Diane Miriam Renz MD, Presenter: Nothing to Disclose

Pascal Andreas Thomas Baltzer MD, Abstract Co-Author: Nothing to Disclose

Joachim Boettcher MD, Abstract Co-Author: Nothing to Disclose

Mieczyslaw Gajda MD, Abstract Co-Author: Nothing to Disclose

Oumar Camara, Abstract Co-Author: Nothing to Disclose

Werner Alois Kaiser MD, PhD, Abstract Co-Author: Researcher, Siemens AG Researcher, Bayer AG (Berlex Inc) Researcher, General Electric Company (Amersham plc) Researcher, Suros Surgical Systems, Inc Researcher, C. R. Bard, Inc Researcher, Boston Scientific Corporation Researcher, Galil Researcher, Invivo Researcher, Confirma Researcher, CAD Sciences Researcher, Carl-Zeiss

Although inflammatory breast carcinoma (IBC) accounts for approximately 1-4% of all breast cancer cases, the appearance of this highly malignant tumor in magnetic resonance imaging (MRI) is still not well characterized. The aim of this study was to identify typical imaging features useful for diagnosis.

Dynamic MR examinations (1.5T; 0,1 mmol Gd-DTPA/kg bw) of 42 patients with IBC were evaluated by two radiologists independently. To assess characteristic imaging findings, a multitude of dynamic and morphological criteria were evaluated. All cases were associated with histopathological results, such as tumor grading.

Of all 42 cases, 35.7% were classified as G2 (moderately differentiated), and 64.3% as G3 (poorly differentiated). MRI revealed the following imaging findings: edema (cutaneous 81.0%, perifocal 69.0%, diffuse 88.1%, prepectoral 71.4%, intramuscular pectoral 35.7%), prominent vessels (88.1%), skin enlargement (83.3%), thickening (73.8%) and pathological enhancement (59.5%) of Cooper ligaments, pathological nipple configuration (64.3%), pathological enhancement of the pectoralis muscle (31.0%), initial signal increase >100% (85.7%), postinitial wash-out phenomenon (64.3%). Positive Punched-out-sign (initially strong, focal enhancement of some dermal parts followed by a slow-continuous enhancement of the surrounding skin) was detected in 57.1% of all cases. Significant differences could be revealed for (p<0.05): tumor grading versus prominent vessels, Punched-out-sign, prepectoral and intramuscular pectoral edema. G3 tumors presented these evaluation parameters more often than G2 malignomas.

Inflammatory breast carcinoma seems to show a characteristic appearance in MR imaging. Some of the evaluated criteria occur more often in poorly differentiated tumors. Some parameters, e.g. Punched-out-sign, thickening and pathological enhancement of Cooper ligaments, may be pathognomonic for inflammatory carcinomas because of their extensive lymphovascular infiltration.

An implementation of different dynamic and morphological features seems to be helpful to increase the diagnostic value of MRI in the early and precise detection of inflammatory breast carcinomas.

Renz, D, Baltzer, P, Boettcher, J, Gajda, M, Camara, O, Kaiser, W, Inflammatory Breast Carcinoma in Magnetic Resonance Imaging: Characteristic Findings for Dynamic and Morphological Criteria.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5013123.html