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Chung M, Ton L, Lee AY. Forget Me Not: Incidental Findings on Breast MRI. JOURNAL OF BREAST IMAGING 2024:wbae023. [PMID: 38758984 DOI: 10.1093/jbi/wbae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Indexed: 05/19/2024]
Abstract
With the growing utilization and expanding role of breast MRI, breast imaging radiologists may encounter an increasing number of incidental findings beyond the breast and axilla. Breast MRI encompasses a large area of anatomic coverage extending from the lower neck to the upper abdomen. While most incidental findings on breast MRI are benign, identifying metastatic disease can have a substantial impact on staging, prognosis, and treatment. Breast imaging radiologists should be familiar with common sites, MRI features, and breast cancer subtypes associated with metastatic disease to assist in differentiating malignant from benign findings. Furthermore, detection of malignancies of nonbreast origin as well as nonmalignant, but clinically relevant, incidental findings can significantly impact clinical management and patient outcomes. Breast imaging radiologists should consistently follow a comprehensive search pattern and employ techniques to improve the detection of these important incidental findings.
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Affiliation(s)
- Maggie Chung
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Lauren Ton
- School of Medicine, University of California, San Francisco, CA, USA
| | - Amie Y Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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2
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Szczyrek M, Bitkowska P, Jutrzenka M, Szudy-Szczyrek A, Drelich-Zbroja A, Milanowski J. Pleural Neoplasms-What Could MRI Change? Cancers (Basel) 2023; 15:3261. [PMID: 37370871 DOI: 10.3390/cancers15123261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/16/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
The primary pleural neoplasms constitute around 10% of the pleural tumors. The currently recommended method for their imaging is CT which has been shown to have certain limitations. Strong development of the MRI within the last two decades has provided us with a number of sequences that could potentially be superior to CT when it comes to the pleural malignancies' detection and characterization. This literature review discusses the possible applications of the MRI as a diagnostic tool in patients with pleural neoplasms. Although selected MRI techniques have been shown to have a number of advantages over CT, further research is required in order to confirm the obtained results, broaden our knowledge on the topic, and pinpoint the sequences most optimal for pleural imaging, as well as the best methods for reading and analysis of the obtained data.
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Affiliation(s)
- Michał Szczyrek
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Paulina Bitkowska
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Marta Jutrzenka
- Collegium Medicum, University of Warmia and Mazury in Olsztyn, Aleja Warszawska 30, 11-041 Olsztyn, Poland
| | - Aneta Szudy-Szczyrek
- Department of Haematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-090 Lublin, Poland
| | - Anna Drelich-Zbroja
- Department of Radiology and Neuroradiology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Janusz Milanowski
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
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Gleckler L, Roy N, Bernstein M, Balija TM, LaPlaca C, Nevid DR, Lee JH, Port E, Bernik SF. Impact of Preoperative Extramammary Findings in Patients with Newly Diagnosed Breast Cancer. J Am Coll Surg 2023; 236:1047-1053. [PMID: 36719075 DOI: 10.1097/xcs.0000000000000605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Breast MRI has been associated with significant rates of false positive findings. We aimed to determine the frequency of extramammary findings (EMFs) in newly diagnosed breast cancer patients on breast MRI with contrast and assess the significance of these findings and need for additional imaging and follow-up. STUDY DESIGN A retrospective review of patients diagnosed with breast cancer from October 2018 to October 2019 was performed. Clinicopathologic features were collected, including type of breast cancer, size, stage, and whether the patients had a breast MRI. Those who had MRI were included, and the MRI was reviewed to determine if EMFs were identified. Further imaging and follow-up were assessed and recorded. RESULTS Of the 480 patients included in this cohort, 353 (74%) had invasive cancer, and the remainder had ductal carcinoma in situ. Two hundred ninety patients (60%) underwent MRI, and 53 of 290 (18%) had EMFs on MRI. Of these, 28 of 53 (53%) underwent additional imaging to further evaluate findings. Two invasive procedures were performed (fine needle aspiration and thymectomy), and 1 malignancy was identified in the thymus. No metastatic breast cancer was identified in any patient. CONCLUSIONS MRIs are frequently obtained for newly diagnosed breast cancer patients, and additional findings, especially extramammary, can be stressful for patients, and potentially lead to treatment delay if further evaluation is warranted. Our results demonstrate that incidental EMFs discovered via breast MRI are common and often lead to additional imaging studies. However, no metastatic lesions were found, and only 1 separate malignancy was identified, which did not affect breast cancer management. In patients with early-stage breast cancer, EMFs yield a very low rate of malignancy, providing high levels of reassurance and supporting the option of proceeding with surgery or treatment without delay.
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Affiliation(s)
| | - Nikita Roy
- Icahn School of Medicine at Mount Sinai (Roy, LaPlaca), New York, NY
| | - Michelle Bernstein
- Columbia University College of Dental Medicine, New York, NY (Bernstein)
| | - Tara M Balija
- Mount Sinai Hospital West, New York, NY (Balija, Bernik)
| | - Caroline LaPlaca
- Icahn School of Medicine at Mount Sinai (Roy, LaPlaca), New York, NY
| | - Daniella R Nevid
- From the Division of Breast Surgery (Gleckler, Port)
- Icahn School of Medicine at Mount Sinai (Roy, LaPlaca), New York, NY
- Columbia University College of Dental Medicine, New York, NY (Bernstein)
- Mount Sinai Hospital West, New York, NY (Balija, Bernik)
| | - Jean Hee Lee
- From the Division of Breast Surgery (Gleckler, Port)
- Icahn School of Medicine at Mount Sinai (Roy, LaPlaca), New York, NY
- Columbia University College of Dental Medicine, New York, NY (Bernstein)
- Mount Sinai Hospital West, New York, NY (Balija, Bernik)
| | - Elisa Port
- From the Division of Breast Surgery (Gleckler, Port)
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Ryoo JA, Kim SY. Incidental Extramammary Findings on Preoperative Breast MRI in Breast Cancer Patients: A Pictorial Essay. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:372-385. [PMID: 37051390 PMCID: PMC10083632 DOI: 10.3348/jksr.2022.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/21/2022] [Accepted: 08/12/2022] [Indexed: 04/03/2023]
Abstract
Breast cancer is one of the most common cancers and causes several complications in females. Currently, MRI is a necessary method for preoperative studies in patients with breast cancer. A high frequency of breast MRI can lead to an increase in the number of incidental extramammary findings. Moreover, it can provide accurate preoperative workup; therefore, the prognosis of patients can be improved. Herein, we provide several extramammary findings, including the mediastinum, lung, upper abdomen, bone, and soft tissue, correlating with US, chest CT, liver MRI, PET-CT, and bone scan.
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Corines MJ, Coffey K, Dou E, Lobaugh S, Zheng J, Hwang S, Feigin K. Bone Lesions Detected on Breast MRI: Clinical Outcomes and Features Associated with Metastatic Breast Cancer. JOURNAL OF BREAST IMAGING 2022; 4:600-611. [PMID: 37744182 PMCID: PMC10516530 DOI: 10.1093/jbi/wbac053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Objective To determine prevalence and frequency of malignancy among bone lesions detected on breast MRI and to identify clinical and imaging features associated with bone metastases from breast cancer (BC), as bone lesions are suboptimally evaluated on breast imaging protocols and can present a diagnostic challenge. Methods This IRB-approved retrospective review of breast MRIs performed from June 2009 to June 2018 identified patients with bone lesions. Demographic, clinical, and MRI features were reviewed. Clinical outcome of bone lesions was determined based on pathology and/or additional diagnostic imaging. All benign lesions had ≥ 2 years of imaging follow-up. Statistics were computed with Fisher's exact and Wilcoxon rank sum tests. Results Among all patients with breast MRI, 1.2% (340/29 461) had bone lesions. Of these, 224 were confirmed benign or metastatic BC by pathology or imaging follow-up, with 70.1% (157/224) be- nign and 29.9% (67/224) metastatic. Bone metastases were associated with BC history (P < 0.001), with metastases occurring in 58.2% (53/91) of patients with current BC, 17.9% (14/78) patients with prior BC, and 0.0% (0/55) without BC. Bone metastases were associated with invasive and ad- vanced stage BC and, on MRI, with location in sternum, ribs, or clavicles, larger size, multiplicity, andT1 hypointensity (all P < 0.01 in tests of overall association). Conclusion Of clinically confirmed breast MRI-detected bone lesions, 30% were bone metastases; all were detected in patients with current or prior BC. Metastases were associated with advanced stage, invasive carcinoma, larger lesion size, multiplicity, low T1 signal, and non-spine location.
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Affiliation(s)
- Marina J. Corines
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY, USA
| | - Kristen Coffey
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY, USA
| | - Eda Dou
- University of California San Francisco, Department of Radiology and Biomedical Imagery, San Francisco, CA, USA
| | - Stephanie Lobaugh
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Junting Zheng
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sinchun Hwang
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY, USA
| | - Kimberly Feigin
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY, USA
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Gluskin J, Eliades S, Raj A, Sevilimedu V, Do RKG. Incidental liver lesions on baseline breast MRI: Outcomes on subsequent abdominal imaging. Clin Imaging 2022; 84:130-134. [PMID: 35193080 PMCID: PMC9032601 DOI: 10.1016/j.clinimag.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/01/2022] [Accepted: 02/10/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To examine outcomes of incidental liver lesions on baseline breast magnetic resonance imaging (MRI) that were further evaluated with dedicated abdominal imaging. METHODS Consecutive breast MRI reports from 2011 to 2016 were retrospectively reviewed to identify incidental liver lesions. Only patients without prior breast MRI, without prior abdominal imaging, and with subsequent abdominal imaging were included. Patient demographics, breast MRI indication, and final liver lesion diagnosis were recorded. RESULTS Of 131 women (mean age 53.8 years), 94/131 (71.8%) underwent breast MRI for extent of disease evaluation, 25/131 (19.1%) for high-risk screening, 11/131 (8.4%) for implant evaluation, and 1/131 (0.8%) for problem-solving. Of 131 liver lesions (6-80 mm), 117/131 (89.3%) were deemed benign on subsequent abdominal imaging; 10/131 (7.6%) probably benign; and 4/131 lesions (3.1%) were confirmed breast cancer metastases. Metastatic liver lesions identified on breast MRI were more likely for women with a current diagnosis of breast cancer than for women without a current diagnosis of breast cancer: 4.3% vs 0%. Similarly, metastatic liver lesions identified on breast MRI were more likely for those with a higher prognostic stage (2 or 3) vs a lower prognostic stage (0 or 1) or no current breast cancer: 11.1% vs 0%. CONCLUSION Baseline breast MRIs showing incidental liver lesions showed unsuspected liver metastases only in women with a current diagnosis of clinical stage 2 or 3 breast cancer. This suggests breast MRI indication and clinical staging of current breast cancer, if present, can help plan management and decisions to obtain follow-up of liver lesions.
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Ganguli I, Keating NL, Thakore N, Lii J, Raza S, Pace LE. Downstream Mammary and Extramammary Cascade Services and Spending Following Screening Breast Magnetic Resonance Imaging vs Mammography Among Commercially Insured Women. JAMA Netw Open 2022; 5:e227234. [PMID: 35416989 PMCID: PMC9008498 DOI: 10.1001/jamanetworkopen.2022.7234] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Increasing use of screening breast magnetic resonance imaging (MRI), including among women at low or average risk of breast cancer, raises concerns about resulting mammary and extramammary cascades (downstream services and new diagnoses) of uncertain value. OBJECTIVE To estimate rates of cascade events (ie, laboratory tests, imaging tests, procedures, visits, hospitalizations, and new diagnoses) and associated spending following screening breast MRI vs mammography among commercially insured US women. DESIGN, SETTING, AND PARTICIPANTS This cohort study used 2016 to 2018 data from the MarketScan research database (IBM Corporation), which includes claims and administrative data from large US employers and commercial payers. Participants included commercially insured women aged 40 to 64 years without prior breast cancer who received an index bilateral screening breast MRI or mammogram between January 1, 2017, and June 30, 2018. We used propensity scores based on sociodemographic, clinical, and utilization variables to match MRI recipients to mammogram recipients in each month of index service use. Data were analyzed from October 8, 2020, to October 28, 2021. EXPOSURES Breast MRI vs mammography. MAIN OUTCOMES AND MEASURES Mammary and extramammary cascade event rates and associated total and patient out-of-pocket spending in the 6 months following the index test. RESULTS In this study, 9208 women receiving breast MRI were matched with 9208 women receiving mammography (mean [SD] age, 51.4 [6.7] years). Compared with mammogram recipients, breast MRI recipients had 39.0 additional mammary cascade events per 100 women (95% CI, 33.7-44.2), including 5.0 additional imaging tests (95% CI, 3.8-6.2), 17.3 additional procedures (95% CI, 15.5-19.0), 13.0 additional visits (95% CI, 9.4-17.2), 0.34 additional hospitalizations (95% CI, 0.18-0.50), and 3.0 additional new diagnoses (95% CI, 2.5-3.6). For extramammary cascades, breast MRI recipients had 19.6 additional events per 100 women (95% CI, 8.6-30.7) including 15.8 additional visits (95% CI, 10.2-21.4) and no statistically significant differences in other events. Breast MRI recipients had higher total spending for mammary events ($564 more per woman; 95% CI, $532-$596), extramammary events ($42 more per woman; 95% CI, $16-$69), and overall ($1404 more per woman; 95% CI, $1172-$1636). They also had higher overall out-of-pocket spending ($31 more per woman; 95% CI, $6-$55). CONCLUSIONS AND RELEVANCE In this cohort study of commercially insured women, breast MRI was associated with more mammary and extramammary cascade events and spending relative to mammography. These findings can inform cost-benefit assessments and coverage policies to ensure breast MRI is reserved for patients for whom benefits outweigh harms.
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Affiliation(s)
- Ishani Ganguli
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nancy L Keating
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Nitya Thakore
- Grossman School of Medicine, New York University, New York
| | - Joyce Lii
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Sughra Raza
- Department of Radiology, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Lydia E Pace
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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DiPiro PJ, Alper DP, Giess CS, Glazer DI, Lee LK, Lacson R, Khorasani R. Comparing Breast and Abdominal Subspecialists' Follow-Up Recommendations for Incidental Liver Lesions on Breast MRI. J Am Coll Radiol 2020; 17:773-778. [PMID: 32004482 PMCID: PMC7549431 DOI: 10.1016/j.jacr.2019.12.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/27/2019] [Accepted: 12/28/2019] [Indexed: 12/02/2022]
Abstract
Purpose: The aim of this study was to compare breast imaging subspecialists’ follow-up recommendations for incidental liver lesions (ILLs) on breast MRI with abdominal subspecialty radiologists’ opinions informed by best-practice recommendations. Methods: In this retrospective study at an academic medical center, natural language processing identified reports with ILLs among 2,181 breast MRI studies completed in 2015. Electronic health record and radiology report reviews abstracted malignancy presence or absence, prior imaging, and breast subspecialists’ recommendations regarding ILLs for random sets of 30 patients: ILLs with follow-up recommendations, ILLs without recommendations, and without ILLs. Two abdominal radiologists evaluated MRI liver findings and offered follow-up recommendations in consensus. The primary outcome was agreement between breast and abdominal subspecialists in patients with ILL follow-up recommendations compared with those without (χ2 analysis). Secondary outcomes were agreement between subspecialists when ILLs were reported and referring clinicians’ adherence to follow-up recommendations. Results: ILLs were identified in 11.3% of breast MRI reports (247 of 2,181); breast subspecialists made follow-up recommendations in 12% of them (30 of 247). Abdominal subspecialists agreed with breast subspecialists when ILLs required no follow-up (29 of 30 cases) but disagreed with 28 of 30 breast subspecialists’ follow-up recommendations (agreement proportion 29 of 30 versus 2 of 30, P < .0001). Subspecialists agreed in 93% of cases (28 of 30) when breast imagers reported no ILLs. Overall, 16 of 30 breast subspecialists’ follow-up recommendations were performed; ILLs were benign in 15. Conclusions: Abdominal subspecialists disagreed frequently with breast subspecialists regarding follow-up recommendations for ILLs on breast MRI. Abdominal subspecialty consultation or embedding liver imaging decision support in breast imaging reporting workflow may reduce unnecessary imaging and improve care. Improvement opportunities may exist in other cross-subspecialty interpretation workflows.
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Affiliation(s)
- Pamela J DiPiro
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - David P Alper
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Catherine S Giess
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Daniel I Glazer
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Leslie K Lee
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ronilda Lacson
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ramin Khorasani
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
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Lee AY, Navarro R, Busby LP, Greenwood HI, Bucknor MD, Ray KM, Joe BN. Characterization of Metastatic Sternal Lesions on Dynamic Contrast-Enhanced Breast MRI in Women with Invasive Breast Cancer. Acad Radiol 2019; 26:1358-1362. [PMID: 30527457 DOI: 10.1016/j.acra.2018.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 11/07/2018] [Accepted: 11/17/2018] [Indexed: 12/15/2022]
Abstract
RATIONALE AND OBJECTIVES Detecting sternal lesions is not the purpose of breast MRI, but diagnosing metastasis has major clinical implications. Our purpose was to determine the breast MRI features of sternal metastases detected on PET-CT and bone-scan. MATERIALS AND METHODS Between 01/2010-09/2018, 379 patients with breast cancer had sternal findings on PET-CT or bone-scan, 21 of which underwent breast MRI within 100 days. Sternal lesions were considered metastatic if (1) biopsy demonstrated metastasis, (2) the lesion had similar appearance to synchronous sites of biopsy-proven osseous metastases, or (3) there were numerous suspicious lesions in which widespread osseous metastasis was presumed. Four radiologists reviewed the MR images to determine if metastases were retrospectively detectable. MRI reports were reviewed to determine if lesions were prospectively described. MRI features of metastatic sternal lesions were compared to benign controls. RESULTS Fourteen sternal metastases met inclusion criteria. Lesions were retrospectively detectable on breast MRI by all radiologists in 86% (12/14) of cases, but prospectively reported in 57%. Of the 12 MRI-detectable metastases, mean maximum dimension was 33 mm, 7 had >1 lesion, all were T1-hypointense, 11 were T2-hyperintense, 11 were noncircumscribed, 6 extended beyond cortex, 11 enhanced heterogeneously, and 11 demonstrated washout. Heterogeneous enhancement (p = 0.002), noncircumscribed margins (p < 0.001), multiplicity (p = 0.005), and size >1 cm (p < 0.001) were more frequent with metastatic compared to benign sternal lesions. CONCLUSION Most sternal metastases (86%) were retrospectively detectable on breast MRI, but only 57% were prospectively reported, emphasizing the importance evaluating the sternum on breast MRI. Certain MRI features may raise suspicion for metastasis.
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Christopherson KM, Smith BD. How Does MR Imaging Help Care for My Breast Cancer Patient? Perspective of a Radiation Oncologist. Magn Reson Imaging Clin N Am 2018; 26:295-302. [PMID: 29622135 DOI: 10.1016/j.mric.2017.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Radiation therapy is used in many cases of both early and late breast cancer. The authors examine the role of MR imaging as it pertains to radiotherapy planning and treatment approaches for patients with breast cancer. MR imaging can assist the radiation oncologist in determining the best radiation approach and in creating treatment planning volumes. MR imaging may be useful in the setting of accelerated partial breast irradiation. Radiation oncologists should attend to MR breast images, when obtained, to ensure that these imaging findings are taken into consideration when developing a radiation therapy plan.
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Affiliation(s)
- Kaitlin M Christopherson
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Boone Pickens Academic Tower (FCT6.5075), 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Benjamin D Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Unit 1202, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Shah PK, Kafer IA, Grimaldi GM. Incidental hepatic lesions detected on breast MRI: Rate of malignancy and implications for utilization. Clin Imaging 2018; 51:93-97. [PMID: 29452924 DOI: 10.1016/j.clinimag.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/29/2017] [Accepted: 02/01/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The objective of this study was to determine the rate of malignancy in incidentally detected T2 hyperintense hepatic lesions at breast MRI. METHODS Incidental hepatic lesions identified during breast MRI, for which abdominal imaging was recommended, were retrospectively analyzed. RESULTS Of the hepatic lesions, 97.3% were benign, and 2.7% were malignant, with a significant association between indication for the breast MRI and the malignancy status of the hepatic lesion (Fisher's Exact, P < 0.0142). CONCLUSION Our initial experience suggests the benign nature of incidentally detected T2 hyperintense hepatic lesions at breast MRI in women without a newly diagnosed breast cancer.
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Affiliation(s)
- Priya K Shah
- North Shore University Hospital, Hofstra Northwell School of Medicine, 300 Community Drive, Manhasset, NY 11030, United States.
| | - Ilana A Kafer
- North Shore University Hospital, Hofstra Northwell School of Medicine, 300 Community Drive, Manhasset, NY 11030, United States.
| | - Gregory M Grimaldi
- North Shore University Hospital, Hofstra Northwell School of Medicine, 300 Community Drive, Manhasset, NY 11030, United States.
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Knox M, Slanetz P, Phillips J, Fein Zachary V, Venkataraman S, Dialani V, Mehta T. Incidental liver lesions seen on Breast MRI: When is additional imaging warranted? Eur J Radiol 2017; 95:319-324. [DOI: 10.1016/j.ejrad.2017.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 08/08/2017] [Accepted: 08/16/2017] [Indexed: 12/21/2022]
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13
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Gao Y, Ibidapo O, Toth HK, Moy L. Delineating Extramammary Findings at Breast MR Imaging. Radiographics 2017; 37:10-31. [DOI: 10.1148/rg.2017160051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Lallemand M, Barron M, Bingham J, Mosier A, Hardin M, Sohn V. The true impact of breast magnetic resonance imaging on the management of in situ disease: more is not better. Am J Surg 2016; 213:127-131. [PMID: 27842732 DOI: 10.1016/j.amjsurg.2016.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 05/04/2016] [Accepted: 05/16/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND The optimal role of breast magnetic resonance imaging (MRI) in the management of ductal carcinoma in situ (DCIS) remains controversial. We sought to better define the impact of breast MRIs when utilized during the workup of DCIS. METHODS Patients with biopsy-proven DCIS without any additional invasive disease were prospectively enrolled in the multidisciplinary breast cancer pathway and comprised the study group. Patients who met any additional criteria for MRI screening were excluded. RESULTS From 2008 to 2014, 93 women met the inclusion criteria. 81 patients underwent MRI as part of their workup. One patient benefited from MRI via identification of occult malignancy not previously identified. 35 MRIs identified no additional information whereas 46 had additional findings. These findings led to 23 procedures and 16 negative biopsies; recommendations for 16 radiographic studies that were normal; and influenced nodal sampling in 7 women with 1 positive metastatic focus. CONCLUSIONS The routine use of breast MRI for women diagnosed with DCIS has limited benefit. Often, it leads to multiple procedures and studies that are clinically insignificant and delays surgical treatment.
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Affiliation(s)
- Michael Lallemand
- Department of General Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Dr., Joint Base Lewis-McChord, Tacoma, WA 98431, USA.
| | - Morgan Barron
- Department of General Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Dr., Joint Base Lewis-McChord, Tacoma, WA 98431, USA
| | - Jason Bingham
- Department of General Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Dr., Joint Base Lewis-McChord, Tacoma, WA 98431, USA
| | - Andrew Mosier
- Department of Radiology, Madigan Army Medical Center, Tacoma, WA, USA
| | - Mark Hardin
- Department of General Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Dr., Joint Base Lewis-McChord, Tacoma, WA 98431, USA
| | - Vance Sohn
- Department of General Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Dr., Joint Base Lewis-McChord, Tacoma, WA 98431, USA
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Hayes LM, Frebault JS, Landercasper J, Borgert AJ, Vang CA, Johnson JM, Linebarger JH. Extramammary findings in diagnostic breast magnetic resonance imaging among patients with known breast cancer: incidence and cost analysis. Am J Surg 2016; 212:1194-1200. [PMID: 27793323 DOI: 10.1016/j.amjsurg.2016.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 09/08/2016] [Accepted: 09/15/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Extramammary findings (EMFs) are common on breast magnetic resonance imaging (MRI). METHODS A retrospective review of breast MRIs in breast cancer patients between January 2009 and December 2014 was performed to identify EMF occurrences, resultant evaluation, and added cost. RESULTS EMFs were noted in 185 (59%) of 316 MRIs. Overall, 201 new EMFs were identified with 178 (89%) benign and 23 (11%) malignant. New malignant findings included 19 metastatic nodes (18 axillary, 1 internal mammary) and 4 primary malignancies (2 thyroid, 2 lung). New malignant nonaxillary EMFs occurred at a rate of 1.6% (5/316). EMFs resulted in 65 patients undergoing 98 imaging studies, 37 procedures, and 10 consultations with a median (range) total charge of $3,491 ($222 to $29,076] and out of pocket cost of $2,206 ($44 to $12,780) per patient. CONCLUSIONS EMFs occurred in more than half of our patients, were usually benign, and frequently led to additional testing and costs.
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Affiliation(s)
- Lisa M Hayes
- Department of Medical Education, Gundersen Health System (GHS), La Crosse, WI, USA; Department of Surgery, GHS, 1900 South Ave, La Crosse, WI 54601, USA
| | - Julia S Frebault
- Department of Medical Research, Gundersen Medical Foundation, La Crosse, WI, USA
| | - Jeffrey Landercasper
- Department of Medical Research, Gundersen Medical Foundation, La Crosse, WI, USA
| | - Andrew J Borgert
- Department of Medical Research, Gundersen Medical Foundation, La Crosse, WI, USA
| | - Choua A Vang
- Department of Medical Research, Gundersen Medical Foundation, La Crosse, WI, USA
| | - Jeanne M Johnson
- Department of Surgery, GHS, 1900 South Ave, La Crosse, WI 54601, USA; Norma J. Vinger Center for Breast Care, GHS, 1900 South Ave, La Crosse, WI 54601, USA
| | - Jared H Linebarger
- Department of Surgery, GHS, 1900 South Ave, La Crosse, WI 54601, USA; Norma J. Vinger Center for Breast Care, GHS, 1900 South Ave, La Crosse, WI 54601, USA.
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16
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Miquel-Cases A, Steuten LMG, Rigter LS, van Harten WH. Cost-effectiveness and resource use of implementing MRI-guided NACT in ER-positive/HER2-negative breast cancers in The Netherlands. BMC Cancer 2016; 16:712. [PMID: 27595620 PMCID: PMC5011796 DOI: 10.1186/s12885-016-2653-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 07/29/2016] [Indexed: 01/12/2023] Open
Abstract
Background Response-guided neoadjuvant chemotherapy (RG-NACT) with magnetic resonance imaging (MRI) is effective in treating oestrogen receptor positive/human epidermal growth factor receptor-2 negative (ER-positive/HER2-negative) breast cancer. We estimated the expected cost-effectiveness and resources required for its implementation compared to conventional-NACT. Methods A Markov model compared costs, quality-adjusted-life-years (QALYs) and costs/QALY of RG-NACT vs. conventional-NACT, from a hospital perspective over a 5-year time horizon. Health services required for and health outcomes of implementation were estimated via resource modelling analysis, considering a current (4 %) and a full (100 %) implementation scenario. Results RG-NACT was expected to be more effective and less costly than conventional NACT in both implementation scenarios, with 94 % (current) and 95 % (full) certainty, at a willingness to pay threshold of €20.000/QALY. Fully implementing RG-NACT in the Dutch target population of 6306 patients requires additional 5335 MRI examinations and an (absolute) increase in the number of MRI technologists, by 3.6 fte (full-time equivalent), and of breast radiologists, by 0.4 fte. On the other hand, it prevents 9 additional relapses, 143 cancer deaths, 23 congestive heart failure events and 2 myelodysplastic syndrome/acute myeloid leukaemia events. Conclusion Considering cost-effectiveness, RG-NACT is expected to dominate conventional-NACT. While personnel capacity is likely to be sufficient for a full implementation scenario, MRI utilization needs to be intensified.
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Affiliation(s)
- Anna Miquel-Cases
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands
| | - Lotte M G Steuten
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, USA
| | - Lisanne S Rigter
- Department of Medical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands
| | - Wim H van Harten
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands. .,Department of Healthcare Technology and Services Research, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands.
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17
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Whole-body MRI in patients with lymphoma: collateral findings. Radiol Med 2016; 121:793-800. [PMID: 27307001 DOI: 10.1007/s11547-016-0658-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/30/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE To assess the incidence of collateral findings detected on whole-body magnetic resonance (WB-MRI) scans performed on patients with lymphoma. MATERIALS AND METHODS 114 patients (65 male; median age 45.2 years, range 15-86) with histologically confirmed lymphoma (47 Hodgkin, 67 Non-Hodgkin) underwent WB-MRI. The collateral findings were classified into three classes, according to their clinical significance, as follows: not or low significant (class 1), moderately or potentially significant (class 2), and significant (class 3). A Chi-square (χ (2)) test was performed to assess the statistical significance of differences in the incidence of collateral findings based on age (≤50 and >50 years old), gender and histology (Hodgkin and Non-Hodgkin Lymphoma). RESULTS Ninety-one of 114 patients (79.8 %) had one or more incidental findings on WB-MRI. Collateral findings were more frequent in class 1 (43 %); abnormalities found in 35 patients (30.7 %) were considered potentially significant, whereas seven patients (6.1 %) demonstrated significant collateral findings requiring immediate treatment or further diagnostic evaluation. Collateral findings were more frequent in subjects over 50 years old compared to those of 50 years old or younger; differences were statistical significant (χ (2) = 8.42, p < 0.05). There were not statistically significant differences related to gender (χ (2) = 0.17, p > 0.05) and histology (χ (2) = 0.24, p > 0.05). CONCLUSION WB-MRI is an attractive procedure that allows to detect incidental abnormalities of organs not involved by disease offering the opportunity to obtain an early diagnosis of asymptomatic life-threatening diseases.
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18
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Yang SM, Kim SH, Kang BJ, Song BJ. Extramammary findings on breast MRI: prevalence and imaging characteristics favoring malignancy detection: a retrospective analysis. World J Surg Oncol 2016; 14:119. [PMID: 27098094 PMCID: PMC4839123 DOI: 10.1186/s12957-016-0865-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 04/12/2016] [Indexed: 12/21/2022] Open
Abstract
Background Little study of the extramammary finding of breast MRIs has been done with only descriptive work of the prevalence of location and malignancy. The purpose of the present study was to assess the prevalence, the location, and the imaging characteristics of the incidentally detected extramammary findings on breast MRI and to determine potential malignant characteristics. Methods The study evaluated extramammary findings in 109 patients who underwent breast MRI for the staging of breast cancer and for the follow-up of post-therapy. Prevalence, the location, clinicopathologic findings of breast cancer size, metastasis, and MRI characteristics were evaluated retrospectively. Malignancy of extramammary findings was determined based on the pathologic examinations and diagnostic images. Results One hundred forty-nine incidental findings were detected in 109 (4.6 %) of 2361 patients, and 69 cases were confirmed or considered to be malignant. The most common site was the bone (43/149, 28.9 %) with malignancy found in 30 (69.8 %) of 43 bone lesions. Less frequent tumor locations were the liver (22.1 %), lung (21.5 %), pleura or chest wall (10.1 %), mediastinum (6.7 %), supraclavicular lymph nodes (LNs) (6.0 %), and others (4.7 %). Findings of significant relevance with malignancy of the extramammary findings included bigger size of breast cancer, presence of LN metastasis, and distant metastasis (P < 0.01). Lesions showing iso- or hypo signal intensity (SI) on T2-weighted imaging (T2WI) (P = 0.000), contrast enhancement (P = 0.000), high SI on diffusion-weighted imaging (DWI) (P = 0.049), low SI on apparent-diffusion-coefficient map relative to DWI (P = 0.000), and multiplicity (P = 0.000) of the extramammary finding were significantly related to malignancy. Conclusions Extramammary findings on breast MRI are not rare. Clinicopathologic features of the breast cancer and MRI features of extramammary findings could be useful in estimating the malignancy of the incidental extramammary finding.
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Affiliation(s)
- Soung Moon Yang
- Department of Radiology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 137-701, Republic of Korea
| | - Sung Hun Kim
- Department of Radiology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 137-701, Republic of Korea.
| | - Bong Joo Kang
- Department of Radiology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 137-701, Republic of Korea
| | - Byung Joo Song
- Department of General Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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19
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Padia SA, Freyvogel M, Dietz J, Valente S, O'Rourke C, Grobmyer SR. False-positive Extra-Mammary Findings in Breast MRI: Another Cause for Concern. Breast J 2015; 22:90-5. [PMID: 26511429 DOI: 10.1111/tbj.12524] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Breast magnetic resonance imaging (MRI) has been repeatedly shown to have a high false-positive rate for additional findings in the breast resulting in additional breast imaging and biopsies. We hypothesize that breast MRI is also associated with a high rate of false-positive findings outside of the breast requiring additional evaluation, interventions, and delays in treatment. We performed a retrospective review of all breast MRIs performed on breast cancer patients in 2010 at a single institution. MRI reports were analyzed for extra-mammary findings. The timing and yield of the additional procedures was also analyzed. Three hundred and twenty-seven breast cancer patients (average age = 53.53 ± 11.08 years) had a breast MRI. Incidental, extra-mammary findings were reported in 35/327 patients (10.7%) with a total of 38 incidental findings. The extra-mammary findings were located in the liver (n = 21, 60.0%), thoracic cavity (n = 12, 34.3%), kidneys (n = 1, 2.9%), musculoskeletal system (n = 3, 8.6%), and neck (n = 1, 2.9%). Eighteen of the 35 patients (51.4%) received additional radiographic imaging, 3 (8.6%) received additional laboratory testing, 2 (5.7%) received additional physician referrals and 2 (5.7%) received a biopsy of the finding. The average time to additional procedures in these patients was 14.5 days. None of the incidental, extra-mammary findings were associated with breast cancer or other malignancy. Breast MRI was associated with a high rate (10.7%) of extra-mammary findings, which led to costly additional imaging studies, referrals, and tests. These findings were not associated with breast cancer or other malignancies. Extra-mammary findings highlight an unrecognized adverse consequence of breast MRI.
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Affiliation(s)
- Shilpa A Padia
- Division of Breast Surgery, The Cleveland Clinic, Cleveland, Ohio
| | - Mary Freyvogel
- Division of Breast Surgery, The Cleveland Clinic, Cleveland, Ohio
| | - Jill Dietz
- Division of Breast Surgery, The Cleveland Clinic, Cleveland, Ohio
| | | | - Colin O'Rourke
- Department of General Surgery and Quantitative Health Sciences, The Cleveland Clinic, Cleveland, Ohio
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20
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Phadke S, Thomas A, Yang L, Moore C, Xia C, Schroeder MC. Frequency and Clinical Significance of Extramammary Findings on Breast Magnetic Resonance Imaging. Clin Breast Cancer 2015; 16:424-429. [PMID: 26403074 DOI: 10.1016/j.clbc.2015.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 08/17/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Use of breast magnetic resonance imaging (MRI) for screening and local staging of breast cancer has increased. With this, questions have emerged regarding the management and effect of extramammary findings (EMFs) reported on breast MRI. PATIENTS AND METHODS Breast MRI studies performed between January 1, 2007 and December 31, 2012 at the University of Iowa were analyzed. Data were collected regarding number and location of EMFs, characteristics of the patients who had a breast MRI, and time to first treatment among the patients who had a breast MRI for stage I-III breast cancer. RESULTS During the study period, 1305 breast MRIs were obtained in 772 women. An EMF was found in 140 studies (10.7%) and 113 women (14.6%). EMFs were more likely in MRIs of older patients (50 vs. 54 years, P = .004) and postmenopausal women (P = .001). Anatomically, most EMFs were seen in the liver (89 of 140) or bone (21 of 140). Eight women (0.6%) had an EMF on breast MRI that led to upstaging to stage IV breast cancer. For patients with stage I-III breast cancer, the finding of an EMF on breast MRI did not affect time to initial cancer treatment (13 vs. 14 days; P = .586). CONCLUSION EMFs on breast MRI are seen with some frequency and occur more commonly in older, postmenopausal women. In our study, most EMFs were benign and did not affect patient outcome with regard to upstaging to stage IV disease or time to cancer treatment. A very small portion of studies revealed subclinical advanced breast cancer.
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Affiliation(s)
- Sneha Phadke
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Alexandra Thomas
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Limin Yang
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Catherine Moore
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA; Oncology Specialists of Charlotte, Charlotte, NC
| | - Chang Xia
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA; ProMedica Hematology/Oncology Associates, Sylvania, OH
| | - Mary C Schroeder
- Division of Health Services Research, Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA.
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21
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Incidental Internal Mammary Lymph Nodes Visualized on Screening Breast MRI. AJR Am J Roentgenol 2015; 205:209-14. [DOI: 10.2214/ajr.14.13586] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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22
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Schaefer AR, Yang L, Park JM, Xiong J, Fajardo LL. Detection and Clinical Significance of Sternal Lesions on Breast MRI. Breast J 2015; 21:395-402. [PMID: 25864435 DOI: 10.1111/tbj.12416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this study is to characterize sternal lesions detected on breast magnetic resonance imaging (MRI), compare MRI detection of sternal lesions with other imaging modalities (bone scan, positron emission tomography/computed tomography (PET/CT) and chest CT), and ascertain how often patient management is altered by discovery of sternal lesions. Retrospective review of 1143 breast MRIs between 2007 and 2012 identified 17 patients with sternal lesions including 15 patients with newly diagnosed breast cancer and two patients with remote history of breast cancer. Tumor size, histopathology, receptor status, nodal and distant metastasis, and images of breast MRI, and other modalities were reviewed. Sternal lesions in 9 of the 17 patients were determined to be malignant (metastasis) either by biopsy or presence of widespread metastases. Sternal lesions in 8 of the 17 were benign, confirmed by biopsy or presumed benign as not detected by other modalities. The malignant group had statistically significant larger breast cancer size (malignant: 6.4 cm; benign: 2.3 cm), a higher percentage of diffuse sternal lesions (malignant: 56%; benign: 0%), and more frequently showed rapid initial enhancing (malignant: 100%; benign: 63%) and delayed washout curves (malignant: 67%; benign: 13%). Although not statistically significant, the malignant group had a higher frequency of invasive lobular carcinoma (malignant: 44%; benign: 13%) and more lymph node involvement (malignant: 78%; benign: 50%). Breast MRI detected more sternal lesions than did bone scan, PET/CT and chest CT. Four of the 17 (24%) patients were upgraded to stage 4 due to unsuspected metastatic sternal lesions on breast MRI. In conclusion, breast MRI is more sensitive than other modalities in detecting sternal lesions. Sternal metastases occur more frequently in aggressive breast cancer and exhibit malignant-type dynamics on breast MRI. Detection of unsuspected sternal metastasis alters staging and improves patient management with more appropriate treatment.
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Affiliation(s)
| | - Limin Yang
- Department of Radiology, University of Iowa, Iowa City, Iowa
| | - Jeong Mi Park
- Department of Radiology, University of Iowa, Iowa City, Iowa
| | - Jinhu Xiong
- Department of Radiology, University of Iowa, Iowa City, Iowa
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Karp NL, Price ER, Wisner DJ, Chang CB, Hylton NM, Joe BN. Extra-mammary findings on breast MRI: a pictorial review. Clin Imaging 2015; 39:547-52. [PMID: 25772531 DOI: 10.1016/j.clinimag.2015.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 12/22/2014] [Accepted: 01/22/2015] [Indexed: 01/17/2023]
Abstract
Recent improvements in breast coil performance have made detection of extra-mammary findings increasingly common. Some of these findings have important clinical implications. The radiologist should be aware of the spectrum of extra-mammary pathologies found on breast magnetic resonance imaging (MRI) and be able to distinguish clinically significant findings from those that are inconsequential. The purpose of this essay is to demonstrate various common and uncommon extra-mammary findings encountered while interpreting breast MRI and to detail appropriate management recommendations.
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Affiliation(s)
- Norna L Karp
- University of California, 1600 Divisadero, Room C-250, San Francisco, CA, 94115
| | - Elissa R Price
- University of California, 1600 Divisadero, Room C-250, San Francisco, CA, 94115.
| | - Dorota J Wisner
- University of California, 1600 Divisadero, Room C-250, San Francisco, CA, 94115
| | - C Belinda Chang
- University of California, 1600 Divisadero, Room C-250, San Francisco, CA, 94115
| | - Nola M Hylton
- University of California, 1600 Divisadero, Room C-250, San Francisco, CA, 94115
| | - Bonnie N Joe
- University of California, 1600 Divisadero, Room C-250, San Francisco, CA, 94115
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24
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Alduk AM, Prutki M, Stern-Padovan R. Incidental extra-mammary findings in breast MRI. Clin Radiol 2015; 70:523-7. [PMID: 25656660 DOI: 10.1016/j.crad.2015.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 12/14/2014] [Accepted: 01/06/2015] [Indexed: 12/21/2022]
Abstract
AIM To investigate the frequency, distribution, and nature of incidental extra-mammary findings detected with breast MRI. MATERIALS AND METHODS Incidental findings were defined as unexpected lesions outside the breast, not previously known or suspected at the time of referral. Five hundred consecutive breast MRI studies performed from June 2010 to September 2012 were reviewed in this retrospective study for which the institutional review board granted approval and waived the requirement for informed consent. MRI findings were compared with subsequent diagnostic procedures in order to differentiate benign from malignant lesions. RESULTS One hundred and thirty-eight incidental findings were found in 107 of the 500 (21.4%) examined patients. The most common site was the liver (61/138; 44.2%), followed by the lung (24/138; 17.4%), mediastinum (22/138; 15.9%), pleural cavity (15/138; 10.9%), bone tissue (9/138; 6.5%), spleen (3/138; 2.2%), major pectoral muscle (3/138; 2.2%), and kidney (1/138; 0.7%). Twenty-five of the 138 (18.1%) incidental findings were confirmed to be malignant, whereas the remaining 113 (81.9%) were benign. Malignant findings were exclusively detected in patients with known breast carcinoma, whereas incidental findings in patients without a history of carcinoma were all benign. Twenty-five of 100 (24.8%) incidental findings among patients with history of breast cancer were malignant. CONCLUSION Although many of incidental findings were benign, some were malignant, altering the diagnostic work-up, staging, and treatment. Therefore, it is important to assess the entire field of view carefully for abnormalities when reviewing breast MRI studies.
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Affiliation(s)
- A M Alduk
- Department of Radiology, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.
| | - M Prutki
- Department of Radiology, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - R Stern-Padovan
- Department of Radiology, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
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Breast magnetic resonance imaging incidental findings. Top Magn Reson Imaging 2014; 23:361-71. [PMID: 25463407 DOI: 10.1097/rmr.0000000000000036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Suh HJ, Choi JS, Ko K. Extra-mammary findings detected on breast magnetic resonance imaging: a pictorial essay. Korean J Radiol 2014; 15:423-9. [PMID: 25053900 PMCID: PMC4105803 DOI: 10.3348/kjr.2014.15.4.423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 04/20/2014] [Indexed: 12/21/2022] Open
Abstract
Magnetic resonance imaging (MRI) of the breast is used for various indications. Contrary to computed tomography as a staging tool, breast MRI focuses on the breast parenchyma and axilla. In spite of narrow field of view, many structures such as the anterior portion of the lungs, mediastinum, bony structures and the liver are included which should not be neglected because the abnormalities detected on the above structures may influence the staging and provide a clue to systemic metastasis, which results in the change of treatment strategy. The purpose of this pictorial essay was to review the unexpected extra-mammary findings seen on the preoperative breast MRI.
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Affiliation(s)
- Hee Jung Suh
- Cancer Prevention & Detection Center, National Cancer Center, Goyang 410-769, Korea
| | - Ji Soo Choi
- Department of Radiology, National Cancer Center, Goyang 410-769, Korea
| | - Kyungran Ko
- Department of Radiology, National Cancer Center, Goyang 410-769, Korea
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Moschetta M, Telegrafo M, Rella L, Stabile Ianora AA, Angelelli G. Let's go out of the breast: prevalence of extra-mammary findings and their characterization on breast MRI. Eur J Radiol 2014; 83:930-934. [PMID: 24656879 DOI: 10.1016/j.ejrad.2014.02.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 02/18/2014] [Accepted: 02/24/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study is to assess the prevalence, the site and the nature of extra-mammary findings on breast magnetic resonance imaging (MRI) and to determine its accuracy in the characterization of the discovered lesions. MATERIALS AND METHODS A retrospective review of 308 female patients (mean age 50 ± 20) who underwent breast MRI with 1.5T device was performed. 125 out of 308 (40.5%) had a positive personal history of breast cancer (pre-operative n=80; follow-up n=45), while the remaining 183 without history of breast cancer (high familiar risk for breast cancer n=80; dense breast n=103). All incidental findings were characterized by means of additional imaging (US; Bone scintigraphy-MRI; CT-PET-CT). RESULTS 59 incidental findings were found in 53/308 (17%) examined patients. 9/59 incidental findings (15%) were confirmed to be malignant while the remaining 50/59 (84%) benign. The most common site was the liver (33/59; 55.8%), followed by the lung (6/59; 10.1%), bone (6/59; 10.1%), diaphragm (6/59; 10.1%) spleen (3/59; 5%), kidney (2/59; 3.4%), gall bladder (1/5; 1.5%), ascending aorta (1/59; 1.5%), thyroid (1/59; 1.5%). The incidence of malignant incidental findings resulted to be higher in the group of patients with personal breast cancer (36%) than in the other one (8%). By comparing MRI findings with the additional definitive imaging tools, breast MRI allowed a correct diagnosis in 58/59 cases with a diagnostic accuracy value of 98%. CONCLUSION Incidental extramammary findings on breast MRI are common. Benign lesions represent the most frequent findings, however malignant ones need to be searched especially in patients with personal history of breast cancer because they could influence the clinical patient management. Breast MRI can characterize incidental findings with high accuracy value.
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Affiliation(s)
- Marco Moschetta
- DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, Bari, Italy.
| | - Michele Telegrafo
- DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, Bari, Italy.
| | - Leonarda Rella
- DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, Bari, Italy.
| | - Amato Antonio Stabile Ianora
- DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, Bari, Italy.
| | - Giuseppe Angelelli
- DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, Bari, Italy.
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Suh HJ, Moon HJ, Kwak JY, Choi JS, Kim EK. Anaplastic thyroid cancer: ultrasonographic findings and the role of ultrasonography-guided fine needle aspiration biopsy. Yonsei Med J 2013; 54:1400-6. [PMID: 24142644 PMCID: PMC3809886 DOI: 10.3349/ymj.2013.54.6.1400] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To investigate the ultrasonographic (US) features of anaplastic thyroid cancer (ATC) and the diagnostic performance of US-guided fine needle aspiration biopsy (FNAB) therein. MATERIALS AND METHODS Eighteen cases of ATC diagnosed between January 2001 and May 2011 were included. FNAB was performed in all cases. Initial FNAB results were divided into three groups: 1) the cytological ATC group, cytological diagnosis of ATC; 2) the underestimated group, cytological diagnoses of malignancy other than ATC; and 3) the false negative group, cytological diagnoses of atypical, benign and non-diagnostic lesions. We retrospectively reviewed US findings and compared treatment modalities between each group. RESULTS Among the 18 patients, there were nine in the initially cytological ATC group, four in the underestimated group and five in the false negative group. The most common US features of ATC were a solid (64.7%) and irregular shaped (88.2%) mass with lymph node involvement (76.4%). However, except for lymph node involvement (p=0.003), US findings for each group were not statistically different. The initial cytological diagnostic accuracy of ATC was 50% (9/18). Surgery was performed less in the ATC group (11%) and the false negative group (20%) than the underestimated group (75%). CONCLUSION The US features of ATC were not especially different from other types of aggressive thyroid cancer. A correct diagnosis of ATC by initial US-FNAB was made in 50% of the patients, which is significant in that therapeutic surgery can be undertaken in lower numbers if correctly diagnosed.
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Affiliation(s)
- Hee Jung Suh
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
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Prevalence of extramammary findings on breast MRI: a large retrospective single-centre study. Radiol Med 2013; 118:1109-18. [DOI: 10.1007/s11547-013-0937-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Accepted: 04/16/2012] [Indexed: 12/27/2022]
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Schmidt CO, Hegenscheid K, Erdmann P, Kohlmann T, Langanke M, Völzke H, Puls R, Assel H, Biffar R, Grabe HJ. Psychosocial consequences and severity of disclosed incidental findings from whole-body MRI in a general population study. Eur Radiol 2012; 23:1343-51. [DOI: 10.1007/s00330-012-2723-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 10/07/2012] [Accepted: 10/09/2012] [Indexed: 12/26/2022]
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