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Foreword
The infiltrating Lobular
breast Carcinoma is known to often cause diagnostic problems both from
a clinic and from a radiologic point of view (1-3).
These difficulties
are caused by a distinctive histology and by a specific growth modality.
In fact, the development
of the tumour according to an infiltrative modality associated with
a poor connective tissue reaction may result in a neoplasia which remains
iconographically unrecognised until it has reached the most advanced
stages of development.
Thanks to its high
space and contrast resolution powers and by appropriately exploiting
the Gadolinium uptake timing (paramagnetic contrast medium), the MR
methodology is capable of distinguishing more easily the undamaged parenchyma
from the neoplastic tissue, even in the event that the latter is only
present in the shape of small foci (4-6). These qualities are particularly
useful in the case of mammographically "dense" glandular structures,
thus confirming the diagnostic sensitivity and accurateness of this
methodology, also in the staging of this neoplastic histotype (7-8),
sometimes so difficult to identify by means of traditional imaging.
Material
and methods
We have retrospectively
reviewed 27 MR breast tests carried out on patients suffering from Lobular
Carcinoma which had already been histologically ascertained. The age
of the patients ranged from 32 to 81 years.
We deliberately considered
both the infiltrating and the in situ histotype, even though the latter
cannot be considered as an actual malign element, because, while on
the one hand the objective of our research was to establish the reliability
of MR staging, on the other hand we wanted to investigate the correspondence
between histology and dynamic valuation of the methodology.
We therefore reviewed
19 (70%) cases of pure Lobular Carcinoma and 8 (30%) cases in which
the Lobular Carcinoma was associated with an in situ or infiltrating
component of Ductal Carcinoma.
18 (67%) of the cases
of Lobular Carcinoma were infiltrating and 7 (26%) were in situ, whereas
2 (7%) cases were combined. All the patients had preventively undergone
mammography.
10 (37%) of these patients
had been addressed to our Department as part of a research group being
subject to MR valuation combined with mammography to establish the reaction
of locally advanced tumours to neoadjuvant presurgical chemotherapy.
7 (26%) had been subject to MR owing to suspected neoplastic recurrence
after conservative surgery and radiant therapy. The remaining 10 (37%)
patients had undergone MR as a result of a dubious clinic or mammographic
outcome during screening.
The MR test was carried
out by means of Siemens, Vision, 1.5T equipment. Subject to positioning
of a needle-cannula in the cubital fossa for subsequent injection of
the contrast medium (gadolinium) and resting of the breast on a bilateral
dedicated coil, the patients were subject to the test pronely.
We employed a sequence
with a high space resolution power (thickness of individual slices:
2.5 mm), which would enable a quick analysis of the parenchyma (67 sec.),
so as to be able to identify the most precocious - possibly suspect
- uptakes compared to normal parenchyma.
The following sequence
was employed: T1WfastGE: TR=8.1msec, TE=4msec, FlipAngle=20°, mean Field
of Vi-ew=330x330mm, Matrix=192x256, Pixel Size=1.67x1.25mm, and Signal/Sound
Ratio=0.75.
With this sequence,
the whole mammary parenchyma is covered (40 slices having a 2.5 mm thickness,
with no interval between one slice and the next). The artifacts associated
with the cardiac impulse were removed by regulating the phase and frequency
gradients.
The same sequence was
recorded before and five times after the gadolinium injection in the
standard dose of 0.1 mmol/kg of body weight, allowing no interval between
one recording and the next.
After the patient had
left, morphologic and functional tests were carried out on the parenchyma.
From the console of
the equipment, image removal was first of all carried out. From the
first to the last set of images recorded after gadolinium, the same
set of images obtained before the injection was withdrawn. The new images
"erase" anything which does not perceive contrast and therefore supply
a morphologic representation
of the enhancement areas.
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CURRICULUM
