Invasive ductal carcinomaBy Markus HolzhauerHistory: 55 y old female with strong family history of breast cancer and dense fibroglandular tissue on mammogram as well as a recent screening MRI demonstrating a single foci in the left retroareolar breast , classified as probably benign, presents for 6 month follow up breast MRI. Findings:
:: X-Ray 1 ::Left MLO view demonstrating dense fibroglandular tissue - no abnormality.
:: X-Ray 2 ::Left CC view demonstating dense fibroglandular tissue - no focal abnormality.
:: MRI 1 ::MRI , fat supressed T1 weighted gradient echo sequene, left breast demonstrating 5 mm foci of enhancement in the retroareolar breast.
:: MRI 2 ::Non fat suppressed T1 weighted gradient echo sequence left breast demonstrating slightly irregular shaped lesion - 5mm left retroareolar breast.
:: MRI 3 ::Initial , 6 month old MRI , T1 weighted fat suppressed sequence pre contrast.
:: MRI 4 ::Initial, 6 month old MRI, T1 weighted sequence post constrast demonstrating enhancement.
:: MRI 5 ::CAD processed MRI demonstrating plateau enhancement of the lesion (Yellow) left retroareolar breast. Discussion: Several take home points: 1.) Single foci in breast MRI which is often a diagnostic problem. Decision of management is based on morphology and enhancement kinetics . In this particular case foci was approached initially as BIRADS 3 - and 6 month follow up MRI was recommended. Despite of no change in size on the 6 month follow up MRI it was decided to persue biopsy based on the shape (irregular-spiculated) and the enhancement kinetics (plateau). Lesion was biopsied with MRI guidance demonstrating Invasive ductal carcinoma, 2.) The follow up MRI was done is a different institution - the old images were delivered on a disc - but the informations of the CAD (the enhancement kinetics) were not included - which impairs assessment and therefore it is not a good idea in general to change locations in breast MRI . 3.) Good case of a screning MRI which does show an early 5 mm cancer which was impossible to detect on mammogram (see reference article) - you could speculate if US screening would have helped in that paricular case. Differential diagnosis: benign foci (BIRADS 2) vs probably benign foci (BIRADS 3) vs suspicous foci (BIRADS 4) Diagnosis confirmation: Other Category: Other Region / Organ: Head-Muscular system / Connective tissue / Skin Etiology: neoplastic References: consensus paper of the American Cancer Society (google search "breast MRI screening") CA Cancer J Clin 2007; 57:75-89 Get more for Invasive ductal carcinoma Peer-reviewed resources Literature  More publications about Invasive ductal carcinomaChallenge yourself with the case quiz! |