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Underestimation of Atypical Ductal Hyperplasia at MRI-Guided 9-Gauge Vacuum-Assisted Breast Biopsy

¹ Breast Imaging Section, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021.
² Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.

View larger version (112K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —49-year-old woman who had undergone ipsilateral lumpectomy yielding ductal carcinoma in situ (DCIS) 3 years earlier. Sagittal image from first T1-weighted 3D fat-suppressed fast spoiled gradient-echo sequence (TR/TE, 17/2.4; flip angle, 35°) after IV administration of gadopentetate dimeglumine shows susceptibility artifacts (black arrow) in area of previous lumpectomy. Suspicious focal enhancement (white arrow) is present at 12-o'clock axis.

View larger version (104K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —49-year-old woman who had undergone ipsilateral lumpectomy yielding ductal carcinoma in situ (DCIS) 3 years earlier. Sagittal delayed MR image obtained after contrast injection shows susceptibility artifacts (black arrow) and washout (white arrow) from enhancement at 12-o'clock axis.

View larger version (66K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —49-year-old woman who had undergone ipsilateral lumpectomy yielding ductal carcinoma in situ (DCIS) 3 years earlier. Sagittal delayed image obtained after contrast injection and after B shows susceptibility artifacts (black arrow) and that enhancement (white arrow) at 12-o'clock axis has become even less conspicuous, consistent with washout.

View larger version (96K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —49-year-old woman who had undergone ipsilateral lumpectomy yielding ductal carcinoma in situ (DCIS) 3 years earlier. Sagittal image from T1-weighted 3D fat-suppressed fast spoiled gradient-echo sequence (17/2.4; flip angle, 35°) obtained after IV contrast injection on day of MRI-guided vacuum-assisted biopsy. Nipple and susceptibility artifacts (black arrow) serve as landmarks to show that biopsy obturator was placed at site of suspicious enhancement (white arrow). More background enhancement is evident on biopsy day because patient underwent imaging in different phase of menstrual cycle. Histologic examination of MRI vacuum-assisted breast biopsy specimens revealed foci of marked atypical ductal hyperplasia involving florid sclerosing adenosis. Histologic examination after surgical excision showed DCIS, solid and cribriform types, intermediate to high nuclear grade, apocrine cytologic features, and minimal necrosis, mostly involving sclerosing adenosis.

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —52-year-old woman with family history of breast cancer who underwent high-risk-screening MRI. Sagittal image from T1-weighted 3D fat-suppressed fast spoiled gradient-echo sequence (TR/TE, 17/2.4; flip angle, 35°) after IV administration of gadopentetate dimeglumine shows area of clumped enhancement (arrow) in ductal distribution at 6-o'clock axis.

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —52-year-old woman with family history of breast cancer who underwent high-risk-screening MRI. Sagittal image from T1-weighted 3D fat-suppressed fast spoiled gradient-echo sequence (17/2.4; flip angle, 35°) after IV contrast administration on day of biopsy shows clumped ductal enhancement (arrow) at 6-o'clock axis. Round signal void within clumped enhancement is from biopsy obturator, which is in center of enhancement. Histologic examination of MRI vacuum-assisted breast biopsy specimens showed atypical ductal hyperplasia with adenosis and stromal fibrosis. Histologic examination of surgical specimen revealed ductal carcinoma in situ, solid and cribriform types, intermediate nuclear grade, in background of atypical ductal hyperplasia.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —48-year-old woman with family history of breast cancer who underwent high-risk-screening MRI. Sagittal image from T1-weighted 3D fat-suppressed fast spoiled gradient-echo sequence (TR/TE, 17/2.4; flip angle, 35°) after IV administration of gadopentetate dimeglumine shows clumped ductal enhancement (arrow).

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —48-year-old woman with family history of breast cancer who underwent high-risk-screening MRI. Sagittal image from T1-weighted 3D fat-suppressed fast spoiled gradient-echo sequence (17/2.4; flip angle, 35°) after IV contrast administration on day of biopsy shows area of clumped ductal enhancement (black arrow). Round signal void (dotted arrow) within clumped enhancement is from biopsy obturator.

View larger version (101K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —48-year-old woman with family history of breast cancer who underwent high-risk-screening MRI. Zoomed view of sagittal image in A shows individual clumps (arrows) of enhancement in more detail.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —48-year-old woman with family history of breast cancer who underwent high-risk-screening MRI. Photomicrograph of section from specimen obtained at MRI vacuum-assisted biopsy shows multiple small benign intraductal papillomas with sclerosis in background of fibrocystic changes with rare foci of atypical ductal hyperplasia. Individual small benign intraductal papillomas (arrows) correspond to clumped areas of enhancement (arrows, C). Histologic examination of surgical specimen revealed small benign intraductal papillomas with sclerosis, fibrocystic changes, and ductal hyperplasia with focal atypia. (H and E, x20)

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