Multimodality Imaging Studies Of Focal Asymmetry Identified On Mammography

BackgroundThe the tendency of breast disease incidence is on a rise on a global scale. Breastcancer has the highest morbidity among all the tumors in women remains a leading causeof cancer deaths among women in many parts of the world. Women with invasive breastcancers (whether the cancer is low or high grade) of1cm or smaller have a95%chance ofsurvival at10years, while those with invasive cancers2–5cm in size just have60%survival at10years (1).Therefore early diagnosis is the key of therapy of breast cancer andimprovement of prognosis on breast cancer.Mammography is currently the most effective method for early detection anddiagnosis of breast cancer. Focal Asymmetry (FA) as one of the special mammographicabnormalities can be difficult to evaluate and occasionally remain inconclusive despite athorough diagnostic evaluation.It can be the only clue to diagnosis of early invasive cancerand unusual breast cancers. But, focal asymmetry may be the common sign of mastitis,fibrosis, adenosis with ductal hyperplasia, fat necrosis sclerosing adenosis. And there is nosystematic study reported in China.Currently, contrast-enhanced MRI and breast sonography have been found to beuseful adjuncts to mammography. Especially, CE MR has been accepted as a powerful toolto help with the detection, diagnosis, and staging of breast cancer. In many parts of theworld, it has been used as a screening method of breast cancer in high risk women. MRIhas a sufficient spatial and temporal resolution to show the internal structure, shape, edgeand enhanced dynamic curve of abnormal, which is essential for Difference of benign andmalignant.This study is focused on imaging and pathology control study on focal aymmetry withCE-MRI and breast US, by comparing the benign lesions and malignant lesions, to provideimageology evidence for early diagnosis and early treatment of breast cancer. PART Ⅰ: Focal Asymmetry on Mammography:Imaging features and clinicalsignificancePURPOSE: Observation of the Imaging features and genotyping of asymmeties onmammography, and investigate its clinical significance and the limitations and pitfalls ofmammography.METHOD AND MATERIALS: We searched mammographic imagings and clinicaldatas of all6,158women with or without symptoms who underwent bilateralmammography examination at Shanghai East Hospital, TongJi University School ofMedicine from Janurary,2008to February,2012. Two Experienced radiologists read theimages together and classfied parenchymal pattern, according to BI-RADS ofACR.Asymmetry has been observed in1088women (17.67%), including978(15.88%)cases of focal asymmetry and82(1.33%) cases of global asymmetry. All patients weredivided into various groups, according to the patient's age, parenchymal pattern of ACR.We evaluated the distribution of focal asymmetry in different ages and parenchymalpatterns. As for all114patients with histological diagnosis, we choose some morphologicfeatures. Then, all patients were divided into various groups, according to the patient's age,parenchymal pattern of ACR, and with (or without) morphologic features.And analyzemorphologic features and synthetically evaluate the clinical application of mammographyon differential diagnosis of focal asymmetry.Then, we evaluated the relationship betweenthe demonstration of the focal asymmetry and all the relative factors.RESULTS: The demonstration ratio of the faocal asymmetry on mammmography hasobvious correlation with age and parenchymal pattern. The results analysis fordifferentiation of benign and malignant focal asymmetry showed that the morphologicfeature of calcification had high specificity for identification of malignant tumors. Themorphologic features of density, hook sign, the degree of edge and the miky way have nostriking significance. CONCLUSION: Breast parenchymal pattern changes with age. Focal asymmetry isfrequently seen in women of perimenopausal period. And, focal asymmetry withcalcification on mammography may be a clue of malignant.PART Ⅱ: Focal Asymmetry on Mammography:Comparison of ContrastEnhanced MR Imaging, Ultrasonographic Findings and PathologicPURPOSE: To retrospectively compare the diagnostic results of dynamiccontrast-enhanced MR imaging at3.0T, ultrasonographic findings and conjoined test methodsfor the differentiation of malignant from benign lesions which were mammographicallydetected as focal asymmetry(without calcifications, architectural distortion, or associatedmass), with pathology records used as the reference standard.METHOD AND MATERIALS: This retrospective study was institutional review boardapproved. Informed consent was obtained from patients. The study population was derivedfrom all women with or without symptoms who underwent mammography at ShanghaiEast Hospital, TongJi University School of Medicine from Janurary1,2008, to February28,2011. Contrast-enhanced MRI, US, and clinical history were evaluated in48womenwith focal asymmetry on mammography. Two experienced radiologists analyzed the MRI,ultrasonographic findings and provided BI-RADS assessment categories. Diagnosticconfidence was compared by using a receiver operating characteristic (ROC) analysis andKappa analysis.RESULTS: Lumpectomy was performed in37(77.1%) women with obvious symptoms ofall these48cases. The other11patients had puncture biopsy. Fifteen cases of cancerincluding nine invasive ductal carcinoma, two invasive lobular carcinoma, onedeteriorative intraductal papilloma, and three mixde type carcinomas were identified. Ofall these48cases,33cases of benign were identified, including nine adenosis, six adenosiswith ductal hyperplasia, four fat necrosis, two mastitis, two intraductal papilloma, oneadenosis with fibroadenoma, one fibroepithelial tumour, one fibroadenoma,one chronic granuloma, five adenosis with chronic mastitis, and one purulent inflammation. The areaunder the ROC curve for MRI was0.903(95%confidence interval:0.815,0.991; p=0.000).The area under the ROC curve for US was0.765(95%confidence interval:0.610,0.919;p=0.004). The area under the ROC curve for parallel test was0.818(95%confidenceinterval:0.702,0.934; p=0.000). The area under the ROC curve for series test was0.785(95%confidence interval:0.623,0.947; p=0.002). The Kappa value of MRI is0.719which is the highest one of all。CONCLUSION: DCE-MRI can be used as a problem-solving modality to the standarddiagnostic procedures of the focal asymmetry.