (ill-defined or well-defined),
and homogeneity of contrast medium enhancement (homogeneous or inhomogeneous; Table 1).
Uni-or multifocality is presented in Table 2.
The highest detection rate for multifocal invasive disease was seen with MRM,
which identified 21 (72.5%) out of 29 histologically confirmed multifocal invasive cancers,
whereas mammography identified 6 out of 29 (20.7% ; p=0.003).
Lymph node metastases were present in 11 (37%) of 30 patients with malignant invasive carcinoma.