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MR Imaging of the Breast in Patients with Invasive Lobular Carcinoma

Susan Pae Weinstein1, Susan Greenstein Orel1, Rose Heller2, Carol Reynolds3,4, Brian Czerniecki5, Lawrence J. Solin6 and Mitchell Schnall1

1 Department of Radiology, The University of Pennsylvania Medical Center, 1 Silverstein Bldg., 3400 Spruce St., Philadelphia, PA 19104.
2 University Radiology Group, Robert Wood Johnson University Hospital, 800 Ryders La., East Brunswick, NJ 08816.
3 Department of Pathology, The University of Pennsylvania Medical Center, Philadelphia, PA 19104.
4 Present address: Department of Anatomic Pathology, Mayo Clinic, 200 First St., S.W., Rochester, MN 55905.
5 Department of Surgery, Division of Surgical Oncology, The University of Pennsylvania Medical Center, Philadelphia, PA 19104.
6 Department of Radiation Oncology, The University of Pennsylvania Medical Center, Philadelphia, PA 19104.



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  		Fig. 1. —47-year-old woman with palpable left breast mass and negative findings on mammography. Sonography (not shown) revealed 2.5-cm mass corresponding to palpable mass. Sagittal fat-suppressed contrast-enhanced three-dimensional fast spoiled gradient-recalled echo MR image (TR/TE, 9.3/2.2) shows multiple enhancing masses in all quadrants. Additional masses were unsuspected. At mastectomy, invasive lobular carcinoma was found in all four quadrants.

 


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  		Fig. 2A. —51-year-old woman with negative mammographic findings and palpable breast mass. Sagittal fat-suppressed contrast-enhanced three-dimensional fast spoiled gradient-recalled echo MR image (TR/TE, 9.3/2.2) reveals extensive contrast enhancement throughout breast.

 


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  		Fig. 2B. —51-year-old woman with negative mammographic findings and palpable breast mass. Mammographic images from MR imaging—guided needle localization show dense breast tissue. A 9-cm invasive lobular carcinoma was found at mastectomy.

 


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  		Fig. 2C. —51-year-old woman with negative mammographic findings and palpable breast mass. Mammographic images from MR imaging-guided needle localization show dense breast tissue. A 9-cm invasive lobular carcinoma was found at mastectomy.

 


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  		Fig. 3A. —51-year-old woman with palpable breast mass. Mammograms reveal no suspicious findings, which was stable in comparison with prior studies. Sonography (not shown) did not show any suspicious findings.

 


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  		Fig. 3B. —51-year-old woman with palpable breast mass. Mammograms reveal no suspicious findings, which was stable in comparison with prior studies. Sonography (not shown) did not show any suspicious findings.

 


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  		Fig. 3C. —51-year-old woman with palpable breast mass. Sagittal fat-suppressed contrast-enhanced three-dimensional fast spoiled gradient-recalled echo MR image (TR/TE, 9.3/2.2) reveals enhancing spiculated mass (arrow).

 


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  		Fig. 4A. —61-year-old woman with abnormal mammographic findings. Multiple sagittal fat-suppressed contrast-enhanced three-dimensional fast spoiled gradient-recalled echo MR images (TR/TE, 9.3/2.2) reveal focally enhancing dominant mass (arrows) in inferior breast. However, anterior and superior to this mass are additional areas of enhancement (arrows).

 


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  		Fig. 4B. —61-year-old woman with abnormal mammographic findings. Mammographic images from wire localization of dominant mass seen in A. On wide excisional biopsy, multiple foci of invasive lobular carcinoma were found.

 


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  		Fig. 4C. —61-year-old woman with abnormal mammographic findings. Mammographic images from wire localization of dominant mass seen in A. On wide excisional biopsy, multiple foci of invasive lobular carcinoma were found.

 

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