Magnetic resonance imaging

Magnetic resonance imaging

MRI of the breast ( Figure 58.9 ) is useful in a number of settings: - /uni25CF women with dense breasts or discordant or equivocal find - ings on mammogram/ultrasonography; /uni25CF to distinguish scar from recurrence in women who have had previous breast conservation therapy for cancer; /uni25CF to assess multifocality and multicentricity and, in lobular cancer, high-grade ductal carcinoma in situ (DCIS); /uni25CF women with breast cancer ( BRCA ) gene or other genetic Otto Heinrich Warburg , 1883–1970, German physiologist, awarded a Nobel prize in 1931 for describing the metabolic dependence of tumour cells on glucose (the Warburg e ff ect). Most primary tumours and metastatic deposits exhibit high uptake of a radiopharmaceutical ( detected by positron emission tomography . mutations or a strong family history; /uni25CF women with breast implants. MRI-guided biopsy may be performed for lesions not visi - ble on ultrasonography or mammogram.

Category Assessment Probability of malignancy Follow-up recommendation 0 Assessment is incomplete Not applicable 1 Negative Essentially 0% 2 Benign /f_i nding(s) Essentially 0% 3 Probably benign /f_i nding

0% but ≤ 2% 4 Suspicious abnormality: 4a: Findings needing intervention with a 2 to ≤ 10% low suspicion for malignancy 4b: Intermediate suspicion of malignancy 10% to ≤ 50% 4c: Findings of moderate concern, with 50% to <95% high suspicion for malignancy 5 Highly suggestive of malignancy ≥ 95% 6 Known biopsy-proven malignancy Not applicable (a) (b) Figure 58.7 Features of a normal mammogram. (a) Mediolateral oblique view; (b) craniocaudal view. (a) Figure 58.8 Imaging features of breast cancer on mammography (Category BI-RADS 5). (a) Irregular, spiculated mass; (b) /f_i ne pleomorphic microcalci /f_i cations; (c) /uni00A0 architectural distortion. Need for additional imaging evaluation and/or prior mammograms for comparison Routine annual screening mammography (for women over age 40) Routine annual screening mammography (for women over age 40) Initial short-term follow-up (usually 6 months) examination Biopsy should be considered Requires biopsy or surgical treatment Category reserved for lesions identi /f_i ed on imaging study with biopsy proof of malignancy prior to de /f_i nitive therapy