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Nonpalpable Mammographically Occult Invasive Breast Cancers Detected by MRI

Lia Bartella1, Laura Liberman1, Elizabeth A. Morris1 and D. David Dershaw1

1 All authors: Department of Radiology, Breast Imaging Section, Memorial Sloan-Kettering Cancer Center, H118, 1275 York Ave., New York, NY 10021.


Figure 1
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  		Fig. 1A —31-year-old woman with palpable, biopsy-proven left breast invasive ductal cancer in upper outer quadrant. Corresponding to palpable mass, sonography showed focal mass and mammogram showed pleomorphic calcifications. Sagittal T1-weighted MRI of left breast immediately after injection of IV gadolinium shows multiple heterogeneously and rim-enhancing masses.

 

Figure 2
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  		Fig. 1B —31-year-old woman with palpable, biopsy-proven left breast invasive ductal cancer in upper outer quadrant. Corresponding to palpable mass, sonography showed focal mass and mammogram showed pleomorphic calcifications. Sagittal T1-weighted contrast-enhanced, delayed MRI of left breast shows masses have washout kinetics. Histologic analysis showed multicentric invasive ductal cancer. Patient had left mastectomy.

 

Figure 3
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  		Fig. 2 —49-year-old woman at high risk for breast cancer had screening breast MRI examination. Sagittal T1-weighted contrast-enhanced MRI of right breast shows focal clumped enhancement superiorly. MRI-guided needle localization and surgical excision yielded invasive lobular cancer (0.7 cm).

 

Figure 4
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  		Fig. 3 —60-year-old woman with palpable left breast mass that yielded invasive lobular cancer. Sagittal contrast-enhanced T1-weighted image of opposite (right) breast showed mammographically occult, nonpalpable heterogeneously enhancing mass. Biopsy yielded invasive mammary cancer with mixed ductal and lobular features.

 

Figure 5
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  		Fig. 4 —69-year-old woman who presented with palpable left axillary nodes positive for metastatic mammary cancer with no primary cancer identified on mammography or physical examination. Sagittal T1-weighted contrast-enhanced MRI of left breast shows spiculated, irregular, heterogeneously enhancing mass. Biopsy yielded invasive ductal cancer.

 

Figure 6
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  		Fig. 5A —65-year-old woman presented with palpable right breast cancer. Sagittal T1-weighted MRI of right breast immediately after contrast injection shows suspicious regional clumped enhancement in separate quadrant.

 

Figure 7
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  		Fig. 5B —65-year-old woman presented with palpable right breast cancer. Delayed postcontrast image from sagittal T1-weighted MRI of right breast shows plateau kinetics in regional clumped enhancement. Histologic analysis yielded invasive lobular cancer. Patient had right mastectomy.

 

Figure 8
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  		Fig. 6 —69-year-old woman with mammographically occult, nonpalpable breast cancer evident as spiculated mass with washout kinetics on MRI T1-weighted images (not shown). Sagittal T2-weighted unenhanced image shows high signal in mass.

 

Figure 9
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  		Fig. 7A —64-year-old woman 12 days after left lumpectomy for invasive ductal carcinoma with positive surgical margins. Sagittal T1-weighted image from postoperative MRI of left breast immediately after contrast injection shows focal clumped enhancement at anterior aspect of seroma cavity.

 

Figure 10
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  		Fig. 7B —64-year-old woman 12 days after left lumpectomy for invasive ductal carcinoma with positive surgical margins. Delayed contrast-enhanced T1-weighted image from left breast MRI shows clumped enhancement has persistent kinetics. Surgery revealed residual invasive ductal cancer at site.

 

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