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Outcome Analysis and Rational Management of Enhancing Lesions Incidentally Detected on Contrast-Enhanced MRI of the Breast

Andrea Teifke1, Hans Anton Lehr2, Toni Werner Vomweg1, Alexander Hlawatsch1 and Manfred Thelen1

1 Department of Radiology, Johannes Gutenberg University of Mainz, Langenbeckstr. 1, Mainz D-55131, Germany.
2 Department of Pathology, Johannes Gutenberg University of Mainz, Mainz D-55131, Germany.



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  		Fig. 1A. —Enhancing incidental lesion in 51-year-old woman with known contralateral breast cancer. Histologic examination after CT-guided excisional biopsy revealed additional 5-mm tubular carcinoma. Lesion (arrow) does not stand out against surrounding tissue on unenhanced coronal MRI (T1-weighted three-dimensional gradient-echo sequence) of left breast.

 


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  		Fig. 1B. —Enhancing incidental lesion in 51-year-old woman with known contralateral breast cancer. Histologic examination after CT-guided excisional biopsy revealed additional 5-mm tubular carcinoma. First contrast-enhanced MRI obtained at same position as A reveals small irregularly shaped strongly enhancing incidental lesion (arrow).

 


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  		Fig. 1C. —Enhancing incidental lesion in 51-year-old woman with known contralateral breast cancer. Histologic examination after CT-guided excisional biopsy revealed additional 5-mm tubular carcinoma. Axial CT scan obtained after injection of contrast material clearly shows this enhancing incidental lesion (arrow).

 


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  		Fig. 1D. —Enhancing incidental lesion in 51-year-old woman with known contralateral breast cancer. Histologic examination after CT-guided excisional biopsy revealed additional 5-mm tubular carcinoma. CT scan obtained after preoperative localization shows guidewire in correct position.

 


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  		Fig. 2. —Graph shows outcome of all 274 enhancing incidental lesions, depending on their prospective assessment on MRI (category 2, benign; 3, probably benign; 4a, indefinite; 4b, probably malignant; 5, malignant). Altogether 113 lesions were clarified by histology, 104 followed up on MRI, and 45 followed up on mammography and sonography. Eight were lost to follow-up, and four lesions disappeared on MRI under neoadjuvant chemotherapy.

 


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  		Fig. 3A. —Enhancing incidental lesion in 58-year-old woman with history of contralateral breast carcinoma 8 years previously. Histologic examination of this enhancing incidental lesion revealed second primary breast cancer with maximal diameter of 5 mm. Coronal subtraction image from first contrast-enhanced and unenhanced study (T1-weighted dynamic three-dimensional gradient-echo sequence; TR/TE, 15/7; flip angle, 30°) shows slightly irregularly shaped unifocal small enhancing incidental lesion.

 


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  		Fig. 3B. —Enhancing incidental lesion in 58-year-old woman with history of contralateral breast carcinoma 8 years previously. Histologic examination of this enhancing incidental lesion revealed second primary breast cancer with maximal diameter of 5 mm. On repeated sonogram, suspicious lesion (between cursors) that had been missed during first examination was found in corresponding location

 


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  		Fig. 3C. —Enhancing incidental lesion in 58-year-old woman with history of contralateral breast carcinoma 8 years previously. Histologic examination of this enhancing incidental lesion revealed second primary breast cancer with maximal diameter of 5 mm. This small malignant lesion (A and B) was not seen on either previous mammograms (not shown) or specimen radiograph shown here.

 


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  		Fig. 4. —Graph illustrates number of malignant enhancing incidental lesions that could be identified during reevaluation on mammography or sonography (black bars) and that could definitely be seen solely on MRI (white bars), depending on their size.

 


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  		Fig. 5. —Flow diagram of proposed management guidelines for enhancing incidental lesions detected on MRI of breast.

 

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