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Magnetic resonance imaging features of idiopathic granulomatous mastitis: is there any contribution of diffusion-weighted imaging in the differential diagnosis?

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Abstract

Purpose

To identify the magnetic resonance imaging (MRI) appearance of idiopathic granulomatous mastitis, and the usefulness of diffusion-weighted magnetic resonance imaging (DW-MRI) in distinguishing idiopathic granulomatous mastitis (IGM) from malignant breast lesions.

Material and methods

A total of 37 women (mean age 36 + 8; range 20–67 years) with histopathologic diagnoses of idiopathic granulomatous mastitis were enrolled in the study. Five patients had bilateral IGM, which were evaluated as ten cases. Dynamic MRI findings were categorized as enhancing mass lesion, non-mass enhancement, or both together. The frequency of quadrant involvement, retroareolar involvement, accompanying abscess, ductal ectasia, skin thickening, breast edema, extension to pectoral muscle, and presence of fistula were investigated. The mean apparent diffusion coefficient (ADC) values for lesions, contralateral normal breast parenchyma, pectoralis major muscle, and sternum were measured in patients with invasive cancers (n = 42) and those with mastitis (n = 42). The ADC ratio of the lesions to the contralateral normal breast parenchyma, pectoralis major muscle, and sternum were determined.

Results

The findings of idiopathic granulomatous mastitis on MRI were total (in all quadrants) or wide (2 or 3 quadrants) in 30 (71.5 %), retroareolar space involvement in 28 (66.7 %), skin thickening in 21 (50 %), breast edema in 21 (50 %), extension to pectoral muscle in 18 (42.9 %), accompanying abscess formation in 33 (78 %), ductal ectasia in 17 (40.5 %), and fistulas in 13 (31 %). On dynamic contrast-enhanced MRI, 69 % of the patients had mass appearance of IGM. The most frequent enhancement patterns were rim enhancement in 20 (78 %) in masses and clustered ring in 11 (48 %) in non-mass lesions. Early enhancement pattern of IGM was obtained as ‘slow’ in 29 cases (69 %), ‘medium’ in 11 cases (26.1) and ‘rapid’ in 2 (5 %) cases. Time-signal intensity curves were detected as Type-1 in 27 cases (64 %) and Type-2 in 15 cases (36 %). IGM showed significantly lower mean ADC values when compared with the normal parenchyma. When IGM was compared with malignancy, mastitis ADC was 0.98 ± 0.188 × 10−3, and invasive cancer ADC was 0.95 ± 0.229 × 10−3. The difference in ADC values of mastitis and invasive cancers proved not to be significant (P = 0.185). Our results had no discriminatory power for IGM versus malignant lesions for either ADC values and ADC ratios of normal breast parenchyma, pectoralis major muscle, and sternum.

Conclusion

Although not characteristic for idiopathic granulomatous mastitis, masses with rim enhancement or clustered-ring non-mass lesions with segmental distribution on MRI are the most common features of the disease. Ductal ectasia and periductal enhancement were commonly accompanying; this and kinetic analysis are valuable findings for distinguishing IGM from invasive cancer. IGM shows similar ADC values to invasive cancers despite being benign, DW-MRI is not helpful in the differentiation with malignant lesions

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References

  1. Kessler E, Wolloch Y (1972) Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Pathol 58:642–646

    Article  CAS  PubMed  Google Scholar 

  2. Carmalt HL, Ramsey-Stewart G (1981) Granulomatous mastitis. Med J Aust 1:356–359

    CAS  PubMed  Google Scholar 

  3. Yau FM, Macadam SA, Kuusk U, Nimmo M, Van Laeken N (2010) The surgical management of granulomatous mastitis. Ann Plast Surg 64:9–16

    Article  CAS  PubMed  Google Scholar 

  4. Hovanessian Larsen LJ, Peyvandi B, Klipfel N, Grant E, Iyengar G (2009) Granulomatous lobular mastitis: imaging, diagnosis, and treatment. AJR Am J Roentgenol 193:574–581

    Article  PubMed  Google Scholar 

  5. Belaabidia B, Essadki O, el Mansouri A, Squalli S (2002) Idiopathic granulomatous mastitis: apropos of 8 cases and review of the literature. Gynecol Obstet Fertil 30:383–389

    Article  CAS  PubMed  Google Scholar 

  6. Ozturk M, Mavili E, Kahriman G et al (2007) Granulomatous mastitis: radiological findings. Acta Radiol 48:150–155

    Article  CAS  PubMed  Google Scholar 

  7. Dursun M, Yilmaz S, Yahyayev A et al (2012) Multimodality imaging features of idiopathic granulomatous mastitis: outcome of 12 years of experience. Radiol Med 117:529–538

    Article  CAS  PubMed  Google Scholar 

  8. Kocaoglu M, Somuncu I, Ors F et al (2004) Imaging findings in idiopathic granulomatous mastitis. A review with emphasis on magnetic resonance imaging. J Comput Assist Tomogr 28:635–641

    Article  PubMed  Google Scholar 

  9. Yildiz S, Aralasmak A, Kadioglu H et al (2015) Radiologic findings of idiopathic granulomatous mastitis. Med Ultrason 17(39):44

    Google Scholar 

  10. Al-Khawari HA, Al-Manfouhi HA, Madda JP et al (2011) Radiologic features of granulomatous mastitis. Breast J 17:645–650

    Article  PubMed  Google Scholar 

  11. Woodhams R, Matsunaga K, Iwabuchi K et al (2005) Diffusion-weighted imaging of malignant breast tumors: the usefulness of apparent diffusion coefficient (ADC) value and ADC map for the detection of malignant breast tumors and evaluation of cancer extension. J Comput Assist Tomogr 29:644–649

    Article  PubMed  Google Scholar 

  12. Woodhams R, Kakita S, Hata H et al (2005) Identification of residual breast carcinoma following neoadjuvant chemotherapy: diffusion-weighted imaging—comparison with contrast-enhanced MR imaging and pathologic findings. J Comput Assist Tomogr 29:644–649

    Article  PubMed  Google Scholar 

  13. Zhao J, Guan H, Li M, Gu H, Qin J, Wu X (2016) Significance of the ADC ratio in the differential diagnosis of breast lesions. Acta Radiol 57:422–429

    Article  PubMed  Google Scholar 

  14. Aslan H, Pourbagher A, Colakoglu T (2015) Idiopathic granulomatous mastitis: magnetic resonance imaging findings with diffusion MRI. Acta Radiol. Oct 26

  15. Bani-Hani KE, Yaghan RJ, Matalka II, Shatanawi NJ (2004) Idiopathic granulomatous mastitis: time to avoid unnecessary mastectomies. Breast J 10:318–322

    Article  PubMed  Google Scholar 

  16. Parra DM, Santos MN, Guerrero BM et al (1997) Utility of fineneedle aspiration in the diagnosis of granulomatous lesion of the breast. Diagn Cytopathol 17(108–114):17

    Google Scholar 

  17. Jorgensen MB, Nielsen DM (1992) Diagnosis and treatment of granulomatous mastitis. Am J Med 93:97–101

    Article  CAS  PubMed  Google Scholar 

  18. Heer R, Shrimankar J, Griffith CD (2003) Granulomatous mastitis can mimic breast cancer on clinical, radiological or cytological examination: a cautionary tale. Breast 12:283–286

    Article  CAS  PubMed  Google Scholar 

  19. Van Ongeval C, Schraepen T, Van Steen A et al (1997) Idiopathic granulomatous mastitis. Eur Radiol 7:1010–1012

    Article  PubMed  Google Scholar 

  20. Schelfout K, Tjalma WA, Cooremans ID et al (2001) Observations of an idiopathic granulomatous mastitis. Eur J Obstet Gynecol Reprod Biol 97:260–262

    Article  CAS  PubMed  Google Scholar 

  21. Cakir B, Tuncbilek N, Karakas HM et al (2002) Granulomatous mastitis mimicking breast carcinoma. Breast J 8:251–252

    Article  CAS  PubMed  Google Scholar 

  22. Tuncbilek N, Karakas HM, Okten OO (2004) Imaging of granulomatous mastitis: assessment of three cases. Breast 13(510–514):26

    Google Scholar 

  23. Tokunaga E, Kimura Y, Kitamura K, Maehara Y (2004) Granulomatous lobular mastitis misdiagnosed as breast carcinoma. Breast J 10(261–262):27

    Google Scholar 

  24. Breucq C, Verfaillie G, Bourgain C et al (2005) Mastitis granulomatosis. Breast J 11:289–291

    Article  PubMed  Google Scholar 

  25. Tozaki M, Igarashi T, Fukuda K (2006) Breast MRI using the VIBE sequence: clustered ring enhancement in the differential diagnosis of lesions showing non-masslike enhancement. Am J Roentgenol 187:313–321

    Article  Google Scholar 

  26. Kuhl CK, Mielcareck P, Klaschik S, Leutner C, Wardelmann E, Gieseke J, Schild HH (1999) Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions? Radiology 211:101–110

    Article  CAS  PubMed  Google Scholar 

  27. Wenkel E, Geppert C, Schulz-Wendtland R et al (2007) Diffusion weighted imaging in breast MRI: comparison of two different pulse sequences. Acad Radiol 14:1077–1083

    Article  PubMed  Google Scholar 

  28. Yankeelov TE, Lepage M, Chakravarthy A et al (2007) Integration of quantitative DCE-MRI and ADC mapping to monitor treatment response in human breast cancer: initial results. Magn Reson Imaging 25:1–13

    Article  PubMed  Google Scholar 

  29. Marini C, Iacconi C, Giannelli M et al (2007) Quantitative diffusion-weighted MR imaging in the differential diagnosis of breast lesion. Eur Radiol 17:2646–2655

    Article  CAS  PubMed  Google Scholar 

  30. Kuroki-Suzuki S, Kuroki Y, Nasu K et al (2007) Detecting breast cancer with non-contrast MR imaging: combining diffusion-weighted and STIR imaging. Magn Reson Med 6:21–27

    Article  Google Scholar 

  31. Hatakenaka M, Sodea H, Yabuuchi H et al (2008) Apparent diffusion coefficients of breast tumors: clinical application. Magn Reson Med Sci 7:23–29

    Article  PubMed  Google Scholar 

  32. Guo Y, Cai YQ, Cai ZL et al (2002) Differentiation of clinically benign and malignant breast lesions using diffusion-weighted imaging. J Magn Reson Imaging 16:172–178

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul Universitesi Istanbul Tip Fakultesi Radyoloji A.B.D. Fatih, Istanbul, Turkey

    Ravza Yilmaz, Ali Aslan Demir, Atilla Kaplan, Memduh Dursun & Gulden Acunas

  2. Department of Radiology, Institute of Oncology, Istanbul University, Istanbul, Turkey

    Dilek Sahin

  3. Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey

    Enver Ozkurt

Authors
  1. Ravza Yilmaz
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  2. Ali Aslan Demir
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  3. Atilla Kaplan
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Correspondence to Ravza Yilmaz.

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This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Yilmaz, R., Demir, A.A., Kaplan, A. et al. Magnetic resonance imaging features of idiopathic granulomatous mastitis: is there any contribution of diffusion-weighted imaging in the differential diagnosis?. Radiol med 121, 857–866 (2016). https://doi.org/10.1007/s11547-016-0666-x

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  • DOI: https://doi.org/10.1007/s11547-016-0666-x

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