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238 Friday, 26 March 2010 Poster Sessions
615 Poster
Initial experience of breast specific gamma imaging (BSGI) in Asia
S.H. Lee1, R.J. Im1, C.S. Yoon1, M.H. Hur1, H.K. Lee1, S.S. Kang1,
S.S. Ko1.1Cheil General Hospital, Department of Surgery, Seoul, South
Korea
Breast-specific gamma imaging (BSGI) is a functional imaging modality
with using a dedicated small field-of-view system designed to detect and
localize lesions. Initial studies have reported sensitivity equaling that of
magnetic resonance imaging, but with improved specificity. We reviewed
our initial experience to evaluate the impact of this technology at our breast
center in ASIA.
We performed a retrospective review of the initial data of patients
underwent BSGI as part of the imaging work-up between November
2008 and July 2009. Mammography and ultrasonography were categorized
according to BI-RADS criteria. BSGI was classified according to BSGI
reading guideline by George Washington Univ. medical center. Patients
with abnormal BSGI or ultrasonography were underwent biopsy.
A total of 715 patients underwent BSGI because of suspicious imaging,
abnormal physical examination, foreign body implant, multiple lesions or
high risk patient. BSGI was positive for 204 (28.5%) of the patients and
negative for 511 (71.5%). Three patients with a new diagnosis of cancer
obtained BSGI for further work-up. Sensitivity and specificity of BSGI were
estimated 90% and 60% respectively. A positive predictive value (PPV) of
52% with a negative predictive value (NPV) of 92% was calculated. False-
positive results in BSGI included fibroadenoma, intraductal papilloma,
adenosis, phyllodes tumor, atypical ductal hyperplasia, and atypical lobular
hyperplasia.
Breast-specific gamma imaging can be a useful additional diagnostic
tool and detect the occult cancer in negative conventional studies. But,
multiple heterogeneous patchy uptakes were complicated to evaluate of
the breast lesion and high proliferative benign lesion could be revealed in
false positive. Further studies will be needed to define the role of BSGI.
616 Poster
The utility of real-time virtual sonography (RVS)-guided biopsy as the
diagnostic procedure for incidental enhancing lesions on breast MRI
M. Yoshida1, S. Nakano1, K. Fujii1, K. Yorozuya1, Y. Mouri1, J. Kousaka1,
T. Fukutomi1.1Aichi Medical University School of Medicine, Breast and
Endocrine Surgery, Aichi, Japan
Background: Incidental enhancing lesions (IELs) that were initially
identified by breast magnetic resonance imaging (MRI), but not by
conventional imaging, are found in 16−29% of patients upon performing
breast MRI. Particularly, IELs found in separate quadrants from the index
tumor are clinically important. It is often difficult to assess incidental
enhancing lesions (IELs) on breast MRI. We recently have developed a
real-time virtual sonography (RVS) system, in which a position tracking
system is coordinated with a magnetic sensor. RVS can synchronize a
sonography image and the MR image with multi-planar reconstruction
(MPR) of the same section in real time. The aim of this study was to
evaluate the utility of RVS-guided biopsy as the diagnostic procedure for
IELs on breast MRI.
Materials and Methods: Between June 2006 and May 2007, 65 patients
underwent breast MRI for staging of known breast cancer at our hospital.
All patients were examined using mammography, sonography and breast
MRI before their surgeries. MRI was obtained on a Magnetom 1.5 T imager,
with the patient in the supine position using a flexible body surface coil. If a
patient has any IELs on breast MRI, which were suspected of malignancy,
she underwent RVS after a second-look sonography. If the lesion was
identified by RVS, either core needle biopsy (14G) or vacuum-assisted
needle biopsy (11G) was performed while using RVS as a guide. If the
lesion were detected only on the virtual MR image, but not detected on the
sonography image, excisional biopsy was performed after MRI information
was marked onto body surface using the RVS system. Identification rates
of IELs were compared between by a second-look sonography alone and
by RVS. All IELs on breast MRI were correlated with pathologic findings.
Results: Of the 65 patients, a total of 23 IELs were found in 17
patients (26%). Of 23 IELs, 30% (7/23) of IELs could be identified by a
second-look sonography alone, but 83% (19/23) of them were identified
by RVS (P = 0.001). From these 19 IELs which were identified by RVS,
we performed RVS-guided needle biopsy. From the rest of 4 IELs which
were not identified by RVS, we performed excisional biopsy after MRI
information was marked onto the body surface using RVS. The mean
size of IELs was 6.6 mm. The median time required to perform the RVS-
guided biopsy procedure was 35 minutes. RVS-guided biopsy procedures
were successfully completed without important side effects in all patients.
Histopathologically, malignant findings of invasive ductal carcinoma (n = 7)
and ductal carcinoma in situ (DCIS) (n =5) were obtained, whereas benign
findings of fibrocystic disease (n = 6), fibroadenoma (n = 2), intraductal
papilloma (n = 1), intramammary lymph node (n = 1) and hemangioma
(n = 1) were obtained.
Conclusions: Our results suggest that the RVS system can correctly
project enhanced MRI information onto a body surface, as we are checking
sonographic morphology. RVS-guided biopsy of the breast is a conventional
and effective method for the workup of IELs on breast MRI.
617 Poster
Quantitative multivoxel magnetic resonance spectroscopy
M.D. Dorrius1, R.M. Pijnappel2, P. Kappert1, M. Oudkerk1, P.E. Sijens1.
1University Medical Center Groningen, Radiology, Groningen, The
Netherlands; 2Martini Hospital, Radiology, Groningen, The Netherlands
Background: To present a new quantitative multivoxel Magnetic Reso-
nance Spectroscopy (MRS) method for the examination and metabolic
mapping of pathology in the human breast.
Materials and Methods: One patient (53y) with an invasive ductal
carcinoma of the left breast underwent MRS using a 1.5T Avanto MRI
system. Multivoxel 2D-chemical shift imaging (CSI) with point resolved
spectroscopy (PRESS) and a spatial resolution of 0.5x0.5x1 cm3,was
performed without suppression of the water and fat signals (repetition
time (TR) 1500ms, echo time (TE) 30ms) to serve as a reference
measurement and was repeated with suppression of the water and fat
signals (TR 1500ms, TE 135ms) to be able to detect Choline (Cho).
The number of peaks fitted included the chemical shift ranges restricted
to 3.1−3.3 ppm for Cho, 4.5−5.0 ppm for water, and 1.0−1.5 ppm for
the main resonance of fat (−CH2−). Using standardized postprocessing
protocols, the raw data were processed automatically, allowing for
operator-independent quantifications. The mean and the highest choline
concentration were measured in 36 voxels of 0.25cm3each.
Results: The unsuppressed CSI spectral map shows intense water (at
4.7 ppm) and minor fat peaks (at 1.3 ppm) for each voxel containing lesion.
After application of water and fat suppression, tumour voxels showed an
intense Cho peak at 3.23 ppm as compared with lack of signal in voxels
containing adipose tissue. In 4 tumour voxels the mean concentration of
Cho was 0.35 mM with a highest level of 0.51 mM.
Conclusion: Quantitative multivoxel MR spectroscopy can be well
performed in a standard clinical setting with use of a regular 1.5 T MR
scanner.
619 Poster
Impact of pre-operative breast magnetic resonance imaging upon
surgical management of breast carcinoma
F. Constantinidis1, G. Christodoulidis2, M. Spyridakis2, V. Pappi3,
D. Dimas4, A. Moustaka2, E. Athanasiou2.1MHTERA Hospital, Radiology,
Athens, Greece; 2University Hospital of Larisa, General Surgery Dep,
Larisa, Greece; 3University Hospital LAIKO, Oncology-Haematology,
Athens, Greece; 4Naval Hospital, General Surgery Dep, Athens, Greece
Background: The use of Magnetic resonance imaging (MRI) in determin-
ing the extent breast cancer has been advocated. The aim of this study
was to evaluate the effect of pre-operative MRI on the surgical decision
making in patients suffering from breast cancer.
Patients and Methods: In a period of 4 years (2005–2009) 82 patients
diagnosed with breast cancer by the conventional clinical examination and
mammography, were also subjected to breast MRI. The MRI study was
performed using a 1.5-T Phillips Eclipse magnetic resonance scanner with
a standard bilateral breast coil. Radiologic findings and clinicopathological
data were evaluated.
Results: The mean age of patients was 50 years (30−70 years).
In 16 patients (19.5%) additional lesion were identified which have not
previously detected by conventional diagnostic modalities. All the new
lesions identified at MRI were localized for biopsy. In 9 patients (56.25%)
the biopsy revealed malignancy and in the rest 7 the lesions were benign. In
eleven patients (13.4%) who were initially considered for breast conserving
surgery, the surgical decision was shifted to mastectomy based upon
MRI results revealing multicenter malignant lesions. MRI had a sensitivity
of 100% and in comparison to with mammography the specificity was
statistically significant higher (92.7% vs 74.7%, p <0.005). The positive
predictive value of MRI was 42.3%. The overall accuracy of MRI was higher
but not statistically significant compared to mammography (p = 0.0054).
Conclusion: Breast MRI influences the surgical treatment options for
patients with diagnosed breast carcinoma. MRI together with biopsy to the
newly identified lesions seems to be the most accurate and safe method
in surgical decision making in patients with breast cancer.