Answer for BIR CoW 09 Oct 2022
DUCTAL CARCINOMA INSITU
Findings
T1 hypointense / T2 hyperintense irregualar mass lesions with spiculated margins noted in upper outer quadrant of right breast which shows diffusion restriction with skin thickening on contrast administration,Lesion shows heterogenous enhancement. Largest lesion measures 3.4 x 3.2 cm Similar looking lesion noted in upper inner quadrant. Temporal resolution kinetic analysis reveals Type II curve within the lesion. Right apical, right lateral group of axillary lymphnodes noted,largest measuring 1.12 cm x 1.2 cm. Impression Features suggestive carcinoma breast T4bN2aMx–BIRADS IV
Discussion
MRI has a very high sensitivity for detecting invasive breast cancer • A combination of lesion morphology and enhancement kinetics following gadolinium injection is key to successful diagnosis Normal breast tissue may enhance and this enhancement is in part dependent on the phase of the menstrual cycle. The optimum time for performing a breast MRI is during the second week of the menstrual cycle (between days 7 and 13) when background glandular enhancement should be least intense. Enhancement patterns return to normal between 3 and 6 months after radiotherapy. Percutaneous breast biopsy (fine-needle aspiration cytology [FNAC], core or VAB) rarely interferes with MRI interpretation important role of MRI is identifying an occult primary tumour in women presenting with malignant axillary lymphadenopathy with a normal mammogram and breast ultrasound MRI is the gold standard to assess response to treatment in women receiving neoadjuvant chemotherapy It can recognise responders to treatment earlier than other imaging methods by demonstrating a reduction in lesion size, or a change in the enhancement pattern, with the level of enhancement reducing or taking on a more benign appearance MR imaging may be useful in diminishing the over-diagnosis of biologically inert DCIS and the under-diagnosis of prognostically relevant DCIS. Contrast enhancement is biomarker of angiogenic and protease activity. The degree of vascularity in DCIS increases with histologic grade. Protease activity is required to penetrate the ductal membrane and to invade beyond it. It is thus suggested that DCIS lesions visualized on MR images may be more clinically relevant and have a higher probability of progressing to invasive carcinoma than those detected with mammography The most common morphologic pattern is NME, and the most common kinetic pattern is one of rapid initial uptake. However, DCIS can also show slower uptake and more benign-appearing kinetic curves;thus, it is important that image interpretations should be based on morphologic features instead of kinetic features
Findings
T1 hypointense / T2 hyperintense irregualar mass lesions with spiculated margins noted in upper outer quadrant of right breast which shows diffusion restriction with skin thickening on contrast administration,Lesion shows heterogenous enhancement. Largest lesion measures 3.4 x 3.2 cm Similar looking lesion noted in upper inner quadrant. Temporal resolution kinetic analysis reveals Type II curve within the lesion. Right apical, right lateral group of axillary lymphnodes noted,largest measuring 1.12 cm x 1.2 cm. Impression Features suggestive carcinoma breast T4bN2aMx–BIRADS IV
Discussion
MRI has a very high sensitivity for detecting invasive breast cancer • A combination of lesion morphology and enhancement kinetics following gadolinium injection is key to successful diagnosis Normal breast tissue may enhance and this enhancement is in part dependent on the phase of the menstrual cycle. The optimum time for performing a breast MRI is during the second week of the menstrual cycle (between days 7 and 13) when background glandular enhancement should be least intense. Enhancement patterns return to normal between 3 and 6 months after radiotherapy. Percutaneous breast biopsy (fine-needle aspiration cytology [FNAC], core or VAB) rarely interferes with MRI interpretation important role of MRI is identifying an occult primary tumour in women presenting with malignant axillary lymphadenopathy with a normal mammogram and breast ultrasound MRI is the gold standard to assess response to treatment in women receiving neoadjuvant chemotherapy It can recognise responders to treatment earlier than other imaging methods by demonstrating a reduction in lesion size, or a change in the enhancement pattern, with the level of enhancement reducing or taking on a more benign appearance MR imaging may be useful in diminishing the over-diagnosis of biologically inert DCIS and the under-diagnosis of prognostically relevant DCIS. Contrast enhancement is biomarker of angiogenic and protease activity. The degree of vascularity in DCIS increases with histologic grade. Protease activity is required to penetrate the ductal membrane and to invade beyond it. It is thus suggested that DCIS lesions visualized on MR images may be more clinically relevant and have a higher probability of progressing to invasive carcinoma than those detected with mammography The most common morphologic pattern is NME, and the most common kinetic pattern is one of rapid initial uptake. However, DCIS can also show slower uptake and more benign-appearing kinetic curves;thus, it is important that image interpretations should be based on morphologic features instead of kinetic features
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!