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Abstract
Purpose
The purpose of this study was to evaluate the usefulness of MR imaging and to describe the MR imaging findings of pregnancy-associated breast cancer.
Materials and Methods
From 2006 to 2013, MR images of 23 patients with preg-nancy-associated breast cancer were retrospectively evaluated. MR images were re-viewed to evaluate lesion detection and imaging findings of pregnancy-associated breast cancer. MR images were analyzed by using the Breast Imaging Reporting and Data System and an additional MR-detected lesion with no mammographic or sonographic abnormality was determined.
Results
MR imaging depicted breast cancer in all patients, even in marked background parenchymal enhancement. Pregnancy-associated breast cancer was seen as a mass in 20 patients and as non-mass enhancement with segmental distribution in 3 patients. The most common features of the masses were irregular shape (85%), non-circumscribed margin (85%), and heterogeneous enhancement (60%). An additional site of cancer was detected with MR imaging in 5 patients (21.7%) and the type of surgery was changed.
Index terms
Breast Neoplasm, Pregnancy Complications, Neoplastic, Lactation Magnetic Resonance ImagingREFERENCES
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Fig. 1.
A 33-year-old lactating woman with invasive carcinoma of no special type in the right breast. A. Ultrasound image shows an irregular hypoechoic mass in the palpable area of the right breast. An invasive ductal carcinoma was confirmed by an ultrasound-guided core needle biopsy. B. An axial fat-suppressed T2-weighted fast spin-echo MR image shows a large mass with low signal intensity (arrows). Note the extreme fibroglandular tissue and high signal intensity of the contralateral normal lactating breast. C, D. An axial contrast-enhanced fat-suppressed subtraction T1-weighted MR image shows a rim-enhancing mass (arrow in C) in the upper right breast. In addition, segmental non-mass enhancement is seen in the upper outer right breast (arrowheads in D) that extends more than 4.0 cm, which was confirmed to be ductal carcinoma in situ on pathologic examination. Note the marked background parenchymal enhancement of the contralateral breast.
Table 1.
Histopathologic Characteristics
| Characteristics | Number of Lesions (n = 23) | % |
|---|---|---|
| Histologic type | ||
| Invasive carcinoma NST | 18 | 78.3 |
| DCIS | 2 | 8.7 |
| Medullary carcinoma | 2 | 8.7 |
| Metaplastic carcinoma | 1 | 4.3 |
| Pathological tumor size† | ||
| Tis | 1 | 4.3 |
| T1 | 11 | 47.8 |
| T2 | 8 | 34.8 |
| T3 | 1 | 4.3 |
| Pathological nodal status† | ||
| Positive | 9 | 39.1 |
| Negative | 12 | 52.2 |
| ER status∗ | ||
| Positive | 11 | 47.8 |
| Negative | 11 | 47.8 |
| PR status∗ | ||
| Positive | 7 | 30.4 |
| Negative | 15 | 65.2 |
| HER-2 status∗ | ||
| Positive | 6 | 26.1 |
| Negative | 16 | 69.6 |
| Molecular subtype∗ | ||
| Luminal A | 8 | 34.8 |
| Luminal B | 3 | 13.0 |
| HER-2 | 3 | 13.0 |
| Triple-negative | 8 | 34.8 |
Table 2.
Sonographic Findings of Pregnancy-Associated Breast Cancer
Table 3.
Breast Parenchymal Features on MRI
| Features | Number of Lesions (n = 23) | % |
|---|---|---|
| Amount of FGT | ||
| Almost entirely fat | 0 | 0 |
| Scattered | 1 | 4.4 |
| Heterogeneous | 7 | 30.4 |
| Extreme | 15 | 65.2 |
| BPE | ||
| Minimal | 2 | 8.7 |
| Mild | 4 | 17.4 |
| Moderate Marked | 4 | 17.4 |
| Marked | 13 | 56.5 |
Table 4.
MR Imaging Findings of Pregnancy-Associated Breast Cancer
| Findings | Number of Lesions (n = 23) | % |
|---|---|---|
| Mass | 20 | 87.0 |
| Shape | ||
| Oval/round | 3 | 15.0 |
| Irregular | 17 | 85.0 |
| Margin | ||
| Circumscribed | 3 | 15.0 |
| Not circumscribed | 17 | 85.0 |
| Internal enhancement | ||
| Homogeneous | 2 | 10.0 |
| Heterogeneous | 12 | 60.0 |
| Rim | 6 | 30.0 |
| Non-mass enhancement | 3 | 13.0 |
| Kinetic curve∗ | ||
| Initial phase | ||
| Fast | 22 | 100 |
| Delayed phase | ||
| Persistent | 0 | 0 |
| Plateau | 6 | 27.3 |
| Washout | 16 | 72.7 |
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