ABSTRACT
Breast imaging is a prerequisite for providing high quality breast health care. Choosing the appropriate investigation is central to diagnosing breast disease in patients who present to health professionals for treatment. These patients present to doctors of different subspecialties as well as to general practitioners in our country. It is important, therefore, to provide uniform guidance to doctors in different healthcare setups of our country, urban and rural, government and private, for optimal management of breast diseases. These guidelines framed by the task group set up by the Breast Imaging Society, India, have been formulated focusing primarily on the Indian patients and health care infrastructures. They aim to provide a framework for the referring doctors and practicing radiologists to enable them to choose the appropriate investigation for patients with breast symptoms and signs. The aim has been to keep this framework simple and practical so that it can guide not only subspecialists in breast care but also help doctors who do not routinely deal with breast diseases, so that breast cancer is not missed. Overall, the aim of this document is to provide a holistic approach to standardize breast care imaging services in India. Part 2 of these guidelines focuses on the best practice principles for breast interventions and provides algorithms for the investigation of specific common breast symptoms and signs. Ultrasound is the preferred imaging modality for image-guided breast interventions due to real-time needle visualization, easy availability, patient comfort and absence of radiation. Stereotactic mammography guided procedures are performed if the lesion is visualized on mammography but not visualized on ultrasound. 14-gauge automated core biopsy device is preferred for breast biopsies although vacuum assisted biopsy devices are useful for biopsy of certain abnormalities as well as for imaging guided excision of some pathologies. MRI guided biopsy is reserved for suspicious lesions seen only on MRI. Algorithms for investigation of patients presenting with mastalgia, breast lumps, suspicious nipple discharge, infections and inflammation of the breast have been provided. For early breast cancers routine use of investigations to detect occult distant metastasis is not advised. Metastatic work up for advanced breast cancer is required for selection of appropriate treatment options.
ABSTRACT
PURPOSE: To investigate correlations of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor type 2 (HER2) statuses with magnetic resonance imaging (MRI) features and clinicohistological characteristics in patients with invasive lobular carcinoma (ILC). MATERIALS AND METHODS: Data from 64 histologically confirmed ILCs were analyzed retrospectively. Preoperative breast MRI was reviewed for morphology and dynamic contrast-enhanced kinetics of the tumor. Pathologic reports were reviewed for ER, PR, and HER2 positivity, tumor size, lymph node metastasis, and the number of metastatic lymph nodes. Furthermore, there was an investigation of the MRI features and clinicohistologic characteristics, according to the ER, PR, and HER2 statuses. RESULTS: A significant difference in MRI features and clinicohistological tumor characteristics were observed only in relation to PR status. Of the 64 ILCs, 10 (15.6%) were PR negative. PR negative cancers, compared with PR positive cancers, were more likely to present as non-mass enhancement (P = 0.027); have a significantly larger mean tumor size (5.00 +/- 1.05 cm vs. 2.57 +/- 0.21 cm, P = 0.021); and have significantly more metastatic lymph nodes (P = 0.010). CONCLUSIONS: PR negative ILC presented more frequently as non-mass enhancement on MRI, with larger tumors and increased numbers of metastatic lymph nodes. Therefore, the PR status plays an important role in determining MRI features and clinicohistological characteristics of ILC.
Subject(s)
Humans , Breast , Carcinoma, Lobular , Estrogens , Kinetics , Lymph Nodes , Magnetic Resonance Imaging , Neoplasm Metastasis , ErbB Receptors , Receptors, Progesterone , Retrospective StudiesABSTRACT
A ressonância magnética mamária apresenta ótima sensibilidade para o diagnóstico do câncer de mama, detectando cânceres insuspeitos à mamografia, à ultra-sonografia e à palpação. É fundamental que se tenha acesso às lesões diagnosticadas apenas por esse método. Um exame ultra-sonografico dirigido à área da lesão da ressonância magnética só encontra a lesão em cerca de 23% dos casos. Os demais devem ser abordados com orientção pela ressonância magnética. A localização das lesões pela ressonância magnética é rotineira em alguns centros, mas ainda não é amplamente disponível no Brasil. Esse trabalho descreve uma técnica de localização pré-operatória (agulhamento) de lesões mamárias orientada pela ressonância magnética, com o objetivo de tornar essa técnica mais conhecida na comunidade da mastologia.
Magnetic resonance imaging of the breast has excellent sensibility, and is able to detect breast cancers that cannot be detected by mammography, ultrasound or physical examination. It is required, though, that detected lesions can be accessed for biopsy. Second-look sonography fails to demonstrate the lesion in up to 77% of the patients. The remainders will need a magnetic resonance guided procedure. These procedures are routinely performed in many centers, but still not widely available in our country. This paper describes the technique for magnetic resonance guided needle localization of breast lesions, with the purpose of making those involved with breast health care more familiar with it.