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Published on: December 15, 2014
Malignant spiculated breast masses: dynamic contrast enhanced MR (DCE-MR) imaging enhancement characteristics and
Gokhan Gokalp1, Ugur Topal, Nalan Yildirim
1Department of Radiology, Uludag University Medical Faculty, Gorukle, Bursa 16059, Turkey. drgokhangokalp@yahoo.com
Aim:
Spiculation of breast masses is usually the result of significant desmoplastic reaction. Diminished neovascularization is expected due to sparsely dispersed tumor cells within the lesion. This feature can cause differences in enhancement patterns which can cause pitfalls while evaluating MR images as well. Aim of this study is to explore the enhancement characteristics of malignant spiculated masses and to correlate these findings with histopathological features.
Materials And Methods:
Eighteen spiculated and seventeen non-spiculated masses depicted with mammography were included in the study. MR imaging was performed with 1.5 T magnet with breast coil. In MR imaging, T2-weighted turbo spin echo (TSE) with fat suppression sequence followed by pre- and post-contrast T1-weighted 3D-fast low angle shot (FLASH) sequences were used. Lesions were evaluated according to enhancement characteristics: early phase enhancement (first 2 min; less than 50%, 50-100% and more than 100%), late phase enhancement (2-6 min; persistent, plateau and washout) and inner enhancement pattern (homogenous, heterogenous and rim). Desmoplasia and lymphocyte infiltration was classified as mild, moderate and severe. MR images and histopathological findings (desmoplasia, lymphocyte infiltration and grade) of both groups were compared.
Results:
Mean ages of patients in spiculated and non-spiculated-mass groups were 55.07 (41-71) and 47.35 (31-62), respectively. Mean diameter of lesions was 17.3mm (10-31 mm) for spiculated masses while non spiculated masses were 15.8mm (6-40 mm). There were statistically significant differences between late phase enhancement, persistent enhancement, plateau and washout (p<0.05). Intergroup comparison of desmoplasia revealed significant difference between severe versus and mild, moderate (p<0.05).
Conclusion:
Spiculated malignant lesions are supposed to contain intense desmoplastic reaction. On DCE-MR images they can show persistent enhancement pattern more often than non-spiculated lesions.
Insights
Spiculated malignant breast masses often show persistent enhancement on dynamic contrast-enhanced MRI (DCE-MRI) due to intense desmoplastic reactions. This finding helps differentiate them from non-spiculated lesions.
Area of Science:
- Radiology
- Oncology
- Pathology
Background:
- Spiculated breast masses typically exhibit significant desmoplastic reactions.
- Tumor cell dispersion in spiculated lesions can alter neovascularization and MRI enhancement patterns.
- Variations in enhancement can lead to misinterpretations during MRI evaluation.
Purpose of the Study:
- To investigate the enhancement characteristics of malignant spiculated breast masses using MRI.
- To correlate these MRI findings with histopathological features, specifically desmoplasia and lymphocyte infiltration.
Main Methods:
- Compared MRI enhancement patterns (early, late, inner) of 18 spiculated and 17 non-spiculated masses.
- Utilized T2-weighted and contrast-enhanced T1-weighted 3D-FLASH sequences on a 1.5 T magnet.
- Assessed histopathological features including desmoplasia, lymphocyte infiltration, and tumor grade.
Main Results:
- Spiculated masses showed statistically significant differences in late-phase enhancement, including persistent enhancement, plateau, and washout compared to non-spiculated masses (p<0.05).
- A significant difference in the degree of desmoplasia was observed between severe and mild/moderate cases in the spiculated group (p<0.05).
Conclusions:
- Malignant spiculated lesions are frequently associated with intense desmoplastic reactions.
- Dynamic contrast-enhanced MRI (DCE-MRI) can reveal a higher prevalence of persistent enhancement patterns in spiculated lesions compared to non-spiculated ones.
