1
|
Zamora K, Allen E, Hermecz B. Contrast mammography in clinical practice: Current uses and potential diagnostic dilemmas. Clin Imaging 2020; 71:126-135. [PMID: 33197726 DOI: 10.1016/j.clinimag.2020.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 10/28/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This article will discuss the indications for Contrast Enhanced Spectral Mammography (CESM) with a focus on imaging interpretation including diagnostic dilemmas and pitfalls which may be encountered in practice. CONCLUSION Understanding potential diagnostic dilemmas and pitfalls of CESM allows for enhanced interpretation. The clinical utilization of Contrast Enhanced Spectral Mammography (CESM) has increased significantly over the last few years. CESM demonstrates comparable sensitivity and accuracy to magnetic resonance imaging (MRI) for the evaluation of breast cancer but is less time consuming and less expensive. Because of this, CESM is now being used in lieu of MRI for many diagnostic indicators including the evaluation of abnormal mammographic findings, extent of disease, and response to neoadjuvant therapy. Additionally, ongoing research into the role of CESM in asymptomatic screening for breast cancer is evolving. As this technique becomes more popular, focusing on appropriate technique and interpretation is important. This article reviews the current and potential roles of CESM. It provides examples of CESM utilized for diagnostic indications while highlighting diagnostic dilemmas, pitfalls, and artifacts that may be encountered when interpreting CESM images.
Collapse
Affiliation(s)
- Kathryn Zamora
- University of Alabama at Birmingham, Department of Radiology, JTN 478, 619 20th Street South, Birmingham, AL 35249, United States of America.
| | - Elizabeth Allen
- University of Alabama at Birmingham, Department of Radiology, JTN 478, 619 20th Street South, Birmingham, AL 35249, United States of America
| | - Brittany Hermecz
- University of Alabama at Birmingham, Department of Radiology, JTN 478, 619 20th Street South, Birmingham, AL 35249, United States of America
| |
Collapse
|
2
|
Lee JY, Jang M, Kim SM, Yun BL, Jang JY, Ahn HS. Preoperative magnetic resonance imaging characteristics of oval circumscribed fast enhancing lesions in patients with newly diagnosed breast cancer. Medicine (Baltimore) 2018; 97:e0704. [PMID: 29742727 PMCID: PMC5959388 DOI: 10.1097/md.0000000000010704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to investigate the follow-up results and characteristics of oval circumscribed lesions with fast initial enhancement on preoperative magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer.Preoperative data from consecutive patients newly diagnosed with breast cancer between 2010 and 2013 were retrospectively reviewed. Only MRI reports containing, "oval shape, circumscribed margin, and fast initial enhancement," were extracted and analyzed. Follow-up results and clinical and pathological findings were evaluated.A total of 430 oval circumscribed lesions with fast initial enhancement were included. Forty-eight lesions were pathologically confirmed at initial workup and 382 were followed up. Among the 48 lesions, 14 were found to have additional malignancy and 34 were benign. Among the 382 followed-up lesions, only 1 was subsequently confirmed to be malignant. There were no evident changes in any of the remaining lesions during follow-up. The overall rate of malignancy was 3.5% (15/430). When lesions exhibited delayed washout enhancing kinetics (P < .001), were located ipsilaterally (P = .007), and closer to the primary tumor (P = .012), the possibility of malignancy was high. High T2-weighted imaging signal intensity suggested benignity (P = .043).Although the probability of being diagnosed with malignancy during follow-up in this study was low (0.3%), this investigation revealed several preoperative MRI characteristics that should alert clinicians to the possibility of malignancy.
Collapse
Affiliation(s)
- Jong Yoon Lee
- Department of Radiology, Borame Medical Center 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, South Korea
| | - Mijung Jang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
| | - Sun Mi Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
| | - Bo La Yun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
| | - Ja Yoon Jang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
| | - Hye Shin Ahn
- Department of Radiology, Chung-Ang University Hospital, Dongjak-gu, South Korea
| |
Collapse
|
3
|
Lewis TC, Patel BK, Pizzitola VJ. Navigating contrast-enhanced digital mammography. APPLIED RADIOLOGY 2017. [DOI: 10.37549/ar2363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
4
|
Intramammary lymph nodes: A question seeking for an answer or an answer seeking for a question? Breast 2012; 21:615-20. [DOI: 10.1016/j.breast.2012.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 05/30/2012] [Accepted: 06/07/2012] [Indexed: 11/21/2022] Open
|
5
|
Abdullgaffar B, Gopal P, Abdulrahim M, Ghazi E, Mohamed E. The significance of intramammary lymph nodes in breast cancer: a systematic review and meta-analysis. Int J Surg Pathol 2012; 20:555-63. [PMID: 22649167 DOI: 10.1177/1066896912448425] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intramammary lymph nodes (IntraMLNs) are frequent mostly benign incidental findings. However, they are clinically important because they can be the primary sites of metastasis and sentinel lymph nodes. Literature data regarding the clinical significance of IntraMLNs metastasis, however, remains controversial. This study aimed to perform a systematic review and meta-analysis to better define the prognostic value of positive IntraMLNs in patients with breast cancer. A systematic review of the literature without date restrictions was conducted. Five electronic medical databases were searched, and a hand-search of the reference lists of the collected articles was also performed. Studies with sufficient and relevant pathologic and clinical survival data were included. Other studies with insufficient data or normal findings were excluded. This study found 18 studies eligible for systematic review, 3 of which were eligible for outcome meta-analysis. IntraMLNs metastases were strongly correlated with axillary lymph nodes involvement. Positive IntraMLNs are reliable predictors of axillary lymph node involvement and therefore a guide for further surgical management of the axillary nodes. Even though it could be concluded that IntraMLNs metastasis is an independent predictor of outcome, this meta-analysis was limited because of the scarcity of data and the inconsistencies and heterogeneity of the outcome studies.
Collapse
|
6
|
Millet I, Pages E, Hoa D, Merigeaud S, Curros Doyon F, Prat X, Taourel P. Pearls and pitfalls in breast MRI. Br J Radiol 2011; 85:197-207. [PMID: 22128131 DOI: 10.1259/bjr/47213729] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
At our academic institution, we have noticed repeated examples of both false-positive and false-negative MR diagnoses in breast cancer. The most common diagnostic errors in interpreting MRI of the breast are discussed in this review and experience-based advice is provided to avoid similar mistakes. The most common reasons for false-positive diagnoses are misinterpretation of artefacts, confusion between normal enhancing structures and tumours and, above all, insufficient use of the American College of Radiology breast imaging reporting and data system lexicon, whereas false-negative diagnoses are made as a result of missed tiny enhancement, a background-enhancing breast, or enhancement interpreted as benign rather than malignant.
Collapse
Affiliation(s)
- I Millet
- Department of Imaging, Lapeyronie Hospital, Montpellier, France
| | | | | | | | | | | | | |
Collapse
|
7
|
Ojeda-Fournier H, Nguyen JQ. Ultrasound Evaluation of Regional Breast Lymph Nodes. Semin Roentgenol 2011; 46:51-9. [DOI: 10.1053/j.ro.2010.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
8
|
Intramammary lymph node metastasis of breast cancer after sentinel node biopsy: Two cases and a review of the literature. Eur J Surg Oncol 2009; 35:331-2. [DOI: 10.1016/j.ejso.2008.01.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Accepted: 01/29/2008] [Indexed: 11/19/2022] Open
|
9
|
Nassar A, Cohen C, Cotsonis G, Carlson G. Significance of Intramammary Lymph Nodes in the Staging of Breast Cancer: Correlation with Tumor Characteristics and Outcome. Breast J 2008; 14:147-52. [DOI: 10.1111/j.1524-4741.2007.00545.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
10
|
Intra M, Garcia-Etienne CA, Renne G, Trifirò G, Rotmensz N, Gentilini OD, Galimberti V, Sagona A, Mattar D, Sangalli C, Gatti G, Luini A, Veronesi U. When Sentinel Lymph Node is Intramammary. Ann Surg Oncol 2007; 15:1304-8. [DOI: 10.1245/s10434-007-9720-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 10/31/2007] [Accepted: 10/31/2007] [Indexed: 11/18/2022]
|
11
|
Ganglio intramamario metastásico como primera manifestación del cáncer de mama. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2007. [DOI: 10.1016/s0210-573x(07)74518-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
12
|
Guth AA, Mercado C, Roses DF, Hiotis K, Skinner K, Diflo T, Cangiarella J. Intramammary lymph nodes and breast cancer: a marker for disease severity, or just another lymph node? Am J Surg 2006; 192:502-5. [PMID: 16978960 DOI: 10.1016/j.amjsurg.2006.05.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Revised: 05/24/2006] [Accepted: 05/24/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Axillary lymph node status is still considered the most significant prognostic factor for breast cancer outcome, and treatment decisions are based on the presence or absence of nodal disease. Intramammary lymph nodes (IMLNs) can be a site of regional spread. Is this a marker for more aggressive disease? METHODS We reviewed the cancer center pathology database from 1991 to 2005 for all cases of breast cancer with IMLNs. RESULTS IMLNs were identified in 64 breast cancer patients, with metastatic spread in 20 patients, and benign IMLNs described in 44 patients. Positive IMLNs were associated with more aggressive disease, including higher rates of invasive versus noninvasive cancers (5% ductal carcinoma-in-situ [DCIS] with positive IMLNs vs. 23% with negative IMLNs), lymphovascular invasion (55% vs. 11%), and a higher rate of axillary lymph node involvement (72% vs. 18%). Patients with positive IMLNs were also more likely to undergo mastectomy (75% vs. 54%). CONCLUSIONS IMLN metastases are a marker for disease severity; recognition of this may influence choice of adjuvant therapy. The presence of metastatic disease in an IMLN is associated with a high rate of axillary nodal involvement, and should mandate axillary dissection. Preoperative lymphoscintigraphy may help identify these extra-axillary metastases.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Axilla
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/secondary
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Lobular/secondary
- Carcinoma, Lobular/surgery
- Female
- Humans
- Lymph Nodes/pathology
- Mammary Glands, Human/pathology
- Mastectomy
- Middle Aged
- Retrospective Studies
Collapse
Affiliation(s)
- Amber A Guth
- Department of Surgery, NYU School of Medicine, New York, NY 10016, USA.
| | | | | | | | | | | | | |
Collapse
|
13
|
Hong J, Choy E, Chog E, Soni N, Carmalt H, Gillett D, Spillane AJ. Extra-axillary sentinel node biopsy in the management of early breast cancer. Eur J Surg Oncol 2005; 31:942-8. [PMID: 16229984 DOI: 10.1016/j.ejso.2005.08.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Accepted: 08/04/2005] [Indexed: 11/23/2022] Open
Abstract
AIM To document of our experience with EAS SNB and evaluate its impact on the staging, management and the associated morbidities of patients with early breast cancer. METHOD A review of two prospective breast cancer databases identifying all SNB procedures performed at two affiliated breast units from 1998 to 2003. RESULTS A series of 979 patients underwent lymphatic mapping. Sentinel nodes were successfully identified in 903 patients. There were 142 cases in which lymphoscintigraphy identified EAS. In 17 cases extraaxillary sentinel nodes were identified with lymphoscintigraphy but could not be removed. There were 138 cases where internal mammary nodes (IMN) were removed. Of those IMN removed 25 were positive for metastases and in six of these cases only the IMN was positive. Of the 21 cases where other EAS were identified there was one case in which a supraclavicular sentinel node was positive. Twenty-five of the 26 positive sentinel nodes in EAS were macrometastases and one was a micrometastasis. No significant morbidity resulted from biopsy of EAS SNB. During IMN SNB there were eight pleural breeches, which did not result in pneumothoraces, and one case in which bleeding was difficult to control. CONCLUSION EAS SNB is technically feasible in the majority of cases. Minimal morbidity occurs after an initial learning phase. IMN SNB was shown to have significant impact on the staging and management in 18% of patients when IMNs were identified with lymphoscintigraphy. The impact of other extraaxillary lymph nodes is more difficult to assess due to small numbers. As there is little morbidity and valuable information is gained in a significant percentage of cases we strongly advocate EAS SNB.
Collapse
Affiliation(s)
- J Hong
- Sydney Cancer Centre, Breast Unit, Royal Prince Hospital, Sydney, NSW, Australia
| | | | | | | | | | | | | |
Collapse
|
14
|
Lerman H, Metser U, Lievshitz G, Sperber F, Shneebaum S, Even-Sapir E. Lymphoscintigraphic sentinel node identification in patients with breast cancer: the role of SPECT-CT. Eur J Nucl Med Mol Imaging 2005; 33:329-37. [PMID: 16220303 DOI: 10.1007/s00259-005-1927-4] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2005] [Accepted: 07/28/2005] [Indexed: 11/25/2022]
Abstract
PURPOSE Lymph node status is a major factor in determining the stage, appropriate therapy and outcome in patients with breast cancer. It is therefore of clinical importance to accurately identify all sentinel nodes (SNs) for each individual tumour before surgery. The purpose of this study was to assess the role of SPECT-CT lymphoscintigraphy in SN identification in patients with breast cancer. METHODS Lymphoscintigraphy comprising planar and SPECT-CT acquisition was performed in 157 consecutive patients with breast cancer (mean age 54.7+/-10.6, range 27-81 years) with a palpable mass (n=100), with a non-palpable mass (n=52) or post lumpectomy (n=5). Planar and SPECT-CT images were interpreted separately and the two imaging techniques were compared with respect to their ability to identify hot nodes. RESULTS Planar imaging alone was negative for identification of hot nodes in 15% of the patients. SPECT-CT alone was negative in 10% and both techniques were negative in 9% of the patients. Forty-six of the total of 361 (13%) hot nodes identified by lymphoscintigraphy were detected only on SPECT-CT, including 21 nodes obscured by the scattered radiation from the injection site, nine adjacent nodes misinterpreted on planar images as a single node and 16 nodes which were missed on planar images and detected on SPECT data. SPECT-CT detected additional sites of drainage unexpected on planar images, including axillary (n=23 patients), internal mammary (n=5 patients), interpectoral (n=3 patients) and intramammary (n=2 patients) lymph node sites. Fourteen of the 329 (4%) hot lesions seen on planar images were false positive non-nodal sites of uptake that were accurately assessed by SPECT-CT and further validated by surgery. In a single patient, SPECT-CT was negative while planar images identified the SN. CONCLUSION SPECT-CT may improve the preoperative localisation of draining nodes in patients with breast cancer. It may detect hot nodes missed by planar imaging, exclude non-nodal false positive sites of uptake and accurately localise axillary and extra-axillary nodes.
Collapse
Affiliation(s)
- H Lerman
- Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel-Aviv 64239, Israel
| | | | | | | | | | | |
Collapse
|
15
|
Kouskos E, Rovere GQD, Ball S, Koh DM, Freeman A. Metastatic intramammary lymph nodes as the primary presenting sign of breast cancer. Breast 2004; 13:416-20. [PMID: 15454198 DOI: 10.1016/j.breast.2003.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2003] [Revised: 08/12/2003] [Accepted: 11/05/2003] [Indexed: 01/17/2023] Open
Abstract
Intramammary lymph nodes (IMLNs) are not uncommon, and are likely to be more frequently identified with the wider use of mammography and breast ultrasound. IMLNs could be invaded by breast cancer influencing the prognosis and the management of patients. The aim of this study is to present the very rare phenomenon of metastatic involvement of these nodes from an occult breast cancer.
Collapse
Affiliation(s)
- E Kouskos
- Breast Unit, Royal Marsden Hospital, NHS Trust, Downs Road, Sutton, Surrey SM2 5PT, UK.
| | | | | | | | | |
Collapse
|
16
|
Spillane AJ, Sacks NP. Role of axillary surgery in early breast cancer: review of the current evidence. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 2000; 70:515-24. [PMID: 10901581 DOI: 10.1046/j.1440-1622.2000.01838.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Controversy continues to surround the best practice for management of the axilla in patients with early breast cancer (EBC), particularly the clinically negative axilla. The balance between therapeutic and staging roles of axillary surgery (with the consequent morbidity of the procedures utilized) has altered. This is due to the increasing frequency of women presenting with early stage disease, the more widespread utilization of adjuvant chemoendocrine therapy and, more recently, the advent of alternative staging procedures, principally sentinel node biopsy (SNB). The aim of the present review is to critically analyse the current literature concerning the preferred management of the axilla in early breast cancer and make evidence-based recommendations on current management. METHODS A review was undertaken of the English language medical literature, using MEDLINE database software and cross-referencing major articles on the subject, focusing on the last 10 years. The following combinations of key words have been searched: breast neoplasms, axilla, axillary dissection, survival, prognosis, and sentinel node biopsy. RESULTS Despite the trend to more frequent earlier stage diagnosis, levels I and II axillary dissection remain the treatment of choice in the majority of women with EBC and a clinically negative axilla. CONCLUSIONS Sentinel node biopsy has no proven superiority over axillary dissection because no randomized controlled trials have been completed to date. Despite this, SNB will become increasingly utilized due to encouraging results from major centres responsible for its development, and patient demand. Therefore if patients are not being enrolled in clinical trials strict quality controls need to be established at a local level before SNB is allowed to replace standard treatment of the axilla. Unless this is strictly adhered to there is a significant risk of an increase in the frequency of axillary relapse and possible increased understaging and resultant inadequate treatment of patients.
Collapse
Affiliation(s)
- A J Spillane
- Breast Unit, Royal Marsden Hospital, London, UK.
| | | |
Collapse
|