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ABSTRACT: When performing breast-conserving surgery (BCS), it is essential to achieve a complete resection of the tumor while preserving the cosmetic outcome. The aim of this study was to evaluate the accuracy of a MRI marking technique for planning of BCS.
A retrospective review was performed of 14 consecutive patients who underwent MRI in the supine position (supine MRI) using a MRI marking technique. The preoperative histopathological diagnosis was ductal carcinoma in situ in 11 and invasive ductal carcinoma in 3. All of the patients with invasive ductal carcinoma were treated with neoadjuvant chemotherapy. The pills of Breath Care used as MRI markers were placed in the Penrose drain with 2-cm intervals, and drains were put on the resection lines as determined by ultrasonography (US). The final resection lines were modified using information obtained by supine MRI. The rate of the margin-tumor distance (RMTD: longer margin-tumor distance/shorter margin-tumor distance) was calculated.
Thirteen patients (93%) needed modification of the first resection line, whereas one patient (7%) needed no modification. Twelve patients (86%) had negative margins, but two patients (14%) had positive margins: one patient had a medial margin, while the other had a distal margin. One patient showed a pathologically complete response after chemotherapy; the RMTD was not evaluated. Among the 12 patients with medial and lateral negative margins, the medial and lateral margin-tumor distances ranged from 1.0 to 3.5 cm (average 2.1 cm), and the RMTD ranged from 1 to 3.0 (average 1.5).
Our MRI marking technique may be useful for evaluating the extent of the tumor as determined by the US examination in difficult cases.
Breast Cancer 03/2009; 16(3):223-8. · 1.36 Impact Factor
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Mitsuhiro Tozaki,
Norie Yamashiro,
Takako Suzuki,
Naoko Kawano,
Shinji Ozaki,
Naomi Sakamoto,
Satoko Abe, Tomoko Ogawa,
Nobuhito Katayama,
Yuko Tsunoda,
Eisuke Fukuma
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ABSTRACT: In the United States and Europe, MR-guided vacuum-assisted biopsy (VAB) is required for MR-only visible suspicious lesions that cannot be identified with mammography or ultrasonography. However, it is controversial as to whether MR-guided VAB is essential or not in Japan. The purpose of this study was to clarify the frequency of malignancy among the patients that underwent MR-guided VAB, and to discuss the need for this technique in Japan.
This study was approved by the Institutional Review Board of our hospital. A retrospective review was performed of 30 consecutive patients who had undergone MR-guided 11-gauge VAB. The biopsies were performed on a 1.5 T MR scanner using a commercially available biopsy system. All lesions seen with MRI could not be detected by mammography and second-look ultrasonography.
All 30 lesions were assessed as category 4 or 5. The average lesion size of a mass enhancement before biopsy was 0.7 cm, and the average lesion size of a non-mass-like enhancement was 2.3 cm. The average number of cores of VAB was 19. The median time required to perform the VAB procedure was 35 min. The biopsy was successfully performed without important side effects in all patients. Histopathological findings were invasive ductal carcinoma in one (3%); ductal carcinoma in situ (DCIS) in seven (23%); and benign in 22 (73%). In one case, atypical ductal hyperplasia at VAB was upgraded to DCIS at surgical excision.
MR-guided VAB can be performed safely and it is needed for MR-only visible suspicious lesions in Japan.
Breast Cancer 10/2008; 16(2):121-5. · 1.36 Impact Factor
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Mitsuhiro Tozaki,
Masaaki Sakamoto,
Yu Oyama,
Toshihiro O'uchi,
Naoko Kawano,
Takako Suzuki,
Norie Yamashiro,
Shinji Ozaki,
Naomi Sakamoto,
Kuniki Higa,
Satoko Abe, Tomoko Ogawa,
Eisuke Fukuma
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ABSTRACT: To assess the efficacy of (1)H MR spectroscopy (MRS) to evaluate early responses to neoadjuvant chemotherapy in breast cancer patients, as compared to that of the standardized uptake value (SUV) in (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET).
This retrospective study included seven patients with breast cancer who had both single-voxel (1)H MRS and PET/computed tomography (CT) acquired before, during, and after neoadjuvant chemotherapy.
The averages of the Choline (Cho) integral value and peak SUV before chemotherapy were 2.5 (range, 1.2-5.3) and 7.5 (range, 1.9-19), respectively. Three cases became negative for both Cho and peak SUV after two cycles of chemotherapy, and one patient became negative before surgery. In the remaining three patients, the curves of both values paralleled the time course of chemotherapy treatment. The difference between Cho and peak SUV before, during, and after chemotherapy was r = 0.65 (P = 0.12), r = 0.80 (P = 0.03), and r = 0.99 (P < 0.001), respectively. The reduction rate (RR) of both values after chemotherapy was also correlated (r = 0.84, P = 0.02).
A change in the Cho integral value is well correlated with that of peak SUV in the time course of neoadjuvant chemotherapy; thus, breast (1)H MRS is thought to be an alternative to sequential (18)F-FDG PET.
Journal of Magnetic Resonance Imaging 09/2008; 28(2):420-7. · 2.70 Impact Factor
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Tomoko Ogawa,
Mitsuhiro Tozaki,
Norie Yamashiro,
Naoko Kawano,
Takako Suzuki,
Shinji Ozaki,
Masaaki Sakamoto,
Tomoko Tsuruhara,
Naomi Sakamoto,
Kuniki Higa,
Satoko Abe,
Yuko Tsunoda,
Eisuke Fukuma
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ABSTRACT: We herein present a case of non-palpable ductal carcinoma in situ (DCIS) treated with successful breast-conserving surgery (BCS) using MR markers made with commercially available materials in the supine position. The patient was a 40-year-old woman found to have a non-mass lesion by routine screening ultrasonography (US). The margin of the lesion was unclear by the US examination, whereas contrast-enhanced MR mammography (MRM) revealed a clear margin of the lesion. After the resection line was determined by under US guidance, the area was marked by original markers for MRI using the pills of Breath Care inside a Penrose drain. MRM was performed in the supine position (supine MRM), which is similar to the posture used for surgery. The lesion was located within the resection area, but it was not at the center of the resection area; thus, the resection lines were modified using information obtained by MRM. The histological evaluation of the BCS specimen demonstrated a wide extension of the DCIS. The lesion was located at the center of the resection specimen, and the surgical margin was free. In conclusion, since our procedure can be performed easily, it is useful for evaluating the extent of the lesion as determined by the US examination in difficult cases.
Breast Cancer 03/2008; 15(4):309-14. · 1.36 Impact Factor
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Shinji Ozaki,
Mitsuhiro Tozaki,
Eisuke Fukuma,
Naoko Kawano,
Takako Suzuki,
Norie Yamashiro,
Masaaki Sakamoto,
Tomoko Tsuruhara,
Naomi Sakamoto,
Kuniki Higa,
Satoko Abe, Tomoko Ogawa,
Yuko Tsunoda,
Katayama Nobuhito
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ABSTRACT: Breast MR imaging has emerged as a highly sensitive modality for the imaging of breast tumors. However, there have been no reports concerning the usefulness of bilateral breast MRI to evaluate the contralateral breast in Japan. The purpose of this study was to examine the frequency of primary bilateral breast cancer, and to investigate the role of bilateral breast MRI in the detection of contralateral breast cancer.
A retrospective review was performed of 556 consecutive women who had undergone surgery for the primary breast cancer. MR imaging was performed on a 1.5-T system. Both the breasts were examined in the coronal plane on the first-, second-, and fourth-phase dynamic images, acquired at 30, 90 s, and 4.5 min, respectively. The affected single breast was sagittally examined on images obtained in the third phase at 3 min.
Twenty-four (4.3%) patients had bilateral breast cancer, 14 (2.5%) had synchronous cancer and 10 patients (1.8%) had metachronous cancer. In the 14 cases with synchronous cancer, bilateral breast malignancy was suspected at the time of the initial diagnosis in 6 cases. The detection rate of 18 contralateral breast cancer cases by only MMG, only US, MMG and US, and MRI were 50% (9/18), 67% (12/18), 78% (14/18) and 100% (17/17), respectively. For 8 of these cases with a second synchronous cancer, the corresponding rates were 75, 88, 100 and 100%, respectively. For the 10 cases with a second metachronous cancer, the rates were 30, 50, 60 and 100%, respectively.
Bilateral breast MRI is a more sensitive for the detection of contralateral breast cancers compared with conventional imaging methods. In particular, bilateral MRI also allows detection of metachronous contralateral cancers at an earlier stage during the postoperative follow-up period.
Breast Cancer 02/2008; 15(2):169-74. · 1.36 Impact Factor
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Naomi Sakamoto,
Mitsuhiro Tozaki,
Kuniki Higa,
Yuko Tsunoda, Tomoko Ogawa,
Satoko Abe,
Shinji Ozaki,
Masaaki Sakamoto,
Tomoko Tsuruhara,
Naoko Kawano,
Takako Suzuki,
Norie Yamashiro,
Eisuke Fukuma
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ABSTRACT: Breast MR imaging has emerged as a highly sensitive modality for the imaging of breast tumors. However, a standardized method of interpretation of lesions showing non-mass-like enhancement does not exist. The purpose of this study was to analyze the features of non-mass-like breast lesions detected by MRI, and to establish a standardized method of interpretation to allow categorization of these lesions.
A retrospective review was performed for 102 consecutive nonpalpable mammographically occult, non-mass-like lesions detected by MRI that had undergone ultrasound-guided vacuum-assisted biopsy. MR imaging was performed on a 1.5-Tesla system. The distribution patterns were classified into three categories as follows: single quadrant/solitary lesion (linear), single quadrant/grouped lesion (focal, regional, segmental), and multiquadrant lesion (multiple regions, diffuse). The presence of a ductal pattern was assessed in the enhancing lesions after the tumor distribution had been decided. In addition to the BI-RADS-MRI descriptors, the presence of clustered ring enhancement was also assessed in heterogeneous enhancing lesions. We divided non-mass-like lesions into those with a small (category 3a), moderate (category 3b), or substantial (category 4) likelihood of malignancy.
The features with the highest positive predictive value (PPV) for cancer were clustered ring enhancement (67%) (P = 0.004), a branching-ductal pattern (38%) (P = 0.003), and clumped architecture (20%). The PPV for cancer of a linear-ductal pattern was 11% (1/9). All lesions showing multiquadrant distribution, linear-nonspecific lesion, non-branching pattern with homogeneous and stippled internal architectures, and heterogeneous lesion without clustered ring enhancement were diagnosed as benign.
Non-mass-like breast lesions detected on MRI showing a clustered ring enhancement, a branching-ductal pattern, and clumped architecture should be evaluated further by biopsy (category 4), while lesions not showing these characteristics may be observed without unnecessary intervention (category 3a). Lesions showing a linear-ductal pattern may be followed carefully or evaluated by biopsy as needed (category 3b).
Breast Cancer 02/2008; 15(3):241-6. · 1.36 Impact Factor
