Evaluation of BI-RADS 3 lesions in women with a high risk of hereditary breast cancer.

Transcription

1 Evaluation of BI-RADS 3 lesions in women with a high risk of hereditary breast cancer. Poster No.: C-0346 Congress: ECR 2014 Type: Scientific Exhibit Authors: A. Thomas 1, R. Dominguez Oronoz 1, S. Roche 1, S. Gispert 2, X. Merino-Casabiel 1, V. Pineda 1, I. Miranda 1 ; 1 Barcelona/ES, 2 Badalona/ES Keywords: DOI: Cancer, Diagnostic procedure, MR, Oncology, Breast /ecr2014/C-0346 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 15

2 Aims and objectives INTRODUCTION: 85% of all breast cancers are sporadic and 15% occur within families at high genetic risk. Of these, 50% are due to mutations in BRCA1 and BRCA2 genes with incomplete penetrance. Also, there is a cumulative risk for developing breast cancer at the age of 70 of 65-87% for BRCA1 and 45-84% for BRCA2. Fig. 1 on page 3 Furthermore these tumors have special features: they appear in younger women and are much more aggressive, having a more rapid growth. They also have special features on MRI images, where they look highly hyperintense in T2 weighted images and show a type 1-2 kinetic curve. Besides, tumors related to mutations in BRCA1 genes, have a higher histological grade, are triple negative and need a bigger size on mammography to be detected. In fact, mammography only detects less than 50% of these tumors. There have been several studies and MRI has already been demonstrated to be necessary in these patients as an additional exam due to its higher sensitivity and positive predictive value. In our institution they created a special Unit for breast pathology in 2006 (UPM). OBJECTIVES: Our objetives were to: Evaluate the incidence of BI-RADS 3 lesions in women with a high risk of hereditary breast cancer in our institution. Describe the imaging findings in MRI for BI-RADS 3 and 4. Analyze the evolution of these lesions into BI-RADS 2 and 4. Page 2 of 15

3 Images for this section: Fig. 1: Breast Cancer Epidemiology Page 3 of 15

4 Methods and materials We carried out a retrospective and prospective revision of breast MRI in 85 women with a high risk of hereditary breast cancer (BRCA1, BRCA2) in our institution from June 2006 to June Of these 85 patients, 30 had already a personal history of breast cancer (35.29%). We first revised of our imaging protocol in the follow-up of these patients, which includes annual mammography and MRI. Fig. 2 on page 4 Our MRI protocol includes T1 weighted images in the 3 planes of space, sagittal T2 fat saturated weighted images, diffusion weighted images, sagittal dynamic contrast sequences, axial post-gadolinium and substraction images. A preovulatory phase in the patients is required. We describe the morphological findings, size and behavior of BI-RADS 3 and 4 lesions. DWI sequences were also analyzed. BI-RADS 3 lesions are probably benign lesions (<2% malignant). Our lesions where small, round and well defined, with a hyperintense signal in T2 weighted images and showed a benign kinetic curve type 1-2. BI-RADS 4 lesions are suspicious or doubtful (2-94% malignant). Our lesions showed irregular margins and where badly defined, with more suspicious kinetic curves type 2-3. We revised all lesions initially classified as BI-RADS 3 on MRI and studied their transformation and the time they took to evolve into malignant (B4) or benign lesions (B2). Images for this section: Page 4 of 15

5 Fig. 2: Our healtchare algorythm. Page 5 of 15

6 Results BI-RADS 3: Fig. 3 on page 6 20 of our 85 patients (23.53%) were classified as BI-RADS 3 in MRI, of which 15% turned out to be malignant and 65% were benign. All of the malignant lesions where invasive ductal carcinomas (IDC) (100%). Fig. 4 on page 7 Fig. 5 on page 8 Of the benign lesions, 30% where normal gland tissue, and could have been diagnosed from the outset as BI-RADS 2 if the study had been carried out in the preovulatory phase. 2 lesions where biopsied due to the anxiety of the patients, and resulted in normal tissue and fibroadenoma (FAD). Fig. 6 on page 9 4 lesions are still in follow-up. BI-RADS 4: Fig. 7 on page patients were initially classified as BI-RADS 4, of which 45% were actually malignant lesions and 54% benign. Of the malignant lesions we found 4 invasive ductal carcinomas (IDC) Fig. 8 on page 11 and 1 ductal carcinoma in situ (DCIS). Fig. 9 on page 12 Of the benign lesions, 4 where normal tissue (one of them disappeared in the pre-biopsy study), 1 lesion was a fibroadenoma and the other one sclerosing adenosis. Fig. 10 on page 13 Images for this section: Page 6 of 15

7 Fig. 3: BI-RADS 3. Page 7 of 15

8 Fig. 4: Hyperintense small lesion BI-RADS 3. 4 months later, the lesion is much bigger and shows an important contrast uptake. The biopsy was positive to IDC. Page 8 of 15

9 Fig. 5: Small hyperintense lesion in right breast, with very little growth in one year and a benign morphological curve. Due to its growth the lesion was reported as BI-RADS 3. 6 months later the lesion has doubled its size and the curve has changed to type 2. The biopsy was positive to IDC. Page 9 of 15

10 Fig. 6: Patient with right mastectomy. Small hyperintense lesion on left breast, stable in size in 2 years. BI-RADS 3. The patient decides surgery due to the anxiety. Fibroadenoma was found. Page 10 of 15

11 Fig. 7: BI-RADS 4 Page 11 of 15

12 Fig. 8: Espiculated hyperintense lesion in inferior external quadrant of left breast. BI- RADS 4. Biopsy revealed a IDC. Page 12 of 15

13 Fig. 9: Suspicious lesion in right breast in patient with history of left breast cancer. Biospy was positive to ductal carcinoma in situ (DCIS). Page 13 of 15

14 Fig. 10: First MRI shows a well defined hyperintense lesion in right breast. One year later the lesion has grown and a new lesion in the left breast. Both were classified as BI-RADS 4. Biospy revealed sclerosing adenosis. Page 14 of 15

15 Conclusion MRI has been demonstrated to be the principal imaging technique in the screening of women with a high risk of hereditary breast cancer and an adequate protocol and close follow-up of these patients is crucial to make a correct diagnosis and avoid unnecessary anxiety in these patients. Personal information References Gilbert et al. Cancers in BRCA1 and BRCA2 Carriers and in Women at High Risk for Breast Cancer: MR Imaging and Mammographic Features. Radiolog: Volume 252: Number 2-August Sardanelli et al. Multicenter Comparative Multimodality Surveillance of Women at Genetic-Familiar High Risk for Breast Cancer (HIBCRIT Study). Radiology: Volume 242: Number 3-March Friedlander et al. Results of MR imaging Screening for Breast Cancer in High-Risk patients with lobular carcinoma in situ. Radiology: Volume 261: Number 2-November Page 15 of 15