DOI: 10.1148/rg.27si075503
Breast Cancers Detected with Imaging Screening in the BRCA Population: Emphasis on MR Imaging with Histopathologic Correlation1
Petrina A. Causer, MD,
Roberta A. Jong, MD,
Ellen Warner, MD,
Kimberley Hill, BA,
John W. Wong, MD,
Belinda N. Curpen, MD, and
Donald B. Plewes, PhD
1 From the Department of Medical Imaging (P.A.C., R.A.J., B.N.C.), Division of Medical Oncology, Department of Medicine (E.W., K.H.), Department of Anatomic Pathology (J.W.W.), and Imaging Research and Department of Medical Biophysics (D.B.P.), Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, MG166, Toronto, ON, Canada M4N 3M5. Presented as an education exhibit at the 2006 RSNA Annual Meeting. Received February 5, 2007; revision requested March 20 and received May 24; accepted June 21. Supported by the Canadian Breast Cancer Research Initiative, the Terry Fox Foundation of the National Cancer Institute of Canada, the Ontario Research and Development Challenge Fund, and Amersham Health, Oakville, Ontario, Canada. R.A.J. collaborates on research with General Electric, Fairfield, Conn; all other authors have no financial relationships to disclose.
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Figure 1a. IDC of the left breast detected only at MR imaging in a 49-year-old BRCA1 patient. The cancer was diagnosed with MR imaging–guided localization and surgical excision biopsy. (a) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) shows an irregular 8-mm mass (arrow) with a type III enhancement curve. (b) Left mediolateral oblique mammogram shows a normal appearance. (c) Low-power photomicrograph (hematoxylin-eosin [H-E] stain) shows high-grade IDC (horizontal arrows), which corresponds to the mass seen at MR imaging. Vertical arrows = associated DCIS.
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Figure 1b. IDC of the left breast detected only at MR imaging in a 49-year-old BRCA1 patient. The cancer was diagnosed with MR imaging–guided localization and surgical excision biopsy. (a) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) shows an irregular 8-mm mass (arrow) with a type III enhancement curve. (b) Left mediolateral oblique mammogram shows a normal appearance. (c) Low-power photomicrograph (hematoxylin-eosin [H-E] stain) shows high-grade IDC (horizontal arrows), which corresponds to the mass seen at MR imaging. Vertical arrows = associated DCIS.
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Figure 1c. IDC of the left breast detected only at MR imaging in a 49-year-old BRCA1 patient. The cancer was diagnosed with MR imaging–guided localization and surgical excision biopsy. (a) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) shows an irregular 8-mm mass (arrow) with a type III enhancement curve. (b) Left mediolateral oblique mammogram shows a normal appearance. (c) Low-power photomicrograph (hematoxylin-eosin [H-E] stain) shows high-grade IDC (horizontal arrows), which corresponds to the mass seen at MR imaging. Vertical arrows = associated DCIS.
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Figure 2a. DCIS of the left breast detected only at MR imaging in a 50-year-old BRCA1 patient. The cancer was diagnosed with MR imaging–guided vacuum-assisted biopsy. (a) Contrast-enhanced T1-weighted subtracted GRE image (50/4.2, 50° flip angle) shows a spiculated 5-mm mass (arrow) with a type I enhancement curve. (b) Left mediolateral oblique mammogram shows a normal appearance. (c) Low-power photomicrograph (H-E stain) shows an involved cluster of ducts containing intermediate-grade DCIS (arrows), which corresponds to the mass seen at MR imaging.
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Figure 2b. DCIS of the left breast detected only at MR imaging in a 50-year-old BRCA1 patient. The cancer was diagnosed with MR imaging–guided vacuum-assisted biopsy. (a) Contrast-enhanced T1-weighted subtracted GRE image (50/4.2, 50° flip angle) shows a spiculated 5-mm mass (arrow) with a type I enhancement curve. (b) Left mediolateral oblique mammogram shows a normal appearance. (c) Low-power photomicrograph (H-E stain) shows an involved cluster of ducts containing intermediate-grade DCIS (arrows), which corresponds to the mass seen at MR imaging.
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Figure 2c. DCIS of the left breast detected only at MR imaging in a 50-year-old BRCA1 patient. The cancer was diagnosed with MR imaging–guided vacuum-assisted biopsy. (a) Contrast-enhanced T1-weighted subtracted GRE image (50/4.2, 50° flip angle) shows a spiculated 5-mm mass (arrow) with a type I enhancement curve. (b) Left mediolateral oblique mammogram shows a normal appearance. (c) Low-power photomicrograph (H-E stain) shows an involved cluster of ducts containing intermediate-grade DCIS (arrows), which corresponds to the mass seen at MR imaging.
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Figure 3a. IDC and DCIS of the left breast detected at MR imaging and US screening in a 53-year-old BRCA1 patient. The cancer was diagnosed with US-guided core biopsy. (a) Contrast-enhanced T1-weighted subtracted GRE image (50/4.2, 50° flip angle) shows an irregular 9-mm mass (horizontal arrow) with a type III enhancement curve. There is surrounding clumped ductal enhancement (vertical arrows). (b) Normal left mediolateral oblique mammogram shows low mammographic breast density. (c) US image shows the irregular 9-mm mass (arrow). (d) Low-power photomicrograph (H-E stain) shows the lobulated tumor composed of high-grade IDC (arrows), which corresponds to the mass seen at MR imaging and US. The arrowhead indicates DCIS, which corresponds to the ductal enhancement visible only at MR imaging.
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Figure 3b. IDC and DCIS of the left breast detected at MR imaging and US screening in a 53-year-old BRCA1 patient. The cancer was diagnosed with US-guided core biopsy. (a) Contrast-enhanced T1-weighted subtracted GRE image (50/4.2, 50° flip angle) shows an irregular 9-mm mass (horizontal arrow) with a type III enhancement curve. There is surrounding clumped ductal enhancement (vertical arrows). (b) Normal left mediolateral oblique mammogram shows low mammographic breast density. (c) US image shows the irregular 9-mm mass (arrow). (d) Low-power photomicrograph (H-E stain) shows the lobulated tumor composed of high-grade IDC (arrows), which corresponds to the mass seen at MR imaging and US. The arrowhead indicates DCIS, which corresponds to the ductal enhancement visible only at MR imaging.
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Figure 3c. IDC and DCIS of the left breast detected at MR imaging and US screening in a 53-year-old BRCA1 patient. The cancer was diagnosed with US-guided core biopsy. (a) Contrast-enhanced T1-weighted subtracted GRE image (50/4.2, 50° flip angle) shows an irregular 9-mm mass (horizontal arrow) with a type III enhancement curve. There is surrounding clumped ductal enhancement (vertical arrows). (b) Normal left mediolateral oblique mammogram shows low mammographic breast density. (c) US image shows the irregular 9-mm mass (arrow). (d) Low-power photomicrograph (H-E stain) shows the lobulated tumor composed of high-grade IDC (arrows), which corresponds to the mass seen at MR imaging and US. The arrowhead indicates DCIS, which corresponds to the ductal enhancement visible only at MR imaging.
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Figure 3d. IDC and DCIS of the left breast detected at MR imaging and US screening in a 53-year-old BRCA1 patient. The cancer was diagnosed with US-guided core biopsy. (a) Contrast-enhanced T1-weighted subtracted GRE image (50/4.2, 50° flip angle) shows an irregular 9-mm mass (horizontal arrow) with a type III enhancement curve. There is surrounding clumped ductal enhancement (vertical arrows). (b) Normal left mediolateral oblique mammogram shows low mammographic breast density. (c) US image shows the irregular 9-mm mass (arrow). (d) Low-power photomicrograph (H-E stain) shows the lobulated tumor composed of high-grade IDC (arrows), which corresponds to the mass seen at MR imaging and US. The arrowhead indicates DCIS, which corresponds to the ductal enhancement visible only at MR imaging.
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Figure 4a. DCIS of the left breast, detected only at MR imaging screening and visible at second-look US, in a 41-year-old BRCA2 patient. The cancer was diagnosed with US-guided core biopsy. (a) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) shows an irregular 11-mm mass (arrow) with a type III enhancement curve. (b) Left mediolateral oblique mammogram shows a normal appearance. (c) US image shows the irregular, isoechoic mass (arrow) and heterogeneous dense background echotexture. (d) Low-power photomicrograph (H-E stain) shows a focus of high-grade DCIS (arrows), which corresponds to the mass seen at MR imaging. * = fibrocystic changes, which were present throughout the breast at pathologic analysis.
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Figure 4b. DCIS of the left breast, detected only at MR imaging screening and visible at second-look US, in a 41-year-old BRCA2 patient. The cancer was diagnosed with US-guided core biopsy. (a) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) shows an irregular 11-mm mass (arrow) with a type III enhancement curve. (b) Left mediolateral oblique mammogram shows a normal appearance. (c) US image shows the irregular, isoechoic mass (arrow) and heterogeneous dense background echotexture. (d) Low-power photomicrograph (H-E stain) shows a focus of high-grade DCIS (arrows), which corresponds to the mass seen at MR imaging. * = fibrocystic changes, which were present throughout the breast at pathologic analysis.
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Figure 4c. DCIS of the left breast, detected only at MR imaging screening and visible at second-look US, in a 41-year-old BRCA2 patient. The cancer was diagnosed with US-guided core biopsy. (a) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) shows an irregular 11-mm mass (arrow) with a type III enhancement curve. (b) Left mediolateral oblique mammogram shows a normal appearance. (c) US image shows the irregular, isoechoic mass (arrow) and heterogeneous dense background echotexture. (d) Low-power photomicrograph (H-E stain) shows a focus of high-grade DCIS (arrows), which corresponds to the mass seen at MR imaging. * = fibrocystic changes, which were present throughout the breast at pathologic analysis.
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Figure 4d. DCIS of the left breast, detected only at MR imaging screening and visible at second-look US, in a 41-year-old BRCA2 patient. The cancer was diagnosed with US-guided core biopsy. (a) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) shows an irregular 11-mm mass (arrow) with a type III enhancement curve. (b) Left mediolateral oblique mammogram shows a normal appearance. (c) US image shows the irregular, isoechoic mass (arrow) and heterogeneous dense background echotexture. (d) Low-power photomicrograph (H-E stain) shows a focus of high-grade DCIS (arrows), which corresponds to the mass seen at MR imaging. * = fibrocystic changes, which were present throughout the breast at pathologic analysis.
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Figure 5a. IDC and DCIS of the right breast detected at MR imaging and mammography in a 55-year-old BRCA1 patient. The cancer was diagnosed with stereotactic biopsy. (a) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) shows 25-mm linear enhancement (arrow) with a type III enhancement curve. (b) Magnification mammographic view of the right breast shows new faint pleomorphic calcifications (arrow), which represent only a small portion of the malignancy. (c) Low-power photomicrograph (H-E stain) shows high-grade IDC (*), which corresponds to the linear enhancement seen at MR imaging and the calcifications seen at mammography. Arrow = surrounding DCIS. Calcifications demonstrated within the IDC at histopathologic analysis are not shown.
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Figure 5b. IDC and DCIS of the right breast detected at MR imaging and mammography in a 55-year-old BRCA1 patient. The cancer was diagnosed with stereotactic biopsy. (a) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) shows 25-mm linear enhancement (arrow) with a type III enhancement curve. (b) Magnification mammographic view of the right breast shows new faint pleomorphic calcifications (arrow), which represent only a small portion of the malignancy. (c) Low-power photomicrograph (H-E stain) shows high-grade IDC (*), which corresponds to the linear enhancement seen at MR imaging and the calcifications seen at mammography. Arrow = surrounding DCIS. Calcifications demonstrated within the IDC at histopathologic analysis are not shown.
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Figure 5c. IDC and DCIS of the right breast detected at MR imaging and mammography in a 55-year-old BRCA1 patient. The cancer was diagnosed with stereotactic biopsy. (a) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) shows 25-mm linear enhancement (arrow) with a type III enhancement curve. (b) Magnification mammographic view of the right breast shows new faint pleomorphic calcifications (arrow), which represent only a small portion of the malignancy. (c) Low-power photomicrograph (H-E stain) shows high-grade IDC (*), which corresponds to the linear enhancement seen at MR imaging and the calcifications seen at mammography. Arrow = surrounding DCIS. Calcifications demonstrated within the IDC at histopathologic analysis are not shown.
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Figure 6a. DCIS of the right breast detected at MR imaging and mammography in a 46-year-old BRCA2 patient. The cancer was diagnosed with stereotactic biopsy. (a) Contrast-enhanced T1-weighted subtracted GRE image (150/4.2, 50° flip angle) shows a new 1.3-cm focal area of clumped enhancement (vertical arrow) with a type III enhancement curve. Horizontal arrows = stable background stippled enhancement. (b) Magnification mammographic view of the right breast shows new clustered, coarse, heterogeneous calcifications (arrow). (c) Low-power photomicrograph (H-E stain) shows an involved cluster of ducts containing high-grade DCIS (arrows), which corresponds to the focal enhancing area seen at MR imaging and the calcifications seen at mammography. * = surrounding fibrocystic changes.
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Figure 6b. DCIS of the right breast detected at MR imaging and mammography in a 46-year-old BRCA2 patient. The cancer was diagnosed with stereotactic biopsy. (a) Contrast-enhanced T1-weighted subtracted GRE image (150/4.2, 50° flip angle) shows a new 1.3-cm focal area of clumped enhancement (vertical arrow) with a type III enhancement curve. Horizontal arrows = stable background stippled enhancement. (b) Magnification mammographic view of the right breast shows new clustered, coarse, heterogeneous calcifications (arrow). (c) Low-power photomicrograph (H-E stain) shows an involved cluster of ducts containing high-grade DCIS (arrows), which corresponds to the focal enhancing area seen at MR imaging and the calcifications seen at mammography. * = surrounding fibrocystic changes.
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Figure 6c. DCIS of the right breast detected at MR imaging and mammography in a 46-year-old BRCA2 patient. The cancer was diagnosed with stereotactic biopsy. (a) Contrast-enhanced T1-weighted subtracted GRE image (150/4.2, 50° flip angle) shows a new 1.3-cm focal area of clumped enhancement (vertical arrow) with a type III enhancement curve. Horizontal arrows = stable background stippled enhancement. (b) Magnification mammographic view of the right breast shows new clustered, coarse, heterogeneous calcifications (arrow). (c) Low-power photomicrograph (H-E stain) shows an involved cluster of ducts containing high-grade DCIS (arrows), which corresponds to the focal enhancing area seen at MR imaging and the calcifications seen at mammography. * = surrounding fibrocystic changes.
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Figure 7a. IDC of the right breast detected at MR imaging, mammography, and US screening in a 46-year-old BRCA2 patient. The cancer was diagnosed with US-guided biopsy. (a) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) shows an oval 9-mm mass with smooth margins (arrow) and a type III enhancement curve. (b) Mediolateral oblique mammogram of the right breast shows the oval low-density mass (arrow) surrounded by minimal scattered fibroglandular density. (c) US image shows the isoechoic oval mass with microlobulated margins and an echogenic halo (arrow). (d) Low-power photomicrograph (H-E stain) shows high-grade IDC (*), which corresponds to the mass seen at MR imaging, mammography, and US.
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Figure 7b. IDC of the right breast detected at MR imaging, mammography, and US screening in a 46-year-old BRCA2 patient. The cancer was diagnosed with US-guided biopsy. (a) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) shows an oval 9-mm mass with smooth margins (arrow) and a type III enhancement curve. (b) Mediolateral oblique mammogram of the right breast shows the oval low-density mass (arrow) surrounded by minimal scattered fibroglandular density. (c) US image shows the isoechoic oval mass with microlobulated margins and an echogenic halo (arrow). (d) Low-power photomicrograph (H-E stain) shows high-grade IDC (*), which corresponds to the mass seen at MR imaging, mammography, and US.
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Figure 7c. IDC of the right breast detected at MR imaging, mammography, and US screening in a 46-year-old BRCA2 patient. The cancer was diagnosed with US-guided biopsy. (a) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) shows an oval 9-mm mass with smooth margins (arrow) and a type III enhancement curve. (b) Mediolateral oblique mammogram of the right breast shows the oval low-density mass (arrow) surrounded by minimal scattered fibroglandular density. (c) US image shows the isoechoic oval mass with microlobulated margins and an echogenic halo (arrow). (d) Low-power photomicrograph (H-E stain) shows high-grade IDC (*), which corresponds to the mass seen at MR imaging, mammography, and US.
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Figure 7d. IDC of the right breast detected at MR imaging, mammography, and US screening in a 46-year-old BRCA2 patient. The cancer was diagnosed with US-guided biopsy. (a) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) shows an oval 9-mm mass with smooth margins (arrow) and a type III enhancement curve. (b) Mediolateral oblique mammogram of the right breast shows the oval low-density mass (arrow) surrounded by minimal scattered fibroglandular density. (c) US image shows the isoechoic oval mass with microlobulated margins and an echogenic halo (arrow). (d) Low-power photomicrograph (H-E stain) shows high-grade IDC (*), which corresponds to the mass seen at MR imaging, mammography, and US.
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Figure 8a. Invasive lobular cancer of the left breast detected only at US screening in a 60-year-old BRCA2 patient. The cancer was diagnosed with US-guided biopsy. (a) US image from the screening examination shows a 5-mm hypoechoic, spiculated mass (arrow). (b) Image from the second dynamic series of contrast-enhanced T1-weighted subtracted GRE imaging (18.4/4.3, 40° flip angle) shows the minimally enhancing, irregular 5-mm mass (arrow) with a type I enhancement curve; the mass was visible in retrospect. Note the black lines at tissue interfaces (arrowheads), an appearance due to motion artifact. (c) Normal left mediolateral oblique mammogram shows a heterogeneously dense breast. (d) Low-power photomicrograph (H-E stain) shows a focus of invasive lobular cancer (arrows), which corresponds to the mass seen at US and retrospectively visible at MR imaging.
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Figure 8b. Invasive lobular cancer of the left breast detected only at US screening in a 60-year-old BRCA2 patient. The cancer was diagnosed with US-guided biopsy. (a) US image from the screening examination shows a 5-mm hypoechoic, spiculated mass (arrow). (b) Image from the second dynamic series of contrast-enhanced T1-weighted subtracted GRE imaging (18.4/4.3, 40° flip angle) shows the minimally enhancing, irregular 5-mm mass (arrow) with a type I enhancement curve; the mass was visible in retrospect. Note the black lines at tissue interfaces (arrowheads), an appearance due to motion artifact. (c) Normal left mediolateral oblique mammogram shows a heterogeneously dense breast. (d) Low-power photomicrograph (H-E stain) shows a focus of invasive lobular cancer (arrows), which corresponds to the mass seen at US and retrospectively visible at MR imaging.
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Figure 8c. Invasive lobular cancer of the left breast detected only at US screening in a 60-year-old BRCA2 patient. The cancer was diagnosed with US-guided biopsy. (a) US image from the screening examination shows a 5-mm hypoechoic, spiculated mass (arrow). (b) Image from the second dynamic series of contrast-enhanced T1-weighted subtracted GRE imaging (18.4/4.3, 40° flip angle) shows the minimally enhancing, irregular 5-mm mass (arrow) with a type I enhancement curve; the mass was visible in retrospect. Note the black lines at tissue interfaces (arrowheads), an appearance due to motion artifact. (c) Normal left mediolateral oblique mammogram shows a heterogeneously dense breast. (d) Low-power photomicrograph (H-E stain) shows a focus of invasive lobular cancer (arrows), which corresponds to the mass seen at US and retrospectively visible at MR imaging.
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Figure 8d. Invasive lobular cancer of the left breast detected only at US screening in a 60-year-old BRCA2 patient. The cancer was diagnosed with US-guided biopsy. (a) US image from the screening examination shows a 5-mm hypoechoic, spiculated mass (arrow). (b) Image from the second dynamic series of contrast-enhanced T1-weighted subtracted GRE imaging (18.4/4.3, 40° flip angle) shows the minimally enhancing, irregular 5-mm mass (arrow) with a type I enhancement curve; the mass was visible in retrospect. Note the black lines at tissue interfaces (arrowheads), an appearance due to motion artifact. (c) Normal left mediolateral oblique mammogram shows a heterogeneously dense breast. (d) Low-power photomicrograph (H-E stain) shows a focus of invasive lobular cancer (arrows), which corresponds to the mass seen at US and retrospectively visible at MR imaging.
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Figure 9a. IDC of the right breast detected with US and mammographic screening in a 60-year-old BRCA1 patient. The cancer was diagnosed with US-guided biopsy. (a) Spot compression view of the right breast shows a persisting asymmetry and distortion (arrows). (b) US image from the screening examination shows a 2-cm hypoechoic, lobulated mass with smooth margins and posterior acoustic enhancement (arrow). (c) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) shows the irregular 2.5-cm mass (arrow) with a type II enhancement curve; the mass was visible in retrospect. Note that the mass enhances to a greater degree than the surrounding parenchyma (*). (d) Low-power photomicrograph (H-E stain) shows a focus of IDC (arrows), which corresponds to the mass seen at US and retrospectively visible at MR imaging.
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Figure 9b. IDC of the right breast detected with US and mammographic screening in a 60-year-old BRCA1 patient. The cancer was diagnosed with US-guided biopsy. (a) Spot compression view of the right breast shows a persisting asymmetry and distortion (arrows). (b) US image from the screening examination shows a 2-cm hypoechoic, lobulated mass with smooth margins and posterior acoustic enhancement (arrow). (c) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) shows the irregular 2.5-cm mass (arrow) with a type II enhancement curve; the mass was visible in retrospect. Note that the mass enhances to a greater degree than the surrounding parenchyma (*). (d) Low-power photomicrograph (H-E stain) shows a focus of IDC (arrows), which corresponds to the mass seen at US and retrospectively visible at MR imaging.
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Figure 9c. IDC of the right breast detected with US and mammographic screening in a 60-year-old BRCA1 patient. The cancer was diagnosed with US-guided biopsy. (a) Spot compression view of the right breast shows a persisting asymmetry and distortion (arrows). (b) US image from the screening examination shows a 2-cm hypoechoic, lobulated mass with smooth margins and posterior acoustic enhancement (arrow). (c) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) shows the irregular 2.5-cm mass (arrow) with a type II enhancement curve; the mass was visible in retrospect. Note that the mass enhances to a greater degree than the surrounding parenchyma (*). (d) Low-power photomicrograph (H-E stain) shows a focus of IDC (arrows), which corresponds to the mass seen at US and retrospectively visible at MR imaging.
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Figure 9d. IDC of the right breast detected with US and mammographic screening in a 60-year-old BRCA1 patient. The cancer was diagnosed with US-guided biopsy. (a) Spot compression view of the right breast shows a persisting asymmetry and distortion (arrows). (b) US image from the screening examination shows a 2-cm hypoechoic, lobulated mass with smooth margins and posterior acoustic enhancement (arrow). (c) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) shows the irregular 2.5-cm mass (arrow) with a type II enhancement curve; the mass was visible in retrospect. Note that the mass enhances to a greater degree than the surrounding parenchyma (*). (d) Low-power photomicrograph (H-E stain) shows a focus of IDC (arrows), which corresponds to the mass seen at US and retrospectively visible at MR imaging.
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Figure 10a. DCIS of the left breast detected only at mammographic screening in a 39-year-old BRCA2 patient. The cancer was diagnosed with stereotactic biopsy. (a) Magnification mammographic image shows a cluster of new mildly pleomorphic calcifications (arrow). (b) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) shows a 5-mm focal enhancing area (arrow) with a type I enhancement curve; the enhancing area was visible in retrospect. (c) Low-power photomicrograph (H-E stain) shows foci of DCIS (arrows), which correspond to several involved clusters of ducts, the area of calcifications seen at mammography, and the nonmass enhancement retrospectively visible at MR imaging. The calcifications (arrowheads) are stromal in location.
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Figure 10b. DCIS of the left breast detected only at mammographic screening in a 39-year-old BRCA2 patient. The cancer was diagnosed with stereotactic biopsy. (a) Magnification mammographic image shows a cluster of new mildly pleomorphic calcifications (arrow). (b) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) shows a 5-mm focal enhancing area (arrow) with a type I enhancement curve; the enhancing area was visible in retrospect. (c) Low-power photomicrograph (H-E stain) shows foci of DCIS (arrows), which correspond to several involved clusters of ducts, the area of calcifications seen at mammography, and the nonmass enhancement retrospectively visible at MR imaging. The calcifications (arrowheads) are stromal in location.
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Figure 10c. DCIS of the left breast detected only at mammographic screening in a 39-year-old BRCA2 patient. The cancer was diagnosed with stereotactic biopsy. (a) Magnification mammographic image shows a cluster of new mildly pleomorphic calcifications (arrow). (b) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) shows a 5-mm focal enhancing area (arrow) with a type I enhancement curve; the enhancing area was visible in retrospect. (c) Low-power photomicrograph (H-E stain) shows foci of DCIS (arrows), which correspond to several involved clusters of ducts, the area of calcifications seen at mammography, and the nonmass enhancement retrospectively visible at MR imaging. The calcifications (arrowheads) are stromal in location.
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Figure 11a. Interval cancer (IDC and DCIS of the right breast) in a 40-year-old BRCA1 patient. The cancer was diagnosed with US-guided biopsy. (a) Spot magnification view of the right breast, obtained at clinical presentation, shows a persisting asymmetry with distortion and associated pleomorphic clustered calcifications (arrow). (b) US image obtained at presentation shows a 2-cm hypoechoic, irregular mass (arrow) with internal echogenic foci, which correspond to calcifications. (c) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) obtained at presentation shows the rim-enhancing 1.5-cm mass (arrow) with a type III enhancement curve and surrounding clumped ductal enhancement (arrowheads). Note that the mass and the nonmass lesions enhance to a greater degree than the surrounding parenchyma (*). (d) Contrast-enhanced screening MR image obtained 7 months earlier shows a portion of the clumped nonmass enhancement (arrowhead), which was visible in retrospect and also enhanced to a greater degree than the significant background parenchymal enhancement (*). (e) Low-power photomicrograph (H-E stain) shows a focus of IDC (*), which corresponds to the mass seen at US; the asymmetry, distortion, and calcifications seen at mammography; and the mass retrospectively visible at MR imaging. Arrow = associated DCIS and clumped ductal enhancement visible only at MR imaging.
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Figure 11b. Interval cancer (IDC and DCIS of the right breast) in a 40-year-old BRCA1 patient. The cancer was diagnosed with US-guided biopsy. (a) Spot magnification view of the right breast, obtained at clinical presentation, shows a persisting asymmetry with distortion and associated pleomorphic clustered calcifications (arrow). (b) US image obtained at presentation shows a 2-cm hypoechoic, irregular mass (arrow) with internal echogenic foci, which correspond to calcifications. (c) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) obtained at presentation shows the rim-enhancing 1.5-cm mass (arrow) with a type III enhancement curve and surrounding clumped ductal enhancement (arrowheads). Note that the mass and the nonmass lesions enhance to a greater degree than the surrounding parenchyma (*). (d) Contrast-enhanced screening MR image obtained 7 months earlier shows a portion of the clumped nonmass enhancement (arrowhead), which was visible in retrospect and also enhanced to a greater degree than the significant background parenchymal enhancement (*). (e) Low-power photomicrograph (H-E stain) shows a focus of IDC (*), which corresponds to the mass seen at US; the asymmetry, distortion, and calcifications seen at mammography; and the mass retrospectively visible at MR imaging. Arrow = associated DCIS and clumped ductal enhancement visible only at MR imaging.
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Figure 11c. Interval cancer (IDC and DCIS of the right breast) in a 40-year-old BRCA1 patient. The cancer was diagnosed with US-guided biopsy. (a) Spot magnification view of the right breast, obtained at clinical presentation, shows a persisting asymmetry with distortion and associated pleomorphic clustered calcifications (arrow). (b) US image obtained at presentation shows a 2-cm hypoechoic, irregular mass (arrow) with internal echogenic foci, which correspond to calcifications. (c) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) obtained at presentation shows the rim-enhancing 1.5-cm mass (arrow) with a type III enhancement curve and surrounding clumped ductal enhancement (arrowheads). Note that the mass and the nonmass lesions enhance to a greater degree than the surrounding parenchyma (*). (d) Contrast-enhanced screening MR image obtained 7 months earlier shows a portion of the clumped nonmass enhancement (arrowhead), which was visible in retrospect and also enhanced to a greater degree than the significant background parenchymal enhancement (*). (e) Low-power photomicrograph (H-E stain) shows a focus of IDC (*), which corresponds to the mass seen at US; the asymmetry, distortion, and calcifications seen at mammography; and the mass retrospectively visible at MR imaging. Arrow = associated DCIS and clumped ductal enhancement visible only at MR imaging.
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Figure 11d. Interval cancer (IDC and DCIS of the right breast) in a 40-year-old BRCA1 patient. The cancer was diagnosed with US-guided biopsy. (a) Spot magnification view of the right breast, obtained at clinical presentation, shows a persisting asymmetry with distortion and associated pleomorphic clustered calcifications (arrow). (b) US image obtained at presentation shows a 2-cm hypoechoic, irregular mass (arrow) with internal echogenic foci, which correspond to calcifications. (c) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) obtained at presentation shows the rim-enhancing 1.5-cm mass (arrow) with a type III enhancement curve and surrounding clumped ductal enhancement (arrowheads). Note that the mass and the nonmass lesions enhance to a greater degree than the surrounding parenchyma (*). (d) Contrast-enhanced screening MR image obtained 7 months earlier shows a portion of the clumped nonmass enhancement (arrowhead), which was visible in retrospect and also enhanced to a greater degree than the significant background parenchymal enhancement (*). (e) Low-power photomicrograph (H-E stain) shows a focus of IDC (*), which corresponds to the mass seen at US; the asymmetry, distortion, and calcifications seen at mammography; and the mass retrospectively visible at MR imaging. Arrow = associated DCIS and clumped ductal enhancement visible only at MR imaging.
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Figure 11e. Interval cancer (IDC and DCIS of the right breast) in a 40-year-old BRCA1 patient. The cancer was diagnosed with US-guided biopsy. (a) Spot magnification view of the right breast, obtained at clinical presentation, shows a persisting asymmetry with distortion and associated pleomorphic clustered calcifications (arrow). (b) US image obtained at presentation shows a 2-cm hypoechoic, irregular mass (arrow) with internal echogenic foci, which correspond to calcifications. (c) Contrast-enhanced T1-weighted subtracted GRE image (18.4/4.3, 40° flip angle) obtained at presentation shows the rim-enhancing 1.5-cm mass (arrow) with a type III enhancement curve and surrounding clumped ductal enhancement (arrowheads). Note that the mass and the nonmass lesions enhance to a greater degree than the surrounding parenchyma (*). (d) Contrast-enhanced screening MR image obtained 7 months earlier shows a portion of the clumped nonmass enhancement (arrowhead), which was visible in retrospect and also enhanced to a greater degree than the significant background parenchymal enhancement (*). (e) Low-power photomicrograph (H-E stain) shows a focus of IDC (*), which corresponds to the mass seen at US; the asymmetry, distortion, and calcifications seen at mammography; and the mass retrospectively visible at MR imaging. Arrow = associated DCIS and clumped ductal enhancement visible only at MR imaging.
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Figure 12a. MR imaging–guided vacuum-assisted biopsy. (a, b) Photograph (a) and close-up view (b) show a dedicated breast MR imaging and intervention system. (c) Photograph shows the open medial access view. There are medial and lateral access options and a fenestrated plate system with removable surface coils. (d) Computer software is used to calculate needle trajectory in three planes (horizontal [x], vertical [y], and depth) with respect to fiducial markers. The software interface provides grid and needle guide coordinates. (e, f) Sagittal fat-suppressed 3D fast spoiled GRE (8.8/4.2, 10° flip angle) (e) and axial fat-suppressed 2D fast spoiled GRE (150/4.2, 50° flip angle) (f) images obtained at biopsy (see Fig 2) show the targeted mass (horizontal arrow in e) and signal void from the introducer set and inner plastic obturator (vertical arrows), findings that confirm accurate placement. (g) Sagittal fat-suppressed 3D fast spoiled GRE image (8.8/4.2, 10° flip angle) obtained after 9-gauge vacuum-assisted biopsy and titanium clip deployment shows that the targeted mass has been retrieved. Small signal voids from air (arrow) were introduced at biopsy.
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Figure 12b. MR imaging–guided vacuum-assisted biopsy. (a, b) Photograph (a) and close-up view (b) show a dedicated breast MR imaging and intervention system. (c) Photograph shows the open medial access view. There are medial and lateral access options and a fenestrated plate system with removable surface coils. (d) Computer software is used to calculate needle trajectory in three planes (horizontal [x], vertical [y], and depth) with respect to fiducial markers. The software interface provides grid and needle guide coordinates. (e, f) Sagittal fat-suppressed 3D fast spoiled GRE (8.8/4.2, 10° flip angle) (e) and axial fat-suppressed 2D fast spoiled GRE (150/4.2, 50° flip angle) (f) images obtained at biopsy (see Fig 2) show the targeted mass (horizontal arrow in e) and signal void from the introducer set and inner plastic obturator (vertical arrows), findings that confirm accurate placement. (g) Sagittal fat-suppressed 3D fast spoiled GRE image (8.8/4.2, 10° flip angle) obtained after 9-gauge vacuum-assisted biopsy and titanium clip deployment shows that the targeted mass has been retrieved. Small signal voids from air (arrow) were introduced at biopsy.
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Figure 12c. MR imaging–guided vacuum-assisted biopsy. (a, b) Photograph (a) and close-up view (b) show a dedicated breast MR imaging and intervention system. (c) Photograph shows the open medial access view. There are medial and lateral access options and a fenestrated plate system with removable surface coils. (d) Computer software is used to calculate needle trajectory in three planes (horizontal [x], vertical [y], and depth) with respect to fiducial markers. The software interface provides grid and needle guide coordinates. (e, f) Sagittal fat-suppressed 3D fast spoiled GRE (8.8/4.2, 10° flip angle) (e) and axial fat-suppressed 2D fast spoiled GRE (150/4.2, 50° flip angle) (f) images obtained at biopsy (see Fig 2) show the targeted mass (horizontal arrow in e) and signal void from the introducer set and inner plastic obturator (vertical arrows), findings that confirm accurate placement. (g) Sagittal fat-suppressed 3D fast spoiled GRE image (8.8/4.2, 10° flip angle) obtained after 9-gauge vacuum-assisted biopsy and titanium clip deployment shows that the targeted mass has been retrieved. Small signal voids from air (arrow) were introduced at biopsy.
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Figure 12d. MR imaging–guided vacuum-assisted biopsy. (a, b) Photograph (a) and close-up view (b) show a dedicated breast MR imaging and intervention system. (c) Photograph shows the open medial access view. There are medial and lateral access options and a fenestrated plate system with removable surface coils. (d) Computer software is used to calculate needle trajectory in three planes (horizontal [x], vertical [y], and depth) with respect to fiducial markers. The software interface provides grid and needle guide coordinates. (e, f) Sagittal fat-suppressed 3D fast spoiled GRE (8.8/4.2, 10° flip angle) (e) and axial fat-suppressed 2D fast spoiled GRE (150/4.2, 50° flip angle) (f) images obtained at biopsy (see Fig 2) show the targeted mass (horizontal arrow in e) and signal void from the introducer set and inner plastic obturator (vertical arrows), findings that confirm accurate placement. (g) Sagittal fat-suppressed 3D fast spoiled GRE image (8.8/4.2, 10° flip angle) obtained after 9-gauge vacuum-assisted biopsy and titanium clip deployment shows that the targeted mass has been retrieved. Small signal voids from air (arrow) were introduced at biopsy.
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Figure 12e. MR imaging–guided vacuum-assisted biopsy. (a, b) Photograph (a) and close-up view (b) show a dedicated breast MR imaging and intervention system. (c) Photograph shows the open medial access view. There are medial and lateral access options and a fenestrated plate system with removable surface coils. (d) Computer software is used to calculate needle trajectory in three planes (horizontal [x], vertical [y], and depth) with respect to fiducial markers. The software interface provides grid and needle guide coordinates. (e, f) Sagittal fat-suppressed 3D fast spoiled GRE (8.8/4.2, 10° flip angle) (e) and axial fat-suppressed 2D fast spoiled GRE (150/4.2, 50° flip angle) (f) images obtained at biopsy (see Fig 2) show the targeted mass (horizontal arrow in e) and signal void from the introducer set and inner plastic obturator (vertical arrows), findings that confirm accurate placement. (g) Sagittal fat-suppressed 3D fast spoiled GRE image (8.8/4.2, 10° flip angle) obtained after 9-gauge vacuum-assisted biopsy and titanium clip deployment shows that the targeted mass has been retrieved. Small signal voids from air (arrow) were introduced at biopsy.
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Figure 12f. MR imaging–guided vacuum-assisted biopsy. (a, b) Photograph (a) and close-up view (b) show a dedicated breast MR imaging and intervention system. (c) Photograph shows the open medial access view. There are medial and lateral access options and a fenestrated plate system with removable surface coils. (d) Computer software is used to calculate needle trajectory in three planes (horizontal [x], vertical [y], and depth) with respect to fiducial markers. The software interface provides grid and needle guide coordinates. (e, f) Sagittal fat-suppressed 3D fast spoiled GRE (8.8/4.2, 10° flip angle) (e) and axial fat-suppressed 2D fast spoiled GRE (150/4.2, 50° flip angle) (f) images obtained at biopsy (see Fig 2) show the targeted mass (horizontal arrow in e) and signal void from the introducer set and inner plastic obturator (vertical arrows), findings that confirm accurate placement. (g) Sagittal fat-suppressed 3D fast spoiled GRE image (8.8/4.2, 10° flip angle) obtained after 9-gauge vacuum-assisted biopsy and titanium clip deployment shows that the targeted mass has been retrieved. Small signal voids from air (arrow) were introduced at biopsy.
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Figure 12g. MR imaging–guided vacuum-assisted biopsy. (a, b) Photograph (a) and close-up view (b) show a dedicated breast MR imaging and intervention system. (c) Photograph shows the open medial access view. There are medial and lateral access options and a fenestrated plate system with removable surface coils. (d) Computer software is used to calculate needle trajectory in three planes (horizontal [x], vertical [y], and depth) with respect to fiducial markers. The software interface provides grid and needle guide coordinates. (e, f) Sagittal fat-suppressed 3D fast spoiled GRE (8.8/4.2, 10° flip angle) (e) and axial fat-suppressed 2D fast spoiled GRE (150/4.2, 50° flip angle) (f) images obtained at biopsy (see Fig 2) show the targeted mass (horizontal arrow in e) and signal void from the introducer set and inner plastic obturator (vertical arrows), findings that confirm accurate placement. (g) Sagittal fat-suppressed 3D fast spoiled GRE image (8.8/4.2, 10° flip angle) obtained after 9-gauge vacuum-assisted biopsy and titanium clip deployment shows that the targeted mass has been retrieved. Small signal voids from air (arrow) were introduced at biopsy.
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Copyright © 2007 by the Radiological Society of North America.
