- Email: [email protected]
Re: Imaging male breast cancer
512
Correspondence / Clinical Radiology 67 (2012) 511e513
Acknowledgements The authors would like to acknowledge the members of the Junior Radiologist's Forum representatives.
References 1. Chest pain of recent onset: assessment and investigation of recent onset chest pain or discomfort of suspected cardiac origin. NICE guidelines March 2010. 2. Unstable angina and NSTEMI: the early management of unstable angina and non-ST-segment-elevation myocardial infarction. NICE guidelines March 2010. 3. Nicholson T, Bury RW. NICE clinical guidelines 95: chest pain of recent onset (assessment and diagnosis of recent onset of pain or discomfort of suspected cardiac origin): implications for radiology, https://www.rcr.ac. uk/docs/general/pdf/NICE_Guidelines_implications_FINAL_150710.pdf; July 2010 [accessed: 10.09.10].
P. McParlanda,b,*, A. Sharmana, S.P. Hardenb, R. Buryc a Junior Radiologist’s Executive Committee, UK b
British Society of Cardiovascular Imaging Education Subcommittee, UK
c Cardiovascular Imaging Society, UK and correspondent: P. McParland, Junior Radiologist’s Executive Committee, UK. Tel.: þ44 7813171993. E-mail address: [email protected] (P. McParland)
* Guarantor
Ó 2010 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.crad.2010.09.019
Re: Imaging male breast cancer Sir d We read with interest the recent review by Doyle et al., entitled “Imaging male breast cancer”,1 in which the imaging was reviewed of 20 cases of primary male breast cancer diagnosed at Derriford Hospital over a 10 year period. The majority of the patients in this series received a combination of mammography and targeted breast ultrasound. It is important to also raise the point that magnetic resonance imaging (MRI) is being increasingly used in imaging the male breast, and is an important diagnostic and problem-solving tool. Whilst combined clinical examination, conventional mammography, and ultrasound have been reported to have a high sensitivity and specificity,2 there are limitations to these techniques, particularly in the male breast. For example, benign disease, such as gynaecomastia, can mask an underlying malignancy.3 Additionally, as male breast cancer typically occurs in an eccentric, subareolar location, sonographic
DOI of original article: 10.1016/j.crad.2011.05.004.
Figure 1 Axial, contrast-enhanced, T1-weighted, fat-saturated image through the right breast at nipple level. There is a discrete, avidly enhancing nodule medial to the nipple (arrow).
localization and evaluation of lesions can be made difficult by the dense acoustic shadowing of the nipple. The review by Doyle et al. concentrated on the traditional breast imaging techniques of mammography and ultrasound; however, it is increasingly being recognized that MRI can play a role in assessment of the symptomatic male breast. We recently encountered a case in a 72-year-old man who was found to have a 6 mm retro-areolar opacity in the right breast on lateral oblique mammography.4 He had a medical history of left mastectomy for invasive ductal carcinoma. This new lesion was impalpable and sonographically occult. He underwent dynamic, contrastenhanced breast MRI, which demonstrated a nodule in the upper inner quadrant of the right breast, which was intermediate low signal on T1 and T2-weighted imaging (Fig. 1). The lesion was avidly enhancing and demonstrated rapid washout of contrast medium, with overall findings suggestive of malignancy. A repeat, focussed ultrasound was able to demonstrate a 6 mm nodule isodense to normal breast tissue. Core biopsy confirmed grade I invasive ductal carcinoma and the patient underwent mastectomy (Fig 1). Male breast MRI is in its infancy, but published work has demonstrated its potential efficacy, predominantly as a problem-solving tool. In a study by Morakkabati-Spitz et al.5 17 male patients with palpable breast lesions underwent mammography, ultrasound, and contrastenhanced breast MRI. All five breast tumours identified in the cohort were irregular, avidly enhancing lesions that demonstrated rapid washout of contrast medium. Whilst this was a small cohort, these findings suggest that MRI characteristics of male breast cancer may be similar to those seen in female breast cancer. In the case we encountered, although the imaging findings were slightly atypical in that the lesion itself was well-defined, a malignant type enhancement curve was again seen on contrast-enhanced MRI. The application and utilization of breast MRI in male patients are likely to expand with increasing
Correspondence / Clinical Radiology 67 (2012) 511e513
acceptance of this technique and recognition of its capabilities.
References 1. Doyle S, Steel J, Porter G. Imaging male breast cancer. Clin Radiol 2011;66:1079e85. 2. Gracey G, Hanna GG, James CR, et al. Imaging male breast cancer. Oncol News 2009;4:12e4. 3. Chen L, Chantra PK, Larsen LH, et al. Imaging characteristics of malignant lesions of the male breast. RadioGraphics 2006;26: 993e1006. 4. Shaw A, Smith B, Howlett D. Male breast carcinoma and the use of MRI. Radiol Case Reports 2011;6:1e2.
513
5. Morakkabati-Spitz N, Schild HH, Leutner CC, et al. Dynamic contrastenhanced breast MR imaging in men: preliminary results. Radiology 2006;23B:438e45.
O. Westerland*, A. Shaw, D. Howlett Eastbourne District General Hospital, Eastbourne, East Sussex, UK * Guarantor and correspondent: O. Westerland, Eastbourne District General Hospital Radiology Department, Kings Drive, Eastbourne, East Sussex, BN21 2UD, UK. Tel.: +44 01323 435894. E-mail address: [email protected] (O. Westerland) Ó 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.crad.2011.11.015
Correspondence / Clinical Radiology 67 (2012) 511e513
Acknowledgements The authors would like to acknowledge the members of the Junior Radiologist's Forum representatives.
References 1. Chest pain of recent onset: assessment and investigation of recent onset chest pain or discomfort of suspected cardiac origin. NICE guidelines March 2010. 2. Unstable angina and NSTEMI: the early management of unstable angina and non-ST-segment-elevation myocardial infarction. NICE guidelines March 2010. 3. Nicholson T, Bury RW. NICE clinical guidelines 95: chest pain of recent onset (assessment and diagnosis of recent onset of pain or discomfort of suspected cardiac origin): implications for radiology, https://www.rcr.ac. uk/docs/general/pdf/NICE_Guidelines_implications_FINAL_150710.pdf; July 2010 [accessed: 10.09.10].
P. McParlanda,b,*, A. Sharmana, S.P. Hardenb, R. Buryc a Junior Radiologist’s Executive Committee, UK b
British Society of Cardiovascular Imaging Education Subcommittee, UK
c Cardiovascular Imaging Society, UK and correspondent: P. McParland, Junior Radiologist’s Executive Committee, UK. Tel.: þ44 7813171993. E-mail address: [email protected] (P. McParland)
* Guarantor
Ó 2010 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.crad.2010.09.019
Re: Imaging male breast cancer Sir d We read with interest the recent review by Doyle et al., entitled “Imaging male breast cancer”,1 in which the imaging was reviewed of 20 cases of primary male breast cancer diagnosed at Derriford Hospital over a 10 year period. The majority of the patients in this series received a combination of mammography and targeted breast ultrasound. It is important to also raise the point that magnetic resonance imaging (MRI) is being increasingly used in imaging the male breast, and is an important diagnostic and problem-solving tool. Whilst combined clinical examination, conventional mammography, and ultrasound have been reported to have a high sensitivity and specificity,2 there are limitations to these techniques, particularly in the male breast. For example, benign disease, such as gynaecomastia, can mask an underlying malignancy.3 Additionally, as male breast cancer typically occurs in an eccentric, subareolar location, sonographic
DOI of original article: 10.1016/j.crad.2011.05.004.
Figure 1 Axial, contrast-enhanced, T1-weighted, fat-saturated image through the right breast at nipple level. There is a discrete, avidly enhancing nodule medial to the nipple (arrow).
localization and evaluation of lesions can be made difficult by the dense acoustic shadowing of the nipple. The review by Doyle et al. concentrated on the traditional breast imaging techniques of mammography and ultrasound; however, it is increasingly being recognized that MRI can play a role in assessment of the symptomatic male breast. We recently encountered a case in a 72-year-old man who was found to have a 6 mm retro-areolar opacity in the right breast on lateral oblique mammography.4 He had a medical history of left mastectomy for invasive ductal carcinoma. This new lesion was impalpable and sonographically occult. He underwent dynamic, contrastenhanced breast MRI, which demonstrated a nodule in the upper inner quadrant of the right breast, which was intermediate low signal on T1 and T2-weighted imaging (Fig. 1). The lesion was avidly enhancing and demonstrated rapid washout of contrast medium, with overall findings suggestive of malignancy. A repeat, focussed ultrasound was able to demonstrate a 6 mm nodule isodense to normal breast tissue. Core biopsy confirmed grade I invasive ductal carcinoma and the patient underwent mastectomy (Fig 1). Male breast MRI is in its infancy, but published work has demonstrated its potential efficacy, predominantly as a problem-solving tool. In a study by Morakkabati-Spitz et al.5 17 male patients with palpable breast lesions underwent mammography, ultrasound, and contrastenhanced breast MRI. All five breast tumours identified in the cohort were irregular, avidly enhancing lesions that demonstrated rapid washout of contrast medium. Whilst this was a small cohort, these findings suggest that MRI characteristics of male breast cancer may be similar to those seen in female breast cancer. In the case we encountered, although the imaging findings were slightly atypical in that the lesion itself was well-defined, a malignant type enhancement curve was again seen on contrast-enhanced MRI. The application and utilization of breast MRI in male patients are likely to expand with increasing
Correspondence / Clinical Radiology 67 (2012) 511e513
acceptance of this technique and recognition of its capabilities.
References 1. Doyle S, Steel J, Porter G. Imaging male breast cancer. Clin Radiol 2011;66:1079e85. 2. Gracey G, Hanna GG, James CR, et al. Imaging male breast cancer. Oncol News 2009;4:12e4. 3. Chen L, Chantra PK, Larsen LH, et al. Imaging characteristics of malignant lesions of the male breast. RadioGraphics 2006;26: 993e1006. 4. Shaw A, Smith B, Howlett D. Male breast carcinoma and the use of MRI. Radiol Case Reports 2011;6:1e2.
513
5. Morakkabati-Spitz N, Schild HH, Leutner CC, et al. Dynamic contrastenhanced breast MR imaging in men: preliminary results. Radiology 2006;23B:438e45.
O. Westerland*, A. Shaw, D. Howlett Eastbourne District General Hospital, Eastbourne, East Sussex, UK * Guarantor and correspondent: O. Westerland, Eastbourne District General Hospital Radiology Department, Kings Drive, Eastbourne, East Sussex, BN21 2UD, UK. Tel.: +44 01323 435894. E-mail address: [email protected] (O. Westerland) Ó 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.crad.2011.11.015