Radiology

At the Division of Breast Imaging, we not only provide a full range of services for the sophisticated assessment of breast disease, but we also engage in research designed to meet diverse objectives. These objectives encompass the modalities available in the Lee Bell Center for Breast Imaging to image the anatomy of the breast (Mammography, Ultrasound, and Magnetic Resonance Imaging (MRI) and extend to cutting-edge use of our 3T MR scanner to gain information on the chemical composition of breast lesions by MR spectroscopy.

Right: MR Spectroscopy
Below: Four Movies Showing Contrast Uptake

MR Angiomap

Stereotactic Core Biopsy Histopathology: Infiltrating carcinoma, duct cell type and intraductal carcinoma, cribriform type Grade II

DCE MR shows spatial patterns associated with wash-out at multiple foci of invasive cancer. 

* Plateau and persistent pattern at DCIS

Our studies encompass retrospective reviews of data and we conduct research which involves prospective data gathering including “Evaluation of Contrast-Enhanced Breast MR in Women with High Likelihood of Breast Cancer including Ductal Carcinoma In Situ (DCIS) or Invasive Carcinoma”. This study aims to (1) find out whether contrast-enhanced dynamic breast MR along with a computer-aided visualization program will be able to characterize DCIS when compared to the biopsy results from patients with confirmed DCIS, and (2) to establish whether the correlation of the sensitivity and specificity of breast MR is greater on a 3T vs. a 1.5T MR system.

Another study, “Psychological Impact and Decision-Making of Elderly Women after an Abnormal Mammogram” addresses a key issue on counseling the elderly who compose an increasing portion of the patient population. “Imaging and Spectroscopy of Breast Disease at 3T” is another very promising research study being conducted in conjunction with the spectroscopy team. MR spectroscopy may, in the future, characterize breast lesions without the need for contrast agent injection, may possibly improve specificity, and may decrease the number of unnecessary biopsies for benign lesions.

 
Case 1: A 54-year-old woman with a right breast invasive lobular cancer (Estrogen Receptor/Progesterone Receptor +, Her-2 neu -). Ultrasound demonstrates a dominant spiculated and irregular hypoechoic mass with dense posterior shadowing (known cancer). There were adjacent similar appearing hypoechoic irregular spiculated masses present also.

The several retrospective reviews we are conducting in the Division of Breast Imaging include a focus on identifying patients who are at high risk for breast cancer out of a population who have a BRCA1 or BRCA2 altered gene. Other of our reviews involve radiologic-pathologic correlation, which is an essential component of our clinical breast imaging service. We utilize our research databases to track pathological results and analyze outcomes. We have a number of specific objectives regarding the concordance of breast imaging and pathology including:

(1) To determine normal appearance of lumpectomy site vs. recurrence in patients following breast conservation therapy (lumpectomy and irradiation),

(2) To determine the outcome of MR-detected, probably benign lesions and assess the applicability of the mammographic BI-RADS (the American College of Radiology’s Breast Imaging Reporting and Database System) 3 (short interval imaging follow-up) paradigm to these lesions,

(3) To describe and illustrate the variety of common morphologic features, enhancement patterns, and kinetics of pure ductal carcinoma in situ (DCIS) in dynamic contrast-enhanced magnetic resonance imaging (MR) of the breast, using the ACR BI-RADS lexicon,

Case 1: MIP (Maximum Intensity Projection) image of MR shows the known cancer: irregularly marginated mass in the upper outer to central breast. Satellite subcentimeter nodules are present anteromedially and posteriorly.
 

(4) To evaluate the use, final outcome and positive biopsy rates of ACR Breast Ultrasound BI-RADS categories 3,4, and 5 recommended for breast masses,

(5) To retrospectively apply BI-RADS feature analysis to apply to breast MR cases, and

(6) To study the follow up and outcome of enhancement patterns at lumpectomy.

High power view histopathology (H & E) shows high-grade intraductal carcinoma (DCIS)