• 고신대학교 의과대학 학술지
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• 제33권3호
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• pp.297-306
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• 2018

Objectives: Identification of axillary metastases in breast cancer is important for staging disease and planning treatment, but current techniques are associated with a number of adverse events. This report evaluates the diagnostic accuracy of superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) techniques for identification of axillary metastases in breast cancer patients. Methods: We performed a meta-analysis of previous studies that compared SPIO enhanced MRI with histological diagnosis after surgery or biopsy. We searched PubMed, Ovid, Springer Link, and Cochrane library to identify studies reporting data for SPIO enhanced MRI for detection of axillary lymph node metastases in breast cancer until December 2013. The following keywords were used: "magnetic resonance imaging AND axilla" and "superparamagnetic iron oxide AND axilla". Eligible studies were those that compared SPIO enhanced MRI with histological diagnosis. Sensitivity and specificity were calculated for every study; summary receiver operating characteristic and subgroup analyses were done. Study quality and heterogeneity were also assessed. Results: There were 7 publications that met the criteria for inclusion in our meta-analysis. SROC curve analysis for per patient data showed an overall sensitivity of 0.83 (95% Confidence interval (CI): 0.75-0.89) and overall specificity of 0.97 (95% CI: 0.94-0.98). Overall weighted area under the curve was 0.9563. Conclusions: SPIO enhanced MRI showed a trend toward high diagnostic accuracy in detection of lymph node metastases for breast cancer. So, when the breast cancer patients has axillary metastases histologically, SPIO enhanced MRI may be effective diagnostic imaging modality for axillary metastases.

• Investigative Magnetic Resonance Imaging
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• 제23권2호
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• pp.125-135
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• 2019

Purpose: The purpose of this study was to evaluate dynamic contrast-enhanced breast magnetic resonance imaging (DCE-MRI), and diffusion-weighted imaging (DWI) variables, for axillary lymph node (ALN) metastasis in the early stage of breast cancer. Materials and Methods: January 2011-April 2015, 787 patients with early stage of breast cancer were retrospectively reviewed. Only cases of invasive ductal carcinoma, were included in the patient population. Among them, 240 patients who underwent 3.0-T DCE-MRI, including DWI with b value 0 and $800s/mm^2$ were enrolled. MRI variables (adjacent vessel sign, whole-breast vascularity, initial enhancement pattern, quantitative kinetic parameters, signal enhancement ratio (SER), tumor apparent diffusion coefficient (ADC), peritumoral ADC, and peritumor-tumor ADC ratio) clinico-pathologic variables (age, T stage, multifocality, extensive intraductal carcinoma component (EIC), estrogen receptor, progesterone receptor, HER-2 status, Ki-67, molecular subtype, histologic grade, and nuclear grade) were compared between patients with axillary lymph node metastasis and those with no lymph node metastasis. Multivariate regression analysis was performed, to determine independent variables associated with ALN metastasis, and the area under the receiver operating characteristic curve (AUC), for predicting ALN metastasis was analyzed, for those variables. Results: On breast MRI, moderate or prominent ipsilateral whole-breast vascularity (moderate, odds ratio [OR] 3.45, 95% confidence interval [CI] 1.28-9.51 vs. prominent, OR = 15.59, 95% CI 2.52-96.46), SER (OR = 1.68, 95% CI 1.09-2.59), and peritumor-tumor ADC ratio (OR = 6.77, 95% CI 2.41-18.99), were independently associated with ALN metastasis. Among clinico-pathologic variables, HER-2 positivity was independently associated, with ALN metastasis (OR = 23.71, 95% CI 10.50-53.54). The AUC for combining selected MRI variables and clinico-pathologic variables, was higher than that of clinico-pathologic variables (P < 0.05). Conclusion: SER, moderate or prominent increased whole breast vascularity, and peritumor-tumor ADC ratio on breast MRI, are valuable in predicting ALN metastasis, in patients with early stage of breast cancer.

• Investigative Magnetic Resonance Imaging
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• 제19권2호
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• pp.127-130
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• 2015

Direct injection of foreign material, such as liquid paraffin and silicone, into the breast can induce a foreign body granulomatous reaction and fibrosis, resulting in hard, nodular breast masses and architectural distortion that can mimic neoplasm. Conventional methods, including physical examination, mammography, and ultrasonography are of little use to differentiate between foreign body-induced mastopathy and breast cancer. In patients with foreign body injection such as breast augmentation, dynamic contrast enhanced MR imaging is an excellent imaging modality. Here, the authors report the MR imaging and pathological findings of ductal carcinoma in situ (DCIS) with multicystic changes in a 41-year-old woman with a previous history of interstitial mammoplasty by paraffin injection.

• Asian Pacific Journal of Cancer Prevention
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• 제15권2호
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• pp.569-575
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• 2014

Although mammography is the primary imaging modality for the breast, it has its limitations especially with dense breast parenchyma. Breast magnetic resonance imaging (MRI) has evolved into an important adjunctive tool as it is currently the most sensitive technique for breast cancer detection. Despite this high sensitivity, overlap in the appearances of some benign and malignant breast lesions results in additional unnecessary intervention with negative results. These false positives, in addition to high cost and limited availability, necessitate establishing proper indications for breast MRI. The literature was here reviewed for recent clinical trials, meta-analyses and review papers which have studied this important subject. PubMed; the US national library of medicine, was utilized to review the literature in the last twenty years. Using the obtained information, current uses of breast MRI are discussed in this paper to determine the indications which are relevant to clinical practice.

• Investigative Magnetic Resonance Imaging
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• 제22권4호
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• pp.245-248
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• 2018

Foreign body injections into breasts may produce foreign body reactions, fibrosis, and local swelling of involved lymph nodes, which can be misdiagnosed as metastasis or malignancy. Here, the authors report MR imaging, PET-CT imaging, and pathologic findings of contralateral internal mammary lymphadenopathy suspicious of breast cancer metastasis in a 58-year-old woman with history of left breast cancer, and previous interstitial mammoplasty by paraffin injection in both breasts.

• Korean Journal of Radiology
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• 제24권7호
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• pp.640-646
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• 2023

Objective: Prospective studies on postoperative residual breast tissue (RBT) after robotic-assisted nipple-sparing mastectomy (R-NSM) for breast cancer are limited. RBT presents an unknown risk of local recurrence or the development of new cancer after curative or risk-reducing mastectomies. This study investigated the technical feasibility of using magnetic resonance imaging (MRI) to evaluate RBT after R-NSM in women with breast cancer. Materials and Methods: In this prospective pilot study, 105 patients, who underwent R-NSM for breast cancer at Changhua Christian Hospital between March 2017 and May 2022, were subjected to postoperative breast MRI to evaluate the presence and location of RBT. The postoperative MRI scans of 43 patients (age, 47.8 ± 8.5 years), with existing preoperative MRI scans, were evaluated for the presence and location of RBT. In total, 54 R-NSM procedures were performed. In parallel, we reviewed the literature on RBT after nipple-sparing mastectomy, considering its prevalence. Results: RBT was detected in 7 (13.0%) of the 54 mastectomies (6 of the 48 therapeutic mastectomies and 1 of the 6 prophylactic mastectomies). The most common location for RBT was behind the nipple-areolar complex (5 of 7 [71.4%]). Another RBT was found in the upper inner quadrant (2 of 7 [28.6%]). Among the six patients who underwent RBT after therapeutic mastectomies, one patient developed a local recurrence of the skin flap. The other five patients with RBT after therapeutic mastectomies remained disease-free. Conclusion: R-NSM, a surgical innovation, does not seem to increase the prevalence of RBT, and breast MRI showed feasibility as a noninvasive imaging tool for evaluating the presence and location of RBT.

• Investigative Magnetic Resonance Imaging
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• 제23권1호
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• pp.75-80
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• 2019

Metastasis of rhabdomysarcoma to the breast is a very rare manifestation in adult males. Herein, we report a case of metastasis from embryonal rhabdomyosarcoma in the left hypothenar muscle that presented as a breast mass in a 38-year-old man, who four months later expired because of multiple bone metastases related to pancytopenia. We describe the various imaging findings, including mammograms, ultrasonography, computerized tomography (CT), positron emission tomography-computed tomography (PET-CT), and magnetic resonance imaging (MRI) of this rare disease. The various imaging findings of this lesion could be helpful for future diagnosis of male breast lesions.

• Archives of Plastic Surgery
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• 제40권3호
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• pp.203-208
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• 2013

Background Preoperative volume assessment is useful in breast reconstruction. Magnetic resonance imaging (MRI) and mammography are commonly available to reconstructive surgeons in the care of a patient with breast cancer. This study aimed to verify the accuracy of breast volume measured by MRI, and to identify any factor affecting the relationship between measured breast volume and actual breast weight to derive a new model for accurate breast volume estimation. Methods From January 2012 to January 2013, a retrospective review was performed on a total of 101 breasts from 99 patients who had undergone total mastectomy. The mastectomy specimen weight was obtained for each breast. Mammographic and MRI data were used to estimate the volume and density. A standard statistical analysis was performed. Results The mean mastectomy specimen weight was 340.8 g (range, 95 to 795 g). The mean MRI-estimated volume was $322.2mL^3$. When divided into three groups by the "difference percentage value", the underestimated group showed a significantly higher fibroglandular volume, higher percent density, and included significantly more Breast Imaging, Reporting and Data System mammographic density grade 4 breasts than the other groups. We derived a new model considering both fibroglandular tissue volume and fat tissue volume for accurate breast volume estimation. Conclusions MRI-based breast volume assessment showed a significant correlation with actual breast weight; however, in the case of dense breasts, the reconstructive surgeon should note that the mastectomy specimen weight tends to overestimate the volume. We suggested a new model for accurate breast volume assessment considering fibroglandular and fat tissue volume.

• Korean Journal of Radiology
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• 제21권11호
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• pp.1210-1219
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• 2020

Objective: To compare the utility and diagnostic performance of automated breast ultrasound system (ABUS) with that of handheld ultrasound (HHUS) in evaluating pure non-mass enhancement (NME) lesions on breast magnetic resonance imaging (MRI). Materials and Methods: One hundred twenty-six consecutive MRI-visible pure NME lesions of 122 patients with breast cancer were assessed from April 2016 to March 2017. Two radiologists reviewed the preoperative breast MRI, ABUS, and HHUS images along with mammography (MG) findings. The NME correlation rate and diagnostic performance of ABUS were compared with that of HHUS, and the imaging features associated with ABUS visibility were analyzed. Results: Among 126 pure NME lesions, 100 (79.4%) were malignant and 26 (20.6%) were benign. The overall correlation rate was 87.3% (110/126) in ABUS and 92.9% (117/126) in HHUS. The sensitivity and specificity were 87% and 50% for ABUS and 92% and 42.3% for HHUS, respectively, with no significant differences (p = 0.180 and 0.727, respectively). Malignant NME was more frequently visualized than benign NME lesions on ABUS (93% vs. 65.4%, p = 0.001). Significant factors associated with the visibility of ABUS were the size of NME lesions on MRI (p < 0.001), their distribution pattern (p < 0.001), and microcalcifications on MG (p = 0.027). Conclusion: ABUS evaluation of pure NME lesions on MRI in patients with breast cancer is a useful technique with high visibility, especially in malignant lesions. The diagnostic performance of ABUS was comparable with that of conventional HHUS in evaluating NME lesions.

• Investigative Magnetic Resonance Imaging
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• 제19권1호
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• pp.37-46
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• 2015

Purpose: This report compared the diagnostic effectiveness between ultrasmall superparamagnetic iron oxide (USPIO) and gadolinium (Gd) based magnetic resonance imaging (MRI) for differentiation of axillary status in breast cancer patients. Materials and Methods: The present authors performed a meta-analysis of previous studies that compared USPIO or Gd based MRI with histological diagnosis after surgery or biopsy. We searched PubMed, EMBASE, Cochrane Library, ScienceDirect, SpringerLink, Ovid databases and references of articles to identify studies reporting data until December 2013. Pooled sensitivity and specificity were calculated for every study; summary receiver operating characteristic and subgroup analysis was done. Analyses of study quality and heterogeneity were also assessed. Results: There were 14 publications that met the criteria for inclusion in our meta-analysis. USPIO based MRI showed 0.83 (95% CI: 0.75-0.89) and 0.97 (95% CI: 0.94-0.98) for pooled sensitivity and specificity, respectively. Gd based MRI represented pooled sensitivity and specificity of 0.61 (95% CI: 0.55-0.67) and 0.90 (95% CI: 0.87-0.92) for each. Overall weighted area under the curve for USPIO and Gd based MRI were 0.9563 and 0.9051, respectively. Conclusion: USPIO based MRI had a tendency toward high pooled sensitivity and specificity in detection of axillary metastases for breast cancer. This result may mean that USPIO based MRI could be used as complementary modality to differentiate axillary status more precisely, and assist in the decision-making process regarding possible invasive procedures, such as sentinel node biopsy.