Axillary fibrosis or recurrent tumour. An MRI study in breast cancer

Magnetic resonance imaging was performed in 35 patients with breast carcinoma in an attempt to elucidate the cause for arm oedema or neurological symptoms. In each patient the clinician was asked to predict at the outset whether tumour recurrence or radiation fibrosis was more likely on clinical grounds. MRI demonstrated features compatible with fibrosis in 21 and tumour recurrence in 10; the MRI findings were equivocal in four patients. The range of these appearances is described and demonstrated. The MRI findings were at gross variance with the clinical opinion in 10 patients, upgrading eight patients to tumour recurrence and downgrading two to radiation fibrosis. Although histological confirmation is only available in three patients, corroborative evidence (that is repeat MRI, clinical follow up) is presented which suggests that the MRI interpretation was correct in the remaining patients. MRI can provide a working diagnosis in these patients; this allows a more rational approach to treatment than a diagnosis based on clinical examination alone.