Role of short-term follow-up magnetic resonance imaging in the detection of post-operative residual breast cancer

Abstract

The aim of the present study was to evaluate the role of short-term follow-up magnetic resonance imaging (MRI) in the detection of postoperative residual breast cancer. A retrospective analysis was performed on 10 patients who were diagnosed with non-malignant breast lesions by preoperative clinical, ultrasound and mammography examinations and intraoperative frozen-section pathology. These patients were finally confirmed as having malignant breast lesions by paraffin-embedded tissue histology and corresponding received second surgeries. Routine MRI, enhancement MRI and echo-planar imaging-diffusion-weighted imaging were performed on the 10 patients within 1 month after the first surgery. All the cases showed a local distortion of mammary architecture revealed by routine MRI and enhancement MRI images. The enhancement characteristics of the 10 cases were as follows: 3 cases featured stippled enhancement, 2 had small nodular enhancement, 1 showed dendritic enhancement, 1 had a ring-shaped enhancement of the cystic wall and 3 had no abnormal enhancement. The lesions of 7 cases had a type-I enhancement curve (progressive enhancement pattern) and 3 cases had a type-II curve (plateau pattern). The lesions of 4 cases had a decreased apparent diffusion coefficient. In total, 4 cases of tumor residue were diagnosed by MRI and the second pathological examination, while in 1 case the tumor residue was misdiagnosed by MRI but confirmed by the second pathological examination. In conclusion, the present study suggested that short-term follow-up MRI may be of value in the diagnosis of postoperative residual breast tumors and may be helpful for surgeons to develop an accurate surgical plan.

Keywords: breast; magnetic resonance imaging; residual cancer.

Figure 1.

Magnetic resonance images of case no. 6, a 48-year-old with intraductal carcinoma. (A) Vibrant+C T1 sequence with fat suppression showed structural disorder, dendritic enhancement in the medial left breast, as well as thickened skin. (B) Curves of enhancement had a plateau shape (type II). (C) 3D maximum intensity projection reconstruction image showing disordered vasculature which had entered into the lesions in the left breast.

Figure 2.

Magnetic resonance images of case no. 8, a 57-year-old with intraductal carcinoma. (A and B) T1-weighted and T2 fat suppression showed a residual cavity in the lateral left breast, a homogeneous T1-type hypointense signal and a homogeneous T2 fat suppression hyperintense signal. The adjacent skin tissue was defective. (C) Vibrant+C T1 sequence with fat suppression showed a ring-like enhancement of the residual cavity wall.

Figure 3.

Magnetic resonance images of case no. 3, a 54-year-old with intraductal carcinoma. (A and B) T1-weighted and T2 fat suppression showed that the left breast was smaller than the right breast and that its lateral section had structural disorders. A patchy hypointense T1 signal and a hyperintense T2 fat suppression signal were observed, and the adjacent skin tissue was thickened. (C) Echo-planar imaging-diffusion-weighted imaging (DWI) showed a hyperintense lesion in the DWI (b=1,000) and the apparent diffusion coefficient was 0.77×10⁻³ mm²/sec. (D and F) Vibrant+C T1 with fat suppression and 3D maximum intensity projection reconstruction images showed structural disorder and nodular enhancement. (E) The curve of enhancement had a progressive pattern (type I).

Figure 4.

Magnetic resonance images of case no. 4, a 30-year-old with non-specific invasive ductal carcinoma grade II. (A, B and C) Vibrant+C T1 sequence with fat suppression showed multinodular enhancement. (D) Curve of enhancement was plateau-shaped (type II). (E) 3D maximum intensity projection reconstruction image showed multinodular hyperintense enhancement, as well as increased disorders of the vasculature, which had entered the lesions in the left breast. (F) Echo-planar imaging-DWI showed a hypointense lesion in DWI (b=1,000) and the apparent diffusion coefficient was 0.88–1.07×10⁻³ mm²/sec. DWI, diffusion-weighted imaging.

Figure 5.

Magnetic resonance images of case no. 4, a 30-year-old with non-specific invasive ductal carcinoma grade II. (A and B) T1-weighted and T2 fat suppression showed an oval-shaped nodule in the left armpit, a homogeneous T1 hypointense signal and a homogeneous T2 fat suppression hyperintense signal. (C) Vibrant+C T1 with fat suppression showed homogeneity enhancement. (D) The curve of enhancement had a washout enhancement pattern (type III). (E) The apparent diffusion coefficient was 0.7×10⁻³ mm²/sec.