Hanan Ibrahim Khalil MD, Presenter: Nothing to Disclose

Stacey Patterson MD, Abstract Co-Author: Nothing to Disclose

David Martin Panicek MD, Abstract Co-Author: Nothing to Disclose

To evaluate the prevalence and clinical significance of small hepatic lesions demonstrated at initial CT in women with breast cancer.

For each woman diagnosed with breast cancer between 1998-2002 and who then underwent contrast-enhanced CT including the liver at our institution, the report of the first such CT was reviewed for mention of a liver metastasis, a liver lesion indeterminate for metastasis, or a liver lesion considered too small to characterize (TSTC). For each woman with at least one hepatic TSTC but no definite liver metastasis reported at CT, the initial and all available follow-up imaging examinations were reviewed to assess for change in size of each hepatic TSTC; medical records were reviewed for each case in which a hepatic TSTC enlarged.

Of 7692 women diagnosed with breast cancer, 897 (11.7%) underwent contrast-enhanced CT including the liver. The presence of at least one hepatic TSTC was reported in 244 (27.2%) of those 897 women; 167 (68.4%) of the 244 women underwent at least one subsequent imaging examination that included the liver (median interval to longest follow-up examination, 35 weeks [range, 0.2 – 296 weeks]). Hepatic TSTCs were unchanged in size in 142 women (85.0%) and no longer visible in 20 (12.0%); these TSTCs therefore were presumed to be benign clinically. Hepatic TSTCs enlarged in four women (2.4%) and were indeterminate for change in one (0.6%): The enlarging hepatic TSTCs were subsequently proven to represent metastatic breast cancer (n=1 woman), metastasis from a known pancreatic cancer (n=1), and hepatic cysts (n=1); in the remaining woman, the enlarging hepatic TSTC remained of indeterminate etiology.

Hepatic TSTCs are a common finding at CT in women with breast cancer. In women with breast cancer and at least one hepatic TSTC but no definite liver metastasis reported at CT, hepatic TSTCs represent a benign finding in about 97% of such patients. Interval follow-up imaging, rather than immediate further workup, should be considered when a hepatic TSTC is discovered at initial CT in such a patient.

Khalil, H, Patterson, S, Panicek, D, Hepatic Lesions Deemed Too Small to Characterize: Prevalence and Significance at CT in Women with Breast Cancer.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4412108.html