MR Imaging of the Breast in Patients with Invasive Lobular Carcinoma
Susan Pae Weinstein1, Susan Greenstein Orel1, Rose Heller2, Carol Reynolds3,4, Brian Czerniecki5, Lawrence J. Solin6 and Mitchell Schnall1
1 Department of Radiology, The University of Pennsylvania Medical Center, 1 Silverstein Bldg., 3400 Spruce St., Philadelphia, PA 19104.
2 University Radiology Group, Robert Wood Johnson University Hospital, 800 Ryders La., East Brunswick, NJ 08816.
3 Department of Pathology, The University of Pennsylvania Medical Center, Philadelphia, PA 19104.
4 Present address: Department of Anatomic Pathology, Mayo Clinic, 200 First St., S.W., Rochester, MN 55905.
5 Department of Surgery, Division of Surgical Oncology, The University of Pennsylvania Medical Center, Philadelphia, PA 19104.
6 Department of Radiation Oncology, The University of Pennsylvania Medical Center, Philadelphia, PA 19104.
OBJECTIVE. Our objective was to assess the usefulness of MR imaging in patients diagnosed with invasive lobular carcinoma of the breast.
MATERIALS AND METHODS. Between July 1993 and September 1999, 32 women (33 cases) diagnosed with pure invasive lobular carcinoma of the breast underwent contrast-enhanced MR imaging examination. One woman was excluded because of lack of follow-up. Correlation was made between the mammographic and sonographic findings, the MR imaging findings, and the final pathology results for the remaining 32 cases.
RESULTS.In 18 women who did not undergo excisional biopsy before the MR imaging, MR imaging showed more extensive tumor burden or the detection of the primary lesion that was occult on conventional imaging in seven (38.9%) of 18 women. In nine (50%) of 18 women, MR imaging performed equally as well as mammography and sonography. In one case (5.6%), MR imaging and mammography underestimated disease extent. In another patient (5.6%), MR imaging overestimated tumor burden, although mammography failed to show the cancer.
In 14 patients who had excisional biopsy before the MR imaging, residual tumor was shown in eight women (57.1%) with extensive tumor or additional separate foci in five of the eight patients. In two cases (14.3%) that were interpreted as equivocal, residual tumor was shown in both cases on reexcision. In three cases (21.4%), the MR imaging was interpreted as negative, but microscopic tumor was shown around seroma on reexcision. False-positive enhancement was seen in one case (7.1%).
CONCLUSION. MR imaging showed more extensive tumor than conventional imaging and affected the clinical management in 16 (50%) of 32 patients with invasive lobular carcinoma.
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