Although inflammatory breast carcinoma (IBC) accounts for 1%-4% of all breast cancer cases, the appearance of this highly malignant tumor in magnetic resonance imaging (MRI) is still not well characterized. The aim of this study was to identify typical imaging features of IBC in comparison with noninflammatory locally advanced breast carcinoma (LABC).
MRIs of 48 patients with IBC were compared with an equivalent cohort of 52 subjects with LABC. Age and histopathologic subtype were equivalent between the two groups. To delineate characteristic features, a multitude of dynamic and morphologic parameters were evaluated using T1- and T2-weighted sequences.
No significant differences of prevalences could be found for the following criteria: dynamic tumor signal characteristics, prominent vessels, perifocal edema, axillary lymph node involvement, morphology of focal masses, and morphologic pattern of non-mass like enhancement. Otherwise, the quantity of focal masses and the spatial distribution of the tumoral infiltration significantly differed between the two cancer groups. The following parameters occurred more frequently in the IBC cases: edema (cutaneous/subcutaneous 81.3%, perimamillar 70.8%, diffuse 89.6%, prepectoral 72.9%, intramuscular pectoral 41.7%), thickening (75.0%) and pathologic enhancement (60.4%) of Cooper's ligaments, skin thickening (83.3%), punched-out sign (initially strong, focal increase of some dermal or subcutaneous parts followed by slow-continuous enhancement of the surrounding skin; 56.3%).
Inflammatory breast carcinoma seems to represent a specific biological entity resulting in typical MRI characteristics. Some of the parameters are supposed to visualize the characteristic extensive lymphovascular infiltration and therefore may improve the diagnosis of IBC.
"This cancer is typically associated with thickening of the overlying skin as can often be seen on MRI images; and this radiological sign constitutes a marker for diagnosing IBC. The abnormal skin also typically has a large water signal.18 Diffuse signal enhancement is expected for this type of cancer as the associated inflammation has related edema; this is evident in the photomicrograph as ‘separation artifacts’ in the tissue slice. "
[Show abstract][Hide abstract] ABSTRACT: Breast cancer incidence is increasing worldwide. Early detection is critical for long-term patient survival, as is monitoring responses to chemotherapy for management of the disease. Magnetic resonance imaging and spectroscopy (MRI/MRS) has gained in importance in the last decade for the diagnosis and monitoring of breast cancer therapy. The sensitivity of MRI/MRS for anatomical delineation is very high and the consensus is that MRI is more sensitive in detection than x-ray mammography. Advantages of MRS include delivery of biochemical information about tumor metabolism, which can potentially assist in the staging of cancers and monitoring responses to treatment. The roles of MRS and MRI in screening and monitoring responses to treatment of breast cancer are reviewed here. We rationalize how it is that different histological types of breast cancer are differentially detected and characterized by MR methods.
Magnetic Resonance Insights 04/2013; 6:33-49. DOI:10.4137/MRI.S10640
"Néanmoins, quand l'interrogatoire n'apparaît pas fiable, des arguments morphologiques tels que la présence à la mammographie de masses volumineuses et de calcifications extensives peuvent être utilisés. De nombreux auteurs se sont également penchés sur les caractéristiques différentielles de ces deux pathologies à l'IRM  , ce qui a permis d'identifier des caractéristiques très différentes de ces deux pathologies, jusqu'ici souvent confondues. "
[Show abstract][Hide abstract] ABSTRACT: La mastite carcinomateuse est une forme grave de cancer du sein, dont le diagnostic est essentiellement clinique et histologique. La mammographie reste le premier examen à réaliser, non seulement pour apporter des arguments en faveur de ce diagnostic mais également pour rechercher une lésion primitive intramammaire et évaluer l’extension locorégionale. L’étude du sein controlatéral est essentielle, à la recherche d’une bilatéralité. L’échographie apporte également des arguments en faveur d’une inflammation, mais apparaît plus performante à la fois pour la détection des masses et pour l’analyse des aires ganglionnaires. La place de l’IRM est débattue, tant d’un point de vue diagnostique que pour le suivi sous traitement, et doit être réservée à des cas sélectionnés. Une évaluation radiologique initiale optimale permettra un suivi sous chimiothérapie néo-adjuvante.
"Nevertheless, when the patient's answers to questions do not seem to be reliable, decisive morphological aspects can be used, such as the presence on the mammogram of voluminous masses and extensive calcifications . Many authors have also looked into the differential characteristics of these two conditions with MRI  , which has identified very different imaging characteristics for these two diseases that have often been confused in the past. "
[Show abstract][Hide abstract] ABSTRACT: Carcinomatous mastitis is a severe form of breast cancer and its diagnosis is essentially clinical and histological. The first examination to perform is still mammography, not only to provide evidence supporting this diagnosis but also to search for a primary intramammary lesion and assess local/regional spread. It is essential to study the contralateral breast for bilaterality. Ultrasound also provides evidence supporting inflammation, but appears to be better for detecting masses and analysing lymph node areas. The role of MRI is debatable, both from a diagnostic point of view and for monitoring during treatment, and should be reserved for selected cases. An optimal, initial radiological assessment will enable the patient to be monitored during neoadjuvant chemotherapy.
Diagnostic and interventional imaging 02/2012; 93(2):95-103. DOI:10.1016/j.diii.2011.12.003
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