Breast MRI for Evaluating Patients with Metastatic Axillary Lymph Node and Initially Negative Mammography and Sonography

Objective We wanted to investigate the ability of breast MR imaging to identify the primary malignancy in patients with axillary lymph node metastases and initially negative mammography and sonography, and we correlated those results with the conventional imaging. Materials and Methods From September 2001 to April 2006, 12 patients with axillary lymph node metastases and initially negative mammography and sonography underwent breast MR imaging to identify occult breast carcinoma. We analyzed the findings of the MR imaging, the MR-correlated mammography and the second-look sonography. We followed up both the MR-positive and MR-negative patients. Results MR imaging detected occult breast carcinoma in 10 of 12 (83%) patients. Two MR-negative patients were free of carcinoma in the ipsilateral breast during their follow-up period (39 and 44 months, respectively). In nine out of 10 patients, the MR-correlated mammography and second-look sonography localized lesions that were not detected on the initial exam. All the non-MR-correlated sonographic abnormalities were benign. Conclusion Breast MR imaging can identify otherwise occult breast cancer in patients with metastatic axillary lymph nodes. Localization of the lesions through MR-correlated mammography and second-look sonography is practically feasible in most cases.

[1]  M. Antoine,et al.  Ductal carcinoma in situ: Value of sentinel lymph node biopsy , 2006, Journal of surgical oncology.

[2]  J. Zujewski,et al.  Sentinel lymph node biopsy in the management of ductal carcinoma in situ. , 2005, Clinical breast cancer.

[3]  S. Swaminathan,et al.  Detection and localization of occult lesions using breast magnetic resonance imaging: initial experience in a community hospital. , 2005, Academic radiology.

[4]  D. Dershaw Magnetic Resonance Imaging as a Clinical Tool , 2005 .

[5]  Rebecca S Lewis,et al.  Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. , 2004, Radiology.

[6]  J. Lara,et al.  The relevance of occult axillary micrometastasis in ductal carcinoma in situ , 2003, Cancer.

[7]  E. S. de Paredes,et al.  Missed breast carcinoma: pitfalls and pearls. , 2003, Radiographics : a review publication of the Radiological Society of North America, Inc.

[8]  C K Kuhl,et al.  MR imaging--guided large-core (14-gauge) needle biopsy of small lesions visible at breast MR imaging alone. , 2001, Radiology.

[9]  M D Schnall,et al.  MR imaging of the breast for the detection, diagnosis, and staging of breast cancer. , 2001, Radiology.

[10]  M Oudkerk,et al.  MR imaging-guided sonography followed by fine-needle aspiration cytology in occult carcinoma of the breast. , 2000, AJR. American journal of roentgenology.

[11]  D. Fraker,et al.  Breast MR imaging in patients with axillary node metastases and unknown primary malignancy. , 1999, Radiology.

[12]  E. Grabbe,et al.  MRI of the breast in patients with metastatic disease of unknown primary , 1999, European Radiology.

[13]  L. Schwartz,et al.  MR imaging of the breast in patients with occult primary breast carcinoma. , 1997, Radiology.

[14]  C. Scott-Conner,et al.  Axillary metastasis from occult breast carcinoma: diagnosis and management. , 1995, The American surgeon.

[15]  L. Fajardo,et al.  Previous mammograms in patients with impalpable breast carcinoma: retrospective vs blinded interpretation. 1993 ARRS President's Award. , 1993, AJR. American journal of roentgenology.

[16]  S E Harms,et al.  MR imaging of the breast with rotating delivery of excitation off resonance: clinical experience with pathologic correlation. , 1993, Radiology.

[17]  F. Holmes,et al.  Treatment of patients with isolated axillary nodal metastases from an occult primary carcinoma consistent with breast origin , 1990, Cancer.

[18]  M. Kemeny,et al.  Occult primary adenocarcinoma with axillary metastases. , 1986, American journal of surgery.