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OBJECTIVE: To compare the intratumoral T2 signal intensity on MRI and histopathological and molecular expression of biomarkers of aggressiveness (histological grade, hormonal status, HER2, and Ki-67). METHODS: This retrospective study included all women with invasive breast cancer undergoing MRI from January 2014 to October 2016. The intratumoral T2 signal as interpreted at consensus by two radiologists was compared to histopathological and molecular prognostic factors from the surgical specimen. Statistical analyses used Pearson χâ2 test with a confidence level of 95% (P ≤ 0.05). RESULTS: Fifty patients with 50 lesions met study criteria (mean age 65.8 ± 13.5 years). Mean lesion size was 28 mm ± 15.7 mm (range, 15 to 76 mm). Cancer types were invasive ductal (35/50, 70%), invasive lobular (10/50, 20%), and mixed (5/50, 10%). Most lesions were histological grade 1 or 2 (41/50, 82%) and luminal type (45/50, 90%). On T2 images, lesions were hypointense in 62% (31/50), isointense in 20% (10/50), and hyperintense in 18% (9/50) of cases. Among hypointense lesions, 94% (29/31) were low or intermediate grade tumors (P = 0.02), low HER2 overexpression (30/31, 97%) (P = 0.005), and high ER status (30/31, 97%) (P = 0.006), high PR (26/31, 84%) (P = 0.02), and low incidence of necrosis (2/31, 6%). The difference in Ki-67 tumoral expression between groups was not significant. CONCLUSION: Intratumoral T2 hypointensity in invasive breast cancer is associated with better prognostic tumors, such as histological low-grade high hormone receptor status.
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OBJECTIVE: The purpose of this study was to compare two short-tau inversion recovery (STIR) sequences, Cartesian and radial (BLADE) acquisitions, for breast magnetic resonance imaging (MRI) examinations. MATERIALS AND METHODS: Ninety-six women underwent 1.5 T breast MRI exam (48 Cartesian and 48 BLADE). Qualitative analysis including image artifacts, image quality, fat-suppression, chest-wall depiction, lesion detection, lymph node depiction and overall impression were evaluated by three blinded readers. Signal to noise ratios (SNRs) were calculated. Cronbach's alpha test was used to assess inter-observer agreement. Subanalyses of image quality, chest-wall depiction and overall impression in 15 patients with implants and image quality in 31 patients with clips were correlated using Pearson test. Wilcoxon rank sum test and t-test were performed. RESULTS: Motion artifacts were present in 100% and in 0% of the Cartesian and the BLADE exams, respectively. Chemical-shift artifacts were present in 8% of the Cartesian exams. Flow artifacts were more frequent on BLADE. BLADE sequence was statistically superior to Cartesian for all qualitative features (p < 0.05) except for fat-suppression (p = 0.054). In the subanalysis, BLADE was superior for implants and clips (p < 0.05). SNR was statistically greater for BLADE (48.35 vs. 16.17). Cronbach ranged from 0.502 to 0.813. CONCLUSION: BLADE appears to be superior to Cartesian acquisition of STIR imaging as measured by improved image quality, fewer artifacts, and improved chest wall and lymph node depiction.
OBJETIVO: Comparar duas sequências de aquisição, cartesiana e radial (BLADE) ponderadas em short-tau inversion recovery (STIR), em exames de ressonância magnética de mama. MATERIAIS E MÉTODOS: Noventa e seis pacientes foram submetidas a exame de ressonância magnética de mama em 1,5 T (48 aquisições STIR cartesianas e 48 aquisições STIR BLADE). A análise qualitativa incluindo artefatos, qualidade de imagem, supressão de gordura, avaliação da parede torácica, detecção de lesões, linfonodos e impressão geral foi avaliada independentemente por três leitores. Os signal to noise ratios (SNRs) foram calculados. Foi utilizado o teste alfa de Cronbach para avaliar a concordância interobservador. Subanálises da qualidade de imagem, avaliação da parede torácica e impressão geral em 15 pacientes com implantes e qualidade de imagem em 31 pacientes com clipes cirúrgicos foram correlacionadas aplicando o teste de Pearson. Os testes de Wilcoxon rank sum test e Student t foram utilizados para comparação qualitativa e quantitativa entre as duas sequências. RESULTADOS: Os artefatos de movimento estavam presentes em 100% e 0% dos exames de aquisição cartesiana e de BLADE, respectivamente. Os artefatos de desvio químico estavam presentes em 8% dos exames cartesianos. Artefatos de fluxo foram mais frequentes nas sequências BLADE. A sequência BLADE foi estatisticamente superior para todos os atributos qualitativos (p < 0,05), exceto na supressão de gordura (p = 0,054). O BLADE foi superior na avaliação dos implantes e clipes cirúrgicos (p < 0,05). O SNR foi estatisticamente superior na sequência BLADE (48,35 versus 16,17). Cronbach variou entre 0,502 e 0,813. CONCLUSÃO: A sequência BLADE foi superior à sequência de aquisição cartesiana de imagens na ponderação STIR, comprovada por uma melhor qualidade de imagem, menos artefatos e melhor avaliação da parede torácica e de linfonodos.
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Abstract Objective: The purpose of this study was to compare two short-tau inversion recovery (STIR) sequences, Cartesian and radial (BLADE) acquisitions, for breast magnetic resonance imaging (MRI) examinations. Materials and Methods: Ninety-six women underwent 1.5 T breast MRI exam (48 Cartesian and 48 BLADE). Qualitative analysis including image artifacts, image quality, fat-suppression, chest-wall depiction, lesion detection, lymph node depiction and overall impression were evaluated by three blinded readers. Signal to noise ratios (SNRs) were calculated. Cronbach's alpha test was used to assess inter-observer agreement. Subanalyses of image quality, chest-wall depiction and overall impression in 15 patients with implants and image quality in 31 patients with clips were correlated using Pearson test. Wilcoxon rank sum test and t-test were performed. Results: Motion artifacts were present in 100% and in 0% of the Cartesian and the BLADE exams, respectively. Chemical-shift artifacts were present in 8% of the Cartesian exams. Flow artifacts were more frequent on BLADE. BLADE sequence was statistically superior to Cartesian for all qualitative features (p < 0.05) except for fat-suppression (p = 0.054). In the subanalysis, BLADE was superior for implants and clips (p < 0.05). SNR was statistically greater for BLADE (48.35 vs. 16.17). Cronbach ranged from 0.502 to 0.813. Conclusion: BLADE appears to be superior to Cartesian acquisition of STIR imaging as measured by improved image quality, fewer artifacts, and improved chest wall and lymph node depiction.
Resumo Objetivo: Comparar duas sequências de aquisição, cartesiana e radial (BLADE) ponderadas em short-tau inversion recovery (STIR), em exames de ressonância magnética de mama. Materiais e Métodos: Noventa e seis pacientes foram submetidas a exame de ressonância magnética de mama em 1,5 T (48 aquisições STIR cartesianas e 48 aquisições STIR BLADE). A análise qualitativa incluindo artefatos, qualidade de imagem, supressão de gordura, avaliação da parede torácica, detecção de lesões, linfonodos e impressão geral foi avaliada independentemente por três leitores. Os signal to noise ratios (SNRs) foram calculados. Foi utilizado o teste alfa de Cronbach para avaliar a concordância interobservador. Subanálises da qualidade de imagem, avaliação da parede torácica e impressão geral em 15 pacientes com implantes e qualidade de imagem em 31 pacientes com clipes cirúrgicos foram correlacionadas aplicando o teste de Pearson. Os testes de Wilcoxon rank sum test e Student t foram utilizados para comparação qualitativa e quantitativa entre as duas sequências. Resultados: Os artefatos de movimento estavam presentes em 100% e 0% dos exames de aquisição cartesiana e de BLADE, respectivamente. Os artefatos de desvio químico estavam presentes em 8% dos exames cartesianos. Artefatos de fluxo foram mais frequentes nas sequências BLADE. A sequência BLADE foi estatisticamente superior para todos os atributos qualitativos (p < 0,05), exceto na supressão de gordura (p = 0,054). O BLADE foi superior na avaliação dos implantes e clipes cirúrgicos (p < 0,05). O SNR foi estatisticamente superior na sequência BLADE (48,35 versus 16,17). Cronbach variou entre 0,502 e 0,813. Conclusão: A sequência BLADE foi superior à sequência de aquisição cartesiana de imagens na ponderação STIR, comprovada por uma melhor qualidade de imagem, menos artefatos e melhor avaliação da parede torácica e de linfonodos.
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La resonancia magnética (RM) mamaria se está convirtiendo en una herramienta de trabajo frecuentemente utilizada en nuestro medio. Existe un grupo de lesiones que sólo pueden ser identificadas por esta técnica, RMI only. Entre 14 a 20 por ciento de ellas serán malignas, según las diferentes series publicadas. Este tipo de lesiones requieren de biopsia guiada bajo RM. Pacientes y Métodos: se realizó revisión retrospectiva descriptiva de las biopsias asistidas por vacío realizadas en nuestra institución (período entre agosto de 2008 y junio de 2013). Resultados: El 0,3 por ciento (11) de las biopsias realizadas en nuestra institución fueron realizadas bajo RM, en 9 mujeres. En el 55 por ciento de los casos la indicación de la resonancia en la que se detectó la lesión biopsiada, fue etapificación de cáncer mamario recientemente diagnosticado; en el 100 porciento de los casos se realizó ultrasonido de segunda mirada, las lesiones tenían un tamaño promedio de 15 mm (4-29), un 63,6 por ciento fueron nódulos y el resto captaciones tipo no masa. La duración de la biopsia varió entre 40 y 130 minutos, un 27,2 por ciento resultaron lesiones malignas; 36,4 por ciento lesiones de alto riesgo; y 36,4 por ciento benignas. En el 45,5 por ciento el resultado de la biopsia bajo resonancia cambia la conducta quirúrgica. De las 7 lesiones operadas hubo subestimación en un caso de cáncer ductal in situ, que resultó cáncer ductal infiltrante. En el resto la histología quirúrgica fue idéntica a la de la biopsia bajo resonancia. Conclusión: Las biopsias bajo resonancia son infrecuentes, consumen un tiempo considerable, su correlación histológica es muy confiable y cambia la conducta quirúrgica casi en la mitad de los casos, lo cual tiene implicancias en el pronóstico de la paciente.
Abstract. Breast MRI is becoming a frequently used working tool in our environment. A group of lesions exist that can only be identified by this technique, "MRI only". Between 14-20 % of these will be malignant, according to various published series. Such lesions require biopsy guided under MRI. Patients and Methods: A descriptive retrospective review of vacuum-assisted biopsies was performed at our institution (period between August 2008 and June 2013). Results: 0.3 % (11) of the biopsies performed at our institution were done so under MRI, in 9 women. In 55% of the cases the resonance indication in which the biopsied lesion was detected, was newly diagnosed staging of breast cancer; in 100% of the cases a second-look ultrasound was performed, the lesions had an average size of 15 mm (4-29), 63.6% were nodules and the remainder other non-mass type deposits. The duration of the biopsy varied between 40 and 130 min, 27.2% were malignant lesions, 36.4 % high-risk lesions, and 36.4 % benign. In 45.5% the result of the biopsy performed under MRI changed the surgical procedure. Of the 7 operated lesions there was an underestimation in one case of ductal carcinoma in situ, which resulted being invasive ductal carcinoma. In the remainder, the surgical histology was identical to that of the biopsy performed under magnetic resonance. Conclusion: Biopsies performed under MRI are infrequent, they take considerable time, their histological correlation is very reliable and it changes the surgical procedure in almost half of the cases, which has implications in the prognosis of the patient.
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Humanos , Adulto , Femenino , Persona de Mediana Edad , Biopsia con Aguja/métodos , Imagen por Resonancia Magnética , Neoplasias de la Mama/patología , Estudios Retrospectivos , Neoplasias de la Mama/diagnóstico , VacioRESUMEN
Neoadjuvant chemotherapy (NACT) is a treatment used in those breast cancers initially inoperable due to their size, and also in operable breast cancers where NACT could increase the rate of conservative breast surgery. To assess tumor response to treatment, clinical examination, mammography, ultrasound, and breast MRI are used, the latter being the modality that yields the best correlation with histologic tumor volume. We evaluated the correlation of tumor sizes as measured by MRI versus surgical pathological specimen in breast cancers treated with NACT. Eighteen patients underwent MRI to monitor NACT; in 15 (83 percent) of them the final biopsy was obtained. In this group a very good correlation was observed, with a mean difference between MRI and histology of 4 mm regarding tumor volumen, which has allowed an adequate management of patients in our daily practice.
La quimioterapia neoadyuvante (QTNA) es un tratamiento usado en aquellos cánceres mamarios cuyo tamaño los hace inoperables al momento del diagnóstico y en cánceres mamarios operables, pero cuyo uso podría permitir una cirugía conservadora. Para evaluar la respuesta al tratamiento, se ha utilizado el examen clínico, la mamografía, el ultrasonido y la resonancia magnética mamaria, siendo ésta última la que mejor correlación tiene con el tamaño tumoral histológico. Quisimos evaluar la concordancia del tamaño tumoral medido en resonancia magnética con el de la biopsia quirúrgica, en cánceres mamarios tratados con QTNA. Dieciocho pacientes se realizaron resonancia magnética para monitorización de QTNA, en 15 (83 por ciento) de ellas se obtuvo la biopsia definitiva. En este grupo observamos una muy buena correlación, con una diferencia promedio de 4 mm, entre el tamaño de la resonancia y el de la histología, lo que permitió en nuestro medio un adecuado manejo de las pacientes.
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Anciano , Quimioradioterapia Adyuvante , Imagen por Resonancia Magnética , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/tratamiento farmacológico , Antineoplásicos/uso terapéutico , Biopsia , Mamografía , Monitoreo Fisiológico/métodos , Neoplasias de la Mama/patología , Resultado del TratamientoRESUMEN
Preoperative examination intended to detect multifocality, multicentricity and bilaterality-once considered the strongest indication of breast magnetic resonance imaging (MRI)-is currently being strongly questioned in medical literature. This paper aims at evaluating, based on our experience at Clínica Alemana, Santiago, Chile, breast MRI ability to improve preoperative radiological tumour staging by conventional methods, as well as to determine the proportion of patients in which this diagnostic procedure generated changes in the surgical management. We retrospectively reviewed preoperative MRI studies carried out between January 2009 and June 2010. Classification: Group 1: MRI provided no new information. Group 2: by detecting additional lesions, MRI improved radiological staging without changing the type of surgery planned. Group 3: MRI showed new benign lesions and caused unnecessary surgery. Group 4: MRI successfully changed the type of surgery planned based on conventional studies. A total of 419 breast MRI scans were performed during a 18-month period; 39 percent of them were carried out preoperatively. For the analysis, 128 patients were enrolled and distributed in the following categories: Group 1 (66 percent), Group 2 (20 percent), Group 3 (2 percent) and Group 4 (12 percent). In 95.3 percent of the patients, a single surgery with clear margins was performed. This work demonstrated the usefulness of preoperative MRI in our practice, i.e., it allowed for a better radiological staging in one third of the patients and even successfully changed the surgical approach in 12 percent of cases.
El estudio preoperatorio en búsqueda de multifocalidad, multicentricidad y bilateralidad -antes considerada la indicación más sólida de la resonancia magnética (RM) mamaria- hoy se encuentra fuertemente cuestionada en la literatura. En este trabajo nos propusimos evaluar la capacidad de la RM mamaria en nuestro centro para mejorar la etapificación radiológica preoperatoria realizada por métodos convencionales y determinar la proporción de las pacientes en que genera cambio en el enfoque quirúrgico. Hemos revisado retrospectivamente las RM preoperatorias entre enero de 2009 y junio de 2010. Clasificación: Grupo1: la RM no aportó información nueva. Grupo 2: al detectar lesiones adicionales, mejoró la etapificación radiológica, sin cambiar el tipo de la cirugía planificada. Grupo3: demostró nuevas lesiones no malignas y causó cirugía inútil. Grupo 4: cambió correctamente el tipo de cirugía planeada en base a los estudios convencionales. En los 18 meses se realizaron 419 RM mamarias, el 39 por ciento de ellas en preoperatorio. Para el análisis se han reclutado 128 pacientes con la siguiente distribución en los grupos predeterminados: Grupo 1(66 por ciento), Grupo 2(20 por ciento), Grupo 3(2 por ciento) y Grupo 4(12 por ciento). En el 95,3 por ciento de las pacientes se logró realizar una sola cirugía con márgenes libres. Este trabajo demostró la utilidad de la RM preoperatoria en nuestra práctica: permite una mejor etapificación radiológica en el tercio de las pacientes e incluso cambia correctamente el enfoque quirúrgico en el 12 por ciento de los casos.