J Korean Soc Magn Reson Med.  2010 Jun;14(1):41-46. 10.13104/jksmrm.2010.14.1.41.

Role of MRI in Diagnostic Evaluation of Papillary Lesions of the Breast

• Lee SM
• Kim HJ
• Gwak YJ
• Lee HJ
• Jang YJ
• Shin KM
• Park JY
• Jung JH

• KMID: 1782992
• DOI: http://doi.org/10.13104/jksmrm.2010.14.1.41

Abstract

PURPOSE
To evaluate the role of magnetic resonance imaging (MRI) in the diagnosis of papillary lesions of the breast.
MATERIALS AND METHODS
Among 45 papillary lesions diagnosed at ultrasonography-guided core biopsy (USCB), 27 benign papillary lesions in 22 patients who underwent breast MRI were reviewed. The excsional biopsy was performed in 1-10 days after MRI was done. In MRI findings, lesions were considered suspicious if they show irregular, rim enhancement, or linear enhancement in morphologic evaluation, or washout enhancement pattern of delayed phase in dynamic enhancement characteristics. Diffusion-weighted images were analyzed according to visibility of lesions. MRI findings were correlated with pathologic results at excisional biopsy.
RESULTS
At excisional biopsy, two lesions (9%) were diagnosed malignant in 22 benign papillary lesions without atypia by USCB and 4 (80%) were malignant in 5 benign papillary lesions with atypia by USCB. Among 18 lesions detected on MRI, 16 lesions showed suspicious findings on MRI, 11 lesions (69%) were diagnosed as benign and 5 (31%) were malignant. Among 12 lesions detected on diffusion weighted imaging, 10 lesions were diagnosed as benign and 2 were malignant. MRI findings were not significantly correlated with pathologic results at excisional biopsy.
CONCLUSION
MRI findings were not useful to predict malignancy in benign papillary lesions diagnosed at USCB, because MRI findings of these were mostly suspicious (88.9%, 16/18). The benign papillary lesion should be included in the false positive lesion on breast MRI.

Keyword

Breast neoplasm; Magnetic resonance (MR); Biopsy

MeSH Terms

Biopsy
Breast
Breast Neoplasms
Diffusion
Humans
Magnetic Resonance Imaging

Figure

• 

  Fig. 1 39-year-old woman with papilloma at US-guided core biopsy. (a) Subtraction image shows a irregular mass (arrow) and (b) ROI (region of interest) curve demonstrates initial rapid and washout enhancement pattern. (c) Diffusion-weighted image shows high signal intensity (arrow). After excisional biopsy, pathology revealed papilloma.

Reference

1. Tavassoli FA. Tavassoli FA, editor. Papillary lesions, in Pathology of the breast. 1992. New York: Elsevier;193–227.

2. Liberman L. Clinical management issues in percutaneous core breast biopsy. Radiol Clin North Am. 2000. 38(4):791–807.

3. Liberman L, et al. Percutaneous large-core biopsy of papillary breast lesions. AJR Am J Roentgenol. 1999. 172(2):331–337.

4. Rosen EL, et al. Imaging-guided core needle biopsy of papillary lesions of the breast. AJR Am J Roentgenol. 2002. 179(5):1185–1192.

5. Ivan D, et al. Accuracy of core needle biopsy diagnosis in assessing papillary breast lesions: histologic predictors of malignancy. Mod Pathol. 2004. 17(2):165–171.

6. Agoff SN, Lawton TJ. can we accurately predict benign behavior from core needle biopsy? Am J Clin Pathol. 2004. 122(3):440–443.

7. Jacobs TW, Connolly JL, Schnitt SJ. Nonmalignant lesions in breast core needle biopsies: to excise or not to excise? Am J Surg Pathol. 2002. 26(9):1095–1110.

8. Gendler LS, et al. Association of breast cancer with papillary lesions identified at percutaneous image-guided breast biopsy. Am J Surg. 2004. 188(4):365–370.

9. Shin HJ, et al. Papillary lesions of the breast diagnosed at percutaneous sonographically guided biopsy: comparison of sonographic features and biopsy methods. AJR Am J Roentgenol. 2008. 190(3):630–636.

10. Puglisi F, et al. Role of mammography, ultrasound and large core biopsy in the diagnostic evaluation of papillary breast lesions. Oncology. 2003. 65(4):311–315.

11. Lam WW, et al. Role of radiologic features in the management of papillary lesions of the breast. AJR Am J Roentgenol. 2006. 186(5):1322–1327.

12. Bode MK, Rissanen T, Apaja-Sarkkinen M. Ultrasonography-guided core needle biopsy in differential diagnosis of papillary breast tumors. Acta Radiol. 2009. 50(7):722–729.

13. Morris EA. Review of breast MRI: indications and limitations. Semin Roentgenol. 2001. 36(3):226–237.

14. Daniel BL, et al. Magnetic resonance imaging of intraductal papilloma of the breast. Magn Reson Imaging. 2003. 21(8):887–892.

15. Rovno HD, et al. Solitary intraductal papilloma: findings at MR imaging and MR galactography. AJR Am J Roentgenol. 1999. 172(1):151–155.

16. Brookes MJ, Bourke AG. Radiological appearances of papillary breast lesions. Clin Radiol. 2008. 63(11):1265–1273.

17. Rosen PP. Rosen PP, editor. Benign papillary tumors, in Rosen's Breast pathology. 2001. Baltimore, MD: Lippincott Williams & Wilkins;67–104.

18. Radiology, A.C.o., Breast imaging reporting and data system. Magnetic resonance imaging. 2003. 3 ed. American College of Radiology: Reston, VA.

19. Carder PJ, et al. Needle core biopsy can reliably distinguish between benign and malignant papillary lesions of the breast. Histopathology. 2005. 46(3):320–327.

20. Fischer U, Kopka L, Grabbe E. Breast carcinoma: effect of preoperative contrast-enhanced MR imaging on the therapeutic approach. Radiology. 1999. 213(3):881–888.

21. Hata T, et al. Magnetic resonance imaging for preoperative evaluation of breast cancer: a comparative study with mammography and ultrasonography. J Am Coll Surg. 2004. 198(2):190–197.

22. Tsushima Y, Takahashi-Taketomi A, Endo K. Magnetic resonance (MR) differential diagnosis of breast tumors using apparent diffusion coefficient (ADC) on 1.5-T. J Magn Reson Imaging. 2009. 30(2):249–255.

23. Hatakenaka M, et al. Apparent diffusion coefficients of breast tumors: clinical application. Magn Reson Med Sci. 2008. 7(1):23–29.

24. Sinha S, et al. In vivo diffusion-weighted MRI of the breast: potential for lesion characterization. J Magn Reson Imaging. 2002. 15(6):693–704.

25. Woodhams R, et al. ADC mapping of benign and malignant breast tumors. Magn Reson Med Sci. 2005. 4(1):35–42.