Jennifer Drukteinis MD, Presenter: Nothing to Disclose

Sughra Raza MD, Abstract Co-Author: Research grant, Hitachi, Ltd

Eugene Mun Wai Ong MBBS, FRCR, Abstract Co-Author: Nothing to Disclose

Meera Sekar MD, Abstract Co-Author: Nothing to Disclose

Robyn L. Birdwell MD, Abstract Co-Author: Nothing to Disclose

To evaluate location and pathologic outcome of NMLE found on breast MRI examinations in patients with a newly diagnosed ipsilateral or contralateral breast cancer.

IRB approved review of 565 MR-guided breast biopsies from 2/2004 to 2/2009, identified 65 cases of biopsied NMLE in patients with a recent diagnosis of breast cancer. Retrospective evaluation of the NMLE performed by two breast radiologists blinded to final pathology included NMLE descriptors based on ACR BI-RADS lexicon. Patient demographics and final pathology including estrogen, progesterone (ER/PR) and Her-2/neu status were also recorded.

Of 65 study patients, 35 NMLE lesions were ipsilateral to the known cancer and 30 were contralateral. Overall 16/35 (46%) ipsilateral NMLEs were malignant. Of the 35 ipsilateral lesions, 19 were in the same quadrant, of which 12 (63%) were malignant (11 invasive, 1 DCIS) and 7 benign. Of 12 malignant lesions 6 were at 5.0 cm mean distance from the primary and 6 were contiguous to the known cancer representing disease extension. All invasive cancers had the same receptor status as the original cancer; the 1 DCIS had different receptors. The remaining 16/35 ipsilateral NMLEs were in a different quadrant from the known cancer; 4 (25%) were malignant and 12 (75%) benign (p= 0.04). There were 30 NMLEs in the breast contralateral to known cancer; 7/30 (23%) were malignant and 23 (77%) benign. Of 7 malignant lesions, 2 were in the mirror opposite quadrant and 5 in a different quadrant (p=0.4). Of these 7 malignant NMLEs, 5/7 were invasive (1 same type and receptor status as known cancer) and two were DCIS.

In the setting of a newly diagnosed cancer, NMLE on breast MR has a significantly higher chance of malignancy when in the ipsilateral breast (p=0.037) and in the same quadrant (p=0.04). When contralateral to the cancer, NMLE is more likely to be benign (p=0.04), and shows no statistically significant difference in benign vs malignant outcome when located in mirror opposite versus different quadrant (p=0.4).

This study reports pathologic outcome of additional sites of NMLE in patients with newly diagnosed breast cancer, based on proximity to the known cancer, and has implications for management.

Drukteinis, J, Raza, S, Ong, E, Sekar, M, Birdwell, R, Nonmasslike Enhancement (NMLE) in Patients with Recently Diagnosed Breast Cancer: Pathologic Correlation.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8007475.html