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The first withdrawal
obtained shows the earlier uptakes, whereas the second withdrawal includes
later uptakes.
In a subsequent stage,
by employing a dedicated software and subject to the positioning of
a ROI (region of interest), the functional valuation was carried out.
This makes it possible to establish the timing and extent of the contrast
uptake within the morphologically suspect focus.
Results
Morphological parameters
The most common mammographic results obtained were the following:
- Spiculated opacity
in 18 (67%) cases
- Barely defined opacity
in 6 (22%) cases. - Structural distortion in 2 (10%) cases.
- Parenchyma asymmetry
in 1(0.4%) case.
On the other hand, the
most common RM results obtained were the following:
- Nodular enhancement
with well-defined contours in 14 (52%) cases
- Focal enhancement
with fringed contours in 13 (48%) cases
Extent
of pathology
The extent of the pathology
diagnosed by means of MR proved to be consistent with the results of
pathologic anatomy (Table 1), both in the prediction that more than
one quadrant would be involved and in the multicentricity diagnosis
(100% sensitivity).
The data shown in Table
1 also proves that the mammography is not as accurate in connection
with such parameters. The main problem areas for the mammography were
represented by small tumour foci, by the presence of a scar in the case
of suspect recurrence, and by fibroid cancer involution after chemotherapeutic
treatment. In 4 patients with a neoplastic residue at the end of the
chemotherapy and in 2 women with clinical suspected recurrence, the
mammography proved negative.
Even though, on one
side, the multicentricity cases were always obvious from the MR test,
we overestimated the condition of two patients suffering from fibroadenoma.
Dynamic
evaluation
Conventional Malign
Curve
Out of the 27 patients
under examination, the dynamic valuation recorded a suspect conventional
curve in 9 (33%) cases (Table II). The signal intensity rose immediately
and reached high levels within a brief interval after the gadolinium
injection.
From a histological
point of view, 3 were Lobular Carcinomas in situ, and 6 were infiltrating.
In 2 of the latter cases the Lobular Carcinoma coexisted with a ductal
carcinoma, in situ or infiltrating.
Delayed
Malign Curve
In 13 (48%) cases the
conventional malign curve only appeared after an evident delay (Table
II).
From a histological
point of view, 3 were Lobular Carcinomas in situ, 8 were infiltrating
and in 2 cases the in situ carcinoma coexisted with an infiltrating
carcinoma.
None of these 13 cases
of carcinom coexisted with a ductal
variant.
Conventional and Delayed
Malign Curve
In 5 (19%) cases, the
Conventional and Delayed malign curves were both present at the same
time (Table II). In all of these patients the Lobular Carcinoma was
associated with Ductal Carcinoma. Both for the valuation of the extent
of the pathology and for the multicentricity diagnosis, the MR test
proved consistent with the histopathologic results (100% sensitivity).
The contemporary presence
of fibroadenoma in two patients, on the other hand, reduced the specificity
of the survey to 70%. In both cases, the fibroadenoma had shown a quick
and intense uptake and therefore a similarity with respect to the conventional
neoplastic dynamic curve.
These were located in
the same quadrant containing the neoplastic tissue and therefore the
MR results did not influence the surgical approach for these patients.
In none of the patients
suffering from Lobular Carcinoma did the MR test prove negative, which
further confirms the highly Negative Predicting Power of this methodology.
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