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Jo, Kim, Kang, and Choi: MR Findings of Papillary Neoplasms of the Breast
Original Article

Journal of the Korean Society of Magnetic Resonance in Medicine 2014; 18(1): 43-51.

Published online: 26 March 2014

DOI: https://doi.org/10.13104/jksmrm.2014.18.1.43

MR Findings of Papillary Neoplasms of the Breast

Yeseul Jo, Sung Hun Kim, Bong Joo Kang, Byung Gil Choi

Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea.

Address reprint requests to: Sung Hun Kim, M.D., Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-701, Korea. Tel. 82-2-2258-1455 Fax. 82-2-2258-1457, rad-ksh@catholic.ac.kr

Received 20 November 2013       Revised 18 February 2014       Accepted 25 February 2014

Copyright © 2014 Journal of the Korean Society of Magnetic Resonance in Medicine

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To review MR imaging finding of papillary lesion identified as additional suspicious lesion on MR image in women with biopsy-proven breast cancer and to evaluate upgrading rates after subsequent surgical histopathological diagnosis.

Materials and Methods

Among 1729 preoperative MR image of women with biopsy proven breast cancer, US-guided CNB-proven 22 papillary lesions from 21 patients, which showed additional suspicious contrast enhancement other than index cancer on MR image, were subjected to the study. Some of these lesions underwent surgery, thus the comparisons between the histopathologic results were able to be compared to the results of US guided CNB. Also retrospective analysis was done for MR findings of these lesions by BI-RADS MRI lexicon.

Results

On MR imaging, 8 mass lesions, 7 non-mass lesions, 7 focus lesions were detected. All of the focus lesion (100%, 7/7) was diagnosed as benign lesion and showed plateau and washout pattern in dynamic MR image. After excisional biopsy, one of 9 benign papilloma (11.1%), 3 of 3 papillary neoplasm with atypia component (100%), 3 of 5 papillary neoplasm (60%) were upgraded to malignancy such as ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC).

Conclusion

The MR images of papillary lesions diagnosed by US-guided CNB exhibit no significant differences between malignancy and benign lesion. Also 41.2% of the lesion (7/17) was upgraded after subsequent surgery. Thus all of the papillary lesions require excisional biopsy for definite diagnosis and the MR imaging, it's just not enough by itself.

Keywords: Magnetic resonance imaging, Breast cancer, Papillary neoplasm, Upgrade

Figures and Tables

Fig. 1
A 68-year-old woman with left breast cancer.
a. Axial fat saturated contrast-enhanced T1-weighted image shows a focus (arrow) in the left subareolar portion. b. The kinetic curve shows early rapid enhancement and delayed washout pattern. This lesion is categorized as BI-RADS 4A, low suspicion of malignancy. c. US guided core needle biopsy was done in the left subareolar mass and intraductal papilloma was diagnosed. Subsequent surgical exicision after US-guided localization shows no remnant papilloma.
jksmrm-18-43-g001
Fig. 2
A 77-year-old woman with left breast cancer.
a. Axial fat saturated contrast-enhanced T1-weighted image shows a 6 mm sized, smooth round mass with rim enhancement at the right breast. b. The kinetic curve shows early rapid enhancement and delayed washout pattern. This lesion is categorized as BI-RADS 4A, low suspicion of malignancy. c. US-guided core needle biopsy was done in the right breast mass and intraductal papilloma was diagnosed. Subsequent surgical excision revealed same histopathological result.
jksmrm-18-43-g002
Fig. 3
A 47-year-old woman with left breast cancer.
a. Maximal intensity projection (MIP) reconstruction image shows an index cancer, known invasive ductal carcinoma, in the left breast (arrow) and non-mass enhancement in the right breast (arrowheads). b. Axial fat saturated contrast-enhanced T1-weighted image shows a 48 mm sized, clumped, segmental non mass enhancement at the right breast. c. The kinetic curve shows delayed plateau pattern. This lesion is categorized as BI-RADS 4B, intermediate suspicion of malignancy. d. US-guided core needle biopsy is done in the right breast masses and intraductal papilloma is proved. This lesion is upgrade to ductal carcinoma in situ after surgical excision.
jksmrm-18-43-g003
Table 1
MRI Lesion Types of Papillary Neoplasms
jksmrm-18-43-i001
Table 2
MRI Findings of Papillary Neoplasms
jksmrm-18-43-i002
Table 3
MRI BI-RADS Assessment and Pathologic Results
jksmrm-18-43-i003

Note.-Category 3, probably benign finding, Category 4A, low suspicion of malignancy, Category 4B, intermediate suspicion of malignancy, IDP - intraductal papilloma, DCIS - ductal carcinoma in situ, IDC - invasive ductal carcinoma, FCD - Fibrocystic disease, ILC - invasive lobular carcinoma

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