Isabella Fedele MD, Presenter: Nothing to Disclose

Pietro Panizza, Abstract Co-Author: Nothing to Disclose

Elena Belloni MD, Abstract Co-Author: Nothing to Disclose

Francesco Aldo De Cobelli MD, Abstract Co-Author: Nothing to Disclose

Mariagrazia Rodighiero, Abstract Co-Author: Nothing to Disclose

Alessandro Del Maschio MD, Abstract Co-Author: Nothing to Disclose

Occult breast carcinoma represents a clinical and radiological challenge. Our aim was to evaluate the ability of MR to detect primary breast cancer, occult at traditional investigative methods, in patients with metastasis of suspected breast origin, in order to facilitate breast conservation therapy.

Between April 1996 and April 2007 we evaluated with MR 38 patients with diagnosis of metastases (36/38 lymphnodes, 1/38 bone, 1/38 bone, liver and lung) suspected for breast primary, without detectable tumor in the breast by either clinical examination or mammography or sonography. Using a dedicated bilateral breast coil, MR was performed at 1.5T (Philips Intera) with dynamic gadolinium-enhanced 3D T1FFE sequences.

MR identified focal areas of enhancement with malignant aspect in 22/38 patients: 21 underwent surgical intervention; one died before surgery. At surgical and histological analysis, presence of breast cancer was confirmed in 18 of these 21 cases. No malignant lesions were found at histology in the remaining 3 cases and were considered as false positive MR findings. In 16/38 patients, no suspected lesions have been identified at MR. All the 16 patients have been treated with axillary dissection and radio/hormone/ chemotherapy; only 1 underwent quadrantectomy and no lesions were found at histological examination. Two patients died 6 and 12 months later; the remaining 14 have been followed-up for a period ranging from 28 to 125 months (mean 75 months). In one patient a DCis was found at 56 months. In the remaining 13 patients with negative MR, no malignant breast lesions became evident during the follow-up period.

In our experience, in case of metastatic breast cancer not identified with traditional imaging, when MR was negative at the time of primary diagnosis, the primary cancer didn’t appear at follow-up. So, in our opinion, in case of negative MR blind surgical intervention is not justified.

In patients with metastatic occult primary breast cancer, negative breast MR should address to conservative therapy.

Fedele, I, Panizza, P, Belloni, E, De Cobelli, F, Rodighiero, M, Del Maschio, A, Impact of Negative Breast MR in Patients with Metastatic Unidentified Primary Breast Cancer.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5013817.html