, Volume 112, Issue 6, pp 850-862
Date: 21 Sep 2007

Rare breast neoplasms: is there any peculiar feature on magnetic resonance mammography?

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Abstract

Purpose

The purpose of this study is to describe the semiological features of rare breast neoplasms at magnetic resonance mammography (MRM).

Materials and methods

Out of 468 MRMs of patients with a histological diagnosis of breast malignancy, 27 (5.7%) cases of rare breast neoplasms, confirmed by definitive histological analysis on surgical specimens, were selected: four (0.9%) intracystic papillary neoplasms, four (0.9%) intraductal papillary neoplasms, five (1.0%) invasive papillary neoplasms, two (0.4%) medullary carcinomas, seven (1.5%) mucinous carcinomas, three (0.6%) tubular carcinomas, one (0.2%) tubulo-lobular carcinoma and one (0.2%) desmoid tumour. Two radiologists evaluated the MRM images according to Fischer criteria and indicated a level of diagnostic suspicion. In particular, MRM lesion morphology and enhancement characteristics were analysed.

Results

No semiologic features of malignancy or peculiar appearances indicating rare breast neoplasm were identified. On the contrary, MRM appearance was nonspecific and often suggestive of probably benign (Breast Imaging Reporting and Data System-BI-RADS 3) (40%) or benign lesions (BI-RADS 2) (7.5%), or lesions were undetectable at MRM (BI-RADS 1) (7.5%).

Conclusions

Frequently, rare breast neoplasms show low suspicious morphologic and kinetic patterns at MRM, and they are often classified as indeterminate lesions. This is probably due to their high grade of differentiation and their histological features.

Riassunto

Obiettivo

Descrivere gli aspetti semeiologici delle neoplasie maligne rare della mammella studiate in risonanza magnetica mammaria (RMM).

Materiali e metodi

Da una casistica di 468 pazienti con diagnosi istologica di neoplasia mammaria maligna sottoposte a RMM, abbiamo estrapolato 27 casi (5,7%) di neoplasie rare, confermate alla diagnosi istologica definitiva: 4 (0,9%) carcinomi papillari intracistici, 4 (0,9%) carcinomi papillari intraduttali, 5 (1,0 %) carcinomi papillari invasivi, 2 (0,4%) carcinomi midollari, 7 (1,5%) carcinomi mucinosi, 3 (0,6%) carcinomi tubulari, 1 (0,2%) carcinoma tubulo-lobulare e 1 (0,2%) tumore desmoide. Due lettori hanno valutato secondo i parametri di Fischer le relative immagini RMM indicando un grado di sospetto radiologico e ricercando eventuali caratteristiche morfologiche o dinamiche peculiari.

Risultati

Non sono emersi elementi semeiologici orientativi per neoplasie mammarie rare, ma l’aspetto RMM è risultato aspecifico e spesso orientativo per lesioni probabilmente benigne (BI-RADS 3) (40%) o benigne (BI-RADS 2) (7,5%), o addirittura la neoplasia non è stata identificabile alla RMM (BI-RADS 1) (7,5%).

Conclusioni

Di frequente le neoplasie maligne rare della mammella, verosimilmente a causa dell’elevato grado di differenziazione e delle peculiarità istologiche, presentano alla RMM caratteristiche morfologiche e di enhancement poco sospette e vengono classificate come lesioni dubbie/indeterminate.