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Query: UMLS:C0006142 (breast cancer)
 160,383 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

MRI of the breast has proved its role in the diagnosis of breast cancer. Despite the amount of studies with MRI, the technique has not been standardised yet. This is one of the reasons for the huge difference in specificity the reported in the different studies (from 30% to 95%). Because the many pitfalls of the technique, the specificity of MRI of the breast is correlated to the experience of the investigator. When the established indications are respected, specificity increases. Presently accepted indications are: differentiation between postoperative fibrosis and tumor recurrence, multifocality or contralateral breast carcinoma, evaluation of prosthesis, discrepancy between the different diagnostic techniques, high risk patients with dense breasts. Less frequently but nevertheless a good indication is proven axillary lymph node metastases from an unknown primary tumor. Microcalcifications still are not a good indication for MRI of the breast. MRI is still inferior to mammography in detecting ductal in-situ carcinoma or very small carcinomas because the neo-angiogenesis of these tumors is too faint to be detected by contrast-enhanced MRI. MRI instead of mammography or to solve a problem resulting from a bad mammographical examination is certainly not advised. New sequences, including diffusion and perfusion, and new contrast agents are keenly awaited.
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PMID:MR imaging of the breast--present indications. 1085 4

A quasistatic magnetic resonance elastography (MRE) method for the evaluation of breast cancer is proposed. Using a phase contrast, stimulated echo MRI approach, strain imaging in phantoms and volunteers is presented. First-order assessment of tissue biomechanical properties based on inverse strain mapping is outlined and demonstrated. The accuracy of inverse strain imaging is studied through simulations in a two-dimensional model and in an anthropomorphic, three-dimensional finite-element model of the breast. To improve the accuracy of modulus assessment by elastography, inverse methods are discussed as an extension to strain imaging, and simulations quantify MRE in terms of displacement signal/noise required for robust inversion. A direct inversion strategy providing information on tissue modulus and pressure distribution is described along with a novel iterative method utilizing a priori knowledge of tissue geometry. It is shown that through the judicious choice of information from previous contrast-enhanced MRI breast images, MRE data acquisition requirements can be significantly reduced while maintaining robust modulus reconstruction in the presence of strain noise. An experimental apparatus for clinical breast MRE and preliminary images of a normal volunteer are presented.
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PMID:Visualization and quantification of breast cancer biomechanical properties with magnetic resonance elastography. 1087 Jul 13

In recent years, MR mammography has gained increasing importance in breast diagnostics. The main advantage of this technique is its high sensitivity for invasive breast cancer. The two main indications for MR mammography are preoperative staging of breast cancer and the differentiation between postoperative changes and recurrent tumor. In addition, MR mammography is increasingly used for problem solving in cases of questionable clinical, mammographic or sonographic findings. At this it is important to know not only the different manifestations of breast cancer, but also important benign and malignant diagnostic alternatives. Furthermore, it is necessary to be familiar with therapy-related changes. The most important criterion to differentiate between benign and malignant lesions in MR mammography is the extent and temporal course of contrast enhancement. In addition, the lesion morphology and the signal intensity on T2-weighted images can be used to distinguish between different disease entities. The following review article will discuss typical and unusual findings in breast MRI, including rare entities as well as changes after breast conserving therapy and chemotherapy.
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PMID:[Typical and unusual findings in MR mammography]. 1087 68

The UK study of screening for breast cancer compares mammography and dynamic contrast enhanced MRI of the breast in women at high genetic risk of developing cancer. Owing to the high sensitivity of MR in the breast, it is anticipated that some lesions will be visible only on MR. A key issue for the study is how to localize these lesions for histological verification and removal. This article reviews available methods and describes the current UK expertise and recent European developments. The use of MR compatible wires and markers has been explored in a phantom. The use of these markers in vivo is demonstrated in a case imaged by MR and mammography and further discussed. The susceptibility artefacts produced on MRI, and technical properties associated with these needles, wires and markers are discussed. The clinical pathway by which these lesions will be worked up for the study, and the quality control procedures for keeping the number of such biopsies to a minimum, are described. There is an urgent need for further centres in the UK to become proficient at removing lesions found only on MRI in support of this study and other breast MRI applications. The management of these lesions must be resolved in order to realize the full potential of MRI for screening for breast cancer in women at genetic risk, and for other diagnostic applications.
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PMID:Localization of breast lesions shown only on MRI--a review for the UK Study of MRI Screening for Breast Cancer. Advisory Group of MARIBS. 1088 23

There is increasing interest in the radiological diagnosis of axillary lymph nodes in patients with breast cancer, especially in the preoperative diagnosis of metastatic nodes. Both CT (computed tomography) and MRI (magnetic resonance imaging) are cross-sectional imaging methods that produce high-quality images of the axilla. MRI also uses contrast enhancement profile, for example in imaging of breast lesions. Few studies have been published on this subject, but the latest have shown high sensitivity and specificity (CT 93.8 and 82.1%, respectively; MRI 90 and 82%, respectively), although, both CT and MRI are restricted to imaging only. US (ultrasound) is widely spread and is fast and accurate with high resolution. Sensitivity and specificity vary (68.2-92% and 90-100%, respectively). Most importantly, there is the possibility of US-guided FNAB (fine-needle aspiration biopsy) of pathological nodes, which increases the specificity. Initial results with colour Doppler are promising, but a recent study has shown that the presence of colour Doppler flow signal is highly non-specific. Other parameters such as flow pattern and distribution may prove to be of value in this method. Today, the method of choice for the daily routine is US in conjunction with FNAB.
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PMID:Imaging of axillary lymph nodes. 1098 21

Metastatic involvement of axillary lymph nodes is one of the most important prognostic variables in breast cancer. The aim of our work was to study the value of dynamic contrast-enhanced MR imaging in revealing axillary lymph node metastases from breast cancer. A total of 65 patients with invasive breast cancer treated with axillary lymph node dissection were preoperatively evaluated by MRI. T1-weighted dynamic contrast-enhanced 3D images were acquired using a coil covering the breast and the axilla. The dynamic contrast enhancement, size, and morphology of the axillary lymph nodes were registered. Histopathological examination revealed axillary lymph node metastases in 24 patients. When using a signal intensity increase in the lymph nodes of >100% during the first postcontrast image as a threshold for malignancy, 57 of 65 patients were correctly classified (sensitivity 83%, specificity 90%, accuracy 88%). These results were not improved when lymph node size and morphology were used as additional criteria. Axillary lymph nodes can be evaluated as a part of an MR-mammography study without substantial increase in examination time, and provide the surgeon with knowledge about the localization of possible metastatic lymph nodes.
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PMID:Axillary lymph node metastases in breast cancer: preoperative detection with dynamic contrast-enhanced MRI. 1099 38

MRI of the breast is rapidly evolving as a sensitive technique for the detection and staging of breast cancer. It has considerable benefits but is time consuming and expensive. The benefits and limitations of this technique are presented.
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PMID:MRI of the breast. 1102 54

A 46-year-old woman presented with paraplegia and severe lumbago. She had had a radical mastectomy for left breast cancer 10 years earlier, and 6 months prior to presentation she completed CMF chemotherapy for treatment of retroperitoneal metastasis. CT and MRI to identify potential causes of the paraplegia and lumbago showed leptomeningeal carcinomatosis due to dissemination from invasive recurrence of the retroperitoneal tumor. An Ommaya reservoir was inserted, and infusion of intrathecal methotrexate (MTX; 5 mg twice weekly) began. Her clinical symptoms improved after receiving 53 mg MTX. However, after receiving 83 mg MTX, the patient became dizzy from leukoencephalopathy. Although administration of prednisolone mostly resolved her symptom, the patient died 9 months after the diagnosis of carcinomatous meningitis.
Breast Cancer 2000
PMID:Interventricular methotrexate therapy for carcinomatous meningitis due to breast cancer: a case with leukoencephalopathy. 1102 6

The role of contrast-enhanced high resolution MRI for planning surgery in breast cancer was evaluated. Of 72 patients examined, 57 patients had invasive ductal carcinoma, 2 had mucinous carcinoma, 1 had medullary carcinoma, 7 had invasive lobular carcinoma, 2 had ductal carcinoma in situ (DCIS) and 3 had Paget's disease. A 1.5 T Signa imager (GE Medical Systems, Milwaukee, WI) was used with a dedicated breast coil. The pulse sequence based on RARE(rapid acquisition with relaxation enhancement) was used with a fat suppression technique. After examining both breasts, the affected breast alone was examined with Gd enhancement. Linear and/or spotty enhancement on MRI was considered to suggest DCIS or intraductal spread in the area surrounding the invasive cancer. Of 72 patients, 50 showed linear and/or spotty enhancement on MRI and 41 of those 50 patients had DCIS or intraductal spread. In contrast, 22 of 72 patients were considered to have little or no intraductal spread on MRI and 17 of the 22 patients had no or little intraductal spread on pathological examination. The sensitivity, specificity and accuracy for detecting intraductal spread on MRI were 89%, 82% and 81%, respectively. Discrepancies in the estimated extent of intraductal spread were less than 2 cm in 90% of the patients according to pathological mapping. High resolution MRI was considered useful in detecting intraductal spread and in estimating its extent, however, larger study using precise correlation with pathology is necessary.
Breast Cancer 1997 Dec 25
PMID:The Role of Contrast-Enhanced High Resolution MRI in the Surgical Planning of Breast Cancer. 1109 16

A huge phyllodes tumor of the breast that appeared grossly malignant in a 43-year-old woman is described. The patient suffered from a large breast tumor thatsuddenly increased in size over 5 months to occupy the entire breast. The tumorwas hard, ulcerated and 20 cm in greatest diameter. Diagnostic imaging(US, CT and MRI)demonstrated a circumscribed mass with a large cystic cavity. She underwent total mastectomy under a diagnosis of malignant breast tumor. Grossly, the cut surface of the tumor showed a large cystic cavity surrounding a fleshy, hemorrhagic and necrotic mass with a lobulared or trabeculared appearance. Unexpectedly, benign phyllodes tumor(PT)without any stromal overgrowth was diagnosed histologically. She has been doing well since total mastectomy. In our case and in many other reported cases, PT does not show any distinctive correlation between pathologic findings and tumor behavior. Thus wide local excision is the preferred initial treatment for PT.
Breast Cancer 1998 Apr 25
PMID:Phyllodes Tumor of the Breast with a Grossly Malignant Appearance: A Case Report. 1109 50


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