Clinical Application of Multidetector Row Computed Tomography in Patient With Breast Cancer

Doo Kyoung Kang, Min Ji Kim, Yong Sik Jung, Hyunee Yim
2008 Journal of computer assisted tomography  
Although multidetector row computed tomography is not the primary method of evaluating breast cancer, it could be performed as an excellent alternative, especially in the presence of magnetic resonance contraindications. Moreover, computed tomography can still have an important role in evaluation of nodal status, thoracic invasion, and distant metastasis because of the large area covered in a single examination. Our experience together with literature indicates that multidetector row computed
more » ... ctor row computed tomography is a powerful supplementary method for evaluation of patients with breast cancer. FIGURE 2. A 48-year-old woman with infiltrating ductal carcinoma. A, Ultrasonography shows irregularly shaped hypoechoic mass (short arrow) with posterior shadowing (long arrow). B and C, Oblique coronal reconstruction (B) and MIP image (C) show irregularly shaped mass (short arrow) with spiculated margin (long arrow) at the right breast. DYF, CT number of the mass was 42 HU on precontrast study (D), 123 HU on 90 seconds after contrast injection (E), 98 HU on 5 minutes after contrast injection (F). The kinetic pattern of the tumor after contrast enhancement was initially rapid and delayed washout feature. . mass (arrows) with marked hypoechogenicity, spiculated margin, and posterior acoustic shadowing. BYD, Oblique coronal reconstruction images show an irregularly shaped mass (short arrow) with spiculated margin at upper outer quadrant of the left breast. There are spotty nodular enhancement (long arrows) and multifocal nodule (arrowhead) around the index mass. E, MIP image also reveals spotty nodular enhancements (long arrows) around the index mass (short arrow) and demonstrates that the tumor is supplied by branches of both lateral thoracic artery and internal mammary artery (arrowhead). The index mass was measured 3.4 cm in maximum dimension. The maximum extent of disease, including surrounding spotty nodular enhancement and multifocal nodule, was 4.5 cm. The patient underwent modified radical mastectomy. Histopathology confirmed infiltrating ductal carcinoma with EIC. F, Photomicrograph shows intraductal components (long arrows) and multifocal invasive lesion (arrowhead) around the infiltrating ductal carcinoma (short arrows) (hematoxylin-eosin, original magnification Â40). The maximum dimension of invasive component was 3.2 cm, and the maximum extent of the lesion was 4.8 cm. Kang et al FIGURE 10. A 34-year-old woman with breast cancer who received neoadjuvant chemotherapy. A, MIP image before neoadjuvant chemotherapy shows a large irregularly shaped mass (arrow) at the right breast with LN enlargement at the right axilla (arrowhead). The mass was measured by 6 cm in maximum dimension. B, Oblique coronal reconstruction shows an enhanced mass (arrow) with spiculated margin and irregular shape at the right breast. C, There is an enlarged LN (arrowhead) with cortical thickening at the right axilla. D and E, MIP (D) and oblique coronal reconstruction (E) images at 2 months after neoadjuvant chemotherapy show a mass (arrow) that was decreased (in size) to 2.6 cm in maximum dimension. F, Lymph node (arrowhead) at right axilla is decreased in size after neoadjuvant chemotherapy. Histopathology confirmed an invasive ductal carcinoma measured 2.8 cm and 1 metastatic LN. FIGURE 11. A 45-year-old woman with residual infiltrating ductal carcinoma after excision. A, Ultrasonography shows cavity (arrow) with fluid collection in postexcision site. B, Residual solid mass around the cavity (arrow) is not identified on ultrasonography. C and D, Multiplanar reconstruction (C) and MIP (D) images show residual mass (short arrow) around the cavity (long arrow). FIGURE 12. A 49-year-old woman who previously underwent lumpectomy of the right breast for breast cancer. A, MIP image shows asymmetrically enlarged right breast with ipsilaterally increased vascularity (long arrow), compared with the left breast. There are scattered enhancing foci (short arrows) in the right breast without definite enhancing mass. Histopathology of blind gun biopsy of the right breast confirmed carcinoma cells in lymphatic space, representing inflammatory breast cancer. B, There is a metastatic LN at right paratracheal (arrow) chain. Metastatic LNs were also detected at internal mammary chain on the lower slice (not shown). C, Sagittal reconstruction image shows obvious mass (arrows) at chest wall with heterogenous enhancement. FIGURE 13 . A 54-year-old woman with long-standing diabetes mellitus. A, Mammography shows dense glandular tissue of both breast without visible mass. B, Ultrasonography shows multiple hypoechoic masses (arrows) with flame-shaped anterior margin and extremely dense posterior acoustic shadowing at both breasts. We clinically diagnose the breast lesions as diabetic mastopathy because of history of long-standing diabetes mellitus for 23 years and characteristic ultrasonographic findings. However, these multiple masses mimicked breast malignancy, and extensive posterior shadowing prevented us from completely evaluating breast parenchymal tissue. Therefore, the patient underwent MRI to rule out occult malignancy. C, Sonographically detected multiple masses were not enhanced on postcontrast MRI; therefore, they could be considered as benign lesions. On the other hand, a 7-mm-sized enhancing nodule (arrow) was detected at upper outer quadrant of the right breast. The kinetic curve of the nodule showed initial rapid and delayed washout pattern (not shown), representing malignancy. Because our institute does not have MRI-guided biopsy instrument, we performed CT-guided needle localization. D, Axial CT scan shows enhanced nodule (arrow) at the right breast, which seems to be the same nodule seen on MRI. However, sonographically detected multiple masses were not enhanced on MDCT and MRI. E and F, Localization needle (long arrow) located exactly within the mass (short arrow). G, Photomicrograph shows stromal keloidlike fibrosis, consistent with diabetic mastopathy (hematoxylin-eosin, original magnification Â400), contrary to our expectations. Kang et al
doi:10.1097/rct.0b013e31815074ce pmid:18664847 fatcat:7lmjj43zuzfcte35t6swxrqwu4