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Sensitivity of MRI Versus Mammography for Detecting Foci of Multifocal, Multicentric Breast Cancer in Fatty and Dense Breasts Using the Whole-Breast Pathologic Examination as a Gold Standard

¹ Department of Diagnostic Imaging, Istituto Policlinico San Donato, Via Morandi 30, San Donato Milanese, Milan 20097, Italy.
² Institute of Radiology, University of Ancona, Via Conca, Ancona 60020, Italy.
³ Department of Radiology, Vita-Salute University, San Raffaele Hospital, Via Olgettina 60, Milan 20132, Italy.
⁴ Institute of Radiology, Udine University, Via Colugna 50, Udine 33100, Italy.
⁵ Department of Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Viale Oxford 81, Rome 00133, Italy.
⁶ Department of Senology, Policlinico Universitario, Piazza G. Cesare 11, Bari 70124, Italy.

View larger version (71K): [in a new window]   Fig. 1A. —47-year-old woman with multicentric breast cancer in dense breast. Craniocaudal mammogram shows round hyperdense opacity (arrow) at external quadrants.

View larger version (54K): [in a new window]   Fig. 1B. —47-year-old woman with multicentric breast cancer in dense breast. Mediolateral oblique mammogram does not show clear depiction of tumor.

View larger version (86K): [in a new window]   Fig. 1C. —47-year-old woman with multicentric breast cancer in dense breast. Contrast-enhanced subtracted coronal MR image (first dynamic phase) shows not only major tumor as large round area of contrast uptake with irregular borders at external quadrants but also three small satellite foci (arrows) showing multifocal cancer.

View larger version (99K): [in a new window]   Fig. 1D. —47-year-old woman with multicentric breast cancer in dense breast. Subtracted coronal image (first dynamic phase), obtained in plane anterior to that shown in C, confirms multifocality at external quadrants (arrows); however, three other small foci (arrowheads) of contrast uptake are detected at internal quadrants, showing multicentric cancer.

View larger version (41K): [in a new window]   Fig. 2A. —47-year-old woman with multicentric breast cancer with scattered fibroglandular pattern. Lateromedial 90° (A) and craniocaudal (B) mammograms show at least four roundish nodules clustered at internal quadrants of right breast (circle). Small posterior opacity (arrow, A) was recognized only retrospectively.

View larger version (53K): [in a new window]   Fig. 2B. —47-year-old woman with multicentric breast cancer with scattered fibroglandular pattern. Lateromedial 90° (A) and craniocaudal (B) mammograms show at least four roundish nodules clustered at internal quadrants of right breast (circle). Small posterior opacity (arrow, A) was recognized only retrospectively.

View larger version (123K): [in a new window]   Fig. 2C. —47-year-old woman with multicentric breast cancer with scattered fibroglandular pattern. Contrast-enhanced breast MR images from subtracted first dynamic phase, coronal partial maximum intensity projection (C) and two axial multiplanar reconstructions (D and E), confirm group of nodules at internal quadrants (circle) and reveal other three malignant nodules, one at external quadrant (arrow, C), another in retroareolar region (arrow, D), and last at internal quadrant in prepectoral region (arrow, E). Only last one could be retrospectively recognized in lateral mammogram (arrow, A).

View larger version (89K): [in a new window]   Fig. 2D. —47-year-old woman with multicentric breast cancer with scattered fibroglandular pattern. Contrast-enhanced breast MR images from subtracted first dynamic phase, coronal partial maximum intensity projection (C) and two axial multiplanar reconstructions (D and E), confirm group of nodules at internal quadrants (circle) and reveal other three malignant nodules, one at external quadrant (arrow, C), another in retroareolar region (arrow, D), and last at internal quadrant in prepectoral region (arrow, E). Only last one could be retrospectively recognized in lateral mammogram (arrow, A).

View larger version (93K): [in a new window]   Fig. 2E. —47-year-old woman with multicentric breast cancer with scattered fibroglandular pattern. Contrast-enhanced breast MR images from subtracted first dynamic phase, coronal partial maximum intensity projection (C) and two axial multiplanar reconstructions (D and E), confirm group of nodules at internal quadrants (circle) and reveal other three malignant nodules, one at external quadrant (arrow, C), another in retroareolar region (arrow, D), and last at internal quadrant in prepectoral region (arrow, E). Only last one could be retrospectively recognized in lateral mammogram (arrow, A).

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