Skip to main content
SpringerLink
Log in

Utility of Breast Magnetic Resonance Imaging in Patients With Occult Primary Breast Cancer

  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Although carcinoma presenting as axillary metastases is assumed to be due to breast cancer, identification of the primary lesion may prove problematic. We investigated the ability of breast magnetic resonance imaging (MRI) to identify the primary tumor, thereby confirming the diagnosis and broadening treatment options.

Methods

From 1995 to 2001, 69 patients at our institution presented with occult primary breast cancer. All patients had negative breast examinations and mammograms and underwent breast MRI.

Results

Of 69 patients, 55 had axillary adenopathy without evidence of distant disease (stage II); 14 had stage IV disease. In patients with stage II disease, MRI revealed suspicious lesions in 76% (42 of 55). In 62% (26 of 42), the MRI finding proved to be the occult primary tumor. Of these, 58% (15 of 26) were candidates for breast conservation. MRI did not identify the primary tumor in 25 women; 12 underwent mastectomy. Cancer was found in 33% (4 of 12) of these. Thirteen patients were treated with primary breast irradiation; three were lost to follow-up, one developed distant disease, and nine were without evidence of disease with a median follow-up of 4.5 years. In women with stage IV disease, MRI identified the primary tumor in 5 of 9 patients with regional adenopathy and 2 of 5 patients with distant disease (overall 50%; 7 of 14). MRI identified the primary tumor in women with both mammographically dense (19 of 44; 43%) and less dense (10 of 20; 50%) breasts.

Conclusions

Breast MRI detects mammographically occult cancer in half of women with axillary metastases, regardless of breast density. MRI is a powerful tool for stage II and stage IV patients with occult primary breast cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Kuhl CK, Schmutzler RK, Leutner CC et al. Breast MR imaging screening in 192 women proved or suspected to be carriers of a breast cancer susceptibility gene: preliminary results. Radiology 2000;215:267–79.

    PubMed  CAS  Google Scholar 

  2. Warner E, Plewes, DB, Shumak RS et al. Comparison of breast magnetic resonance imaging, mammography, and ultrasound for surveillance of women at high risk for hereditary breast cancer. J Clin Oncol 2001;19:3524–31

    PubMed  CAS  Google Scholar 

  3. Stoutjesdijk MJ, Boetes C, Jager GJ et al. Magnetic resonance imaging and mammography in women with a hereditary risk of breast cancer. J Natl Cancer Inst 2001;93:1095–102

    Article  PubMed  CAS  Google Scholar 

  4. Tilanus-Linthorst MM, Bartels CC, Obdjein AI, Oudkerk M, et al. Earlier detection of breast cancer by surveillance of women at familial risk. Eur J Cancer 2000;36:514–9

    Article  PubMed  CAS  Google Scholar 

  5. Morris EA, Liberman L, Ballon DJ et al. MRI of occult breast carcinoma in a high-risk population. AJR Am J Roentgenol 2003;181:619–26

    PubMed  Google Scholar 

  6. Olson JA Jr, Morris Van Zee KJ, Linehan DC,Borgen PI.et al. Magnetic resonance imaging facilitates breast conservation for occult breast cancer. Ann Surg Oncol 2000;7:411–5

    Article  PubMed  Google Scholar 

  7. Morris EA, Schwartz LH, Dershaw DD, et al. MRI imaging of the breast in patients with occult primary breast carcinoma specimens. Radiology 1997;205:437–40

    PubMed  CAS  Google Scholar 

  8. Morris EA. Screening for breast cancer with MRI. Semin Ultrasound CT MR 2003;24:45–54

    Article  PubMed  Google Scholar 

  9. Kriege M, Brekelmans CT, Boetes C, et al. Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med 2004;351:427–37

    Article  PubMed  CAS  Google Scholar 

  10. Baron PL, Moore MP, Kinne DW, et al. Occult breast cancer presenting with axillary metastases. Updated management. Arch Surg 1990;125:210–4

    Google Scholar 

  11. Vlastos G, Jean ME, Mirza AN, et al. Feasibility of breast preservation in the treatment of occult primary carcinoma presenting with axillary metastases. Ann Surg Oncol 2001;8:425–31

    PubMed  CAS  Google Scholar 

  12. Morris EA, Liberman L, Dershaw DD, et al. Preoperative MR imaging-guided needle localization of breast lesions. AJR Am J Roentgenol 2002;178:1211–20

    Google Scholar 

  13. American College of Radiology. Illustrated Breast Imaging Reporting and Data System (BI-RADS). 3rd ed. Reston, VA: American College of Radiology, 1998

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York, 10021

    Claire L. Buchanan MD, Paige L. Dorn BS, Patrick I. Borgen MD & Kimberly J. Van Zee MD

  2. Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York, 10021

    Elizabeth A. Morris MD

Authors
  1. Claire L. Buchanan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elizabeth A. Morris MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paige L. Dorn BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Patrick I. Borgen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kimberly J. Van Zee MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kimberly J. Van Zee MD.

Additional information

Claire L. Buchanan, MD, is now at Swedish Cancer Institute, 500 17th Avenue, Seattle, WA 98108

Rights and permissions

Reprints and permissions

About this article

Cite this article

Buchanan, C.L., Morris, E.A., Dorn, P.L. et al. Utility of Breast Magnetic Resonance Imaging in Patients With Occult Primary Breast Cancer. Ann Surg Oncol 12, 1045–1053 (2005). https://doi.org/10.1245/ASO.2005.03.520

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/ASO.2005.03.520

Keywords

Search

Navigation