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      Non-enhancing malignant lesions of the breast: A case report and review of literature

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          Abstract

          Due to the elusive nature of invasive lobular carcinoma, mammography, ultrasound, and magnetic resonance imaging have their limitations in early detection.

          A 67-year-old woman presented for mammography and found retraction of breast parenchyma of the right breast. Magnetic resonance imaging and contrast mammography showed no contrast uptake in the region in question.

          Magnetic resonance imaging and ultrasound were found to be superior for the detection of invasive lobular carcinoma, with a sensitivity of more than 90%. On ultrasound examination, invasive lobular carcinoma may occur only with posterior acoustic shadowing. On breast magnetic resonance imaging, it is commonly described as an irregular mass and less commonly as non-mass enhancement. An additional advantage of magnetic resonance imaging is the higher detection rate of multifocal, multicentric, and contralateral breast lesions.

          The reason for no contrast enhancement in this particular tumor before neoadjuvant chemotherapy followed by enhancement after neoadjuvant chemotherapy is most likely at the molecular and histologic level and requires further investigation in similar cases.

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          Breast MRI: State of the Art

          Ritse M. Mann, Nariya Cho, Linda Moy (2019)
          MRI of the breast has the highest sensitivity for breast cancer detection among current clinical imaging modalities and is indispensable for breast imaging practice. While the basis of breast MRI consists of T1-weighted contrast-enhanced imaging, T2-weighted, ultrafast, and diffusion-weighted imaging may be used to improve lesion characterization. Such multiparametric assessment of breast lesions allows for excellent discrimination between benign and malignant breast lesions. Indications for breast MRI are expanding. In preoperative staging, multiple studies confirm the superiority of MRI to other imaging modalities for tumor size estimation and detection of additional tumor foci in the ipsilateral and contralateral breast. Ongoing studies show that in experienced hands this can be used to improve breast cancer surgery, although there is no evidence of improved long-term outcomes. Screening indications are likewise growing as evidence is accumulating that OncologicRI depicts cancers at an earlier stage than mammography in all women. To manage the associated costs for screening, the use of abbreviated protocols may be beneficial. In patients treated with neoadjuvant chemotherapy, MRI is used to document response. It is essential to realize that oncologic and surgical response are different, and evaluation should be adapted to the underlying question.
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            MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study.

            S. Schrading, Walther Kuhn, Heribert B Bieling … (2007)
            Diagnosing breast cancer in its intraductal stage might be helpful to prevent the development of invasive cancer. Our aim was to investigate the sensitivity with which ductal carcinoma in situ (DCIS) is diagnosed by mammography and by breast MRI. During a 5-year period, 7319 women who were referred to an academic national breast centre received MRI in addition to mammography for diagnostic assessment and screening. Mammograms and breast MRI studies were assessed independently by different radiologists. We investigated the sensitivity of each method of detection and compared the biological profiles of mammography-diagnosed DCIS versus DCIS detected by MRI alone. We also compared the risk profiles of women with mammography-detected DCIS with those of MRI-detected DCIS. 193 women received a final surgical pathology diagnosis of pure DCIS. Of those, 167 had undergone both imaging tests preoperatively. 93 (56%) of these cases were diagnosed by mammography and 153 (92%) by MRI (p<0.0001). Of the 89 high-grade DCIS, 43 (48%) were missed by mammography, but diagnosed by MRI alone; all 43 cases missed by mammography were detected by MRI. By contrast, MRI detected 87 (98%) of these lesions; the two cases missed by MRI were detected by mammography. Age, menopausal status, personal or family history of breast cancer or of benign breast disease, and breast density of women with MRI-only diagnosed DCIS did not differ significantly from those of women with mammography-diagnosed DCIS. MRI could help improve the ability to diagnose DCIS, especially DCIS with high nuclear grade.
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              Invasive lobular carcinoma of the breast: morphology, biomarkers and ’omics

              Amy Reed, Jamie Kutasovic, Sunil Lakhani … (2015)
              Invasive lobular carcinoma of the breast is the most common ‘special’ morphological subtype of breast cancer, comprising up to 15% of all cases. Tumours are generally of a good prognostic phenotype, being low histological grade and low mitotic index, hormone receptor positive and HER2, p53 and basal marker negative, and with a generally good response to endocrine therapy. Despite this, clinicians face countless challenges in the diagnosis and long-term management of patients, as they encounter a tumour that can be difficult to detect through screening, elicits a very invasive nature, a propensity for widespread metastatic colonisation and, consequently, in some studies a worse long-term poor outcome compared with invasive carcinoma of no special type. Here we review the morphological and molecular features that underpin the disparate biological and clinical characteristics of this fascinating tumour type.
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                Author and article information

                Contributors
                Petra Valkovic Zujic
                Journal
                Journal ID (nlm-ta): Heliyon
                Journal ID (iso-abbrev): Heliyon
                Title: Heliyon
                Publisher: Elsevier
                ISSN (Electronic): 2405-8440
                Publication date PMC-release: 17 March 2023
                Publication date Collection: March 2023
                Publication date (Electronic): 17 March 2023
                Volume: 9
                Issue: 3
                Electronic Location Identifier: e14498
                Affiliations
                [a ]Department of Radiology, Clinical Hospital Center Rijeka, Croatia
                [b ]Department of Radiology, County General Hospital Nasice, Croatia
                [c ]Department of Radiology, General Hospital Pula, Croatia
                [d ]Department of Pathology, Clinical Hospital Center Rijeka, Croatia
                [e ]Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
                Author notes
                [∗ ]Corresponding author. Clinical Hospital Center Rijeka and Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia. petra.valkovic.zujic@ 123456medri.uniri.hr
                Article
                Publisher Item ID: S2405-8440(23)01705-X Publisher ID: e14498
                DOI: 10.1016/j.heliyon.2023.e14498
                PMC ID: 10033750
                SO-VID: eb59a72d-176c-40c9-8673-92d2d55d95d9
                Copyright © © 2023 The Author(s)
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 29 October 2022
                Date revision received : 5 March 2023
                Date accepted : 8 March 2023
                Categories
                Subject: Case Report

                Keywords: breast neoplasms,carcinoma,lobular,mammography,magnetic resonance imaging
                Data availability:
                Keywords: breast neoplasms, carcinoma, lobular, mammography, magnetic resonance imaging

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