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Published on: December 15, 2014
Stromal fibrosis: imaging features with diagnostic contribution of diffusion-weighted MRI
Ravza Yilmaz1, Zuhal Bayramoglu1, Merve Gulbiz Kartal1
11 Department of Radiology, Istanbul University, Istanbul Faculty of Medicine , Fatih, Istanbul , Turkey.
Objective:
To describe magnetic resonance imaging (MRI) and ultrasonography findings of breast stromal fibrosis (SF) and compare apparent diffusion coefficient (ADC) stromal fibrosis values with breast cancer and normal parenchyma.
Methods:
45 patients (ages 22‒74) with histopathologically proven SF who underwent MRI were included in this study. Their MRI and ultrasonography features were examined and categorized. The mean ADC values for SF, contralateral normal parenchyma, and breast malignancy of the control group values were calculated and compared among each other.
Results:
The vast majority of SF on sonography showed features suggestive of malignancy: (1) irregular in shape 25/45 (55%); (2) indistinct in margin 27/45 (60%); and (3) hypoechoic 39/45 (87%) with posterior acoustic shadowing 11/45 (24%). An SF MRI showed a mass in 12/45 (26%) and non-mass enhancement in 33/45 (74%), mostly with irregular (8/12; 67%) shape. Non-mass lesions showed heterogeneous (12/33), clumped (9/33), and homogenous (9/33) enhancement. The initial SF contrast uptake rate varied between slow (57%), rapid (22%), and medium (21%). Delayed SF enhancement may be persistent (66%) or plateau (34%). Small cysts were located around/near 21 (47%) of lesions. Ductal ectasia was found in 14 (31%) of all patients. Mean ADCs of parenchyma, SF, and malignancy were 1.32 ± 0.32, 1.23 ± 0.25, and 0.99 ± 0.24 × 10-3 mm2 sec-1, respectively.
Conclusion:
SF often mimics breast carcinoma on imaging and leads the radiology‒pathology disagreement. In terms of distinguishing SF from malignancy, ADC could be a significant and promising value in diffusion-weighted MRI along with conventional sequences. Slow initial uptake with delayed persistent contrast enhancement in a non-mass lesion with relatively higher ADC values are very helpful for differentiating SF from malignancy. The presence of small cysts and ductal ectasia were common findings around/near the SF. Advances in knowledge: A quantitative analysis for measuring ADC values along with additional MRI features can be very helpful in distinguishing SF from malignant lesions.
Insights
Breast stromal fibrosis (SF) often mimics breast cancer on imaging. Apparent diffusion coefficient (ADC) values from MRI can help differentiate SF from malignancy, especially when combined with other MRI features.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Breast stromal fibrosis (SF) can present imaging characteristics that mimic breast carcinoma.
- Distinguishing SF from malignancy is crucial to avoid misdiagnosis and unnecessary procedures.
Purpose of the Study:
- To describe magnetic resonance imaging (MRI) and ultrasonography findings of breast SF.
- To compare apparent diffusion coefficient (ADC) values of SF with breast cancer and normal breast parenchyma.
Main Methods:
- Retrospective analysis of MRI and ultrasonography features in 45 patients with histopathologically proven SF.
- Calculation and comparison of mean ADC values for SF, normal parenchyma, and malignancy.
Main Results:
- SF on sonography frequently showed features suggestive of malignancy (e.g., irregular shape, indistinct margins, hypoechogenicity).
- MRI revealed mass or non-mass enhancement in SF lesions, with varying initial uptake and delayed enhancement patterns.
- Mean ADC values were 1.32 ± 0.32 × 10-3 mm2 sec-1 for normal parenchyma, 1.23 ± 0.25 × 10-3 mm2 sec-1 for SF, and 0.99 ± 0.24 × 10-3 mm2 sec-1 for malignancy.
Conclusions:
- SF often mimics breast cancer, leading to potential radiologic-pathology disagreement.
- ADC values, particularly higher values in SF with slow initial uptake and delayed persistent enhancement, show promise in differentiating SF from malignancy on MRI.
- The presence of small cysts and ductal ectasia near SF lesions are common associated findings.
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