Orel S G, Weinstein S P, Schnall M D, Reynolds C A, Schuchter L M, Fraker D L, Solin L J
Department of Radiology, University of Pennsylvania Medical Center, Philadelphia 19104, USA.
Radiology. 1999 Aug;212(2):543-9. doi: 10.1148/radiology.212.2.r99au40543.
To assess the usefulness of magnetic resonance (MR) imaging of the breast in patients with malignant axillary adenopathy and unknown primary malignancy.
Between October 1993 and December 1997, 38 women with malignant axillary adenopathy and negative mammographic and physical examination findings underwent contrast material-enhanced MR imaging. Sixteen patients were excluded due to axillary tail cancer (n = 7), lack of follow-up (n = 4), second primary malignancy (n = 3), or chemotherapy before MR imaging (n = 2). The study population comprised the remaining 22 patients. Histopathologic findings were available in 20 patients; follow-up MR imaging findings were available in two patients.
MR imaging depicted a primary breast cancer in 19 patients (86%; identified at excisional biopsy or mastectomy in 17, resolved on follow-up MR images during treatment in two). MR imaging depicted 4-30-mm cancers (mean, 17 mm), which correlated closely with histopathologic size. Two patients (9%) had false-negative findings: (a) One had a 2-mm invasive ductal carcinoma, and (b) one had 17- and 20-mm invasive ductal carcinomas. Of the 19 patients, 11 underwent mastectomy, seven underwent breast-conservation therapy, and one did not undergo a surgical procedure.
MR imaging is very sensitive for the detection of mammographically and clinically occult breast cancer in patients with malignant axillary adenopathy. In these patients, MR imaging offers potential not only for cancer detection but also for staging the cancer within the breast, which may be useful for treatment planning.
评估磁共振（MR）成像在伴有恶性腋窝腺病且原发恶性肿瘤不明的患者中对乳腺疾病的诊断价值。
1993年10月至1997年12月期间，38例乳腺钼靶和体格检查结果均为阴性但伴有恶性腋窝腺病的女性接受了对比剂增强MR成像检查。16例患者因腋窝尾部癌（n = 7）、缺乏随访（n = 4）、第二原发性恶性肿瘤（n = 3）或在MR成像检查前接受过化疗（n = 2）而被排除。研究人群包括其余22例患者。20例患者有组织病理学检查结果；2例患者有MR成像随访结果。
MR成像显示19例患者（86%）存在原发性乳腺癌（17例在切除活检或乳房切除术中确诊，2例在治疗期间的MR成像随访中病变消失）。MR成像显示的癌灶大小为4 - 30 mm（平均17 mm），与组织病理学大小密切相关。2例患者（9%）出现假阴性结果：（a）1例为2 mm浸润性导管癌，（b）1例为17 mm和20 mm浸润性导管癌。19例患者中，11例行乳房切除术，7例行保乳治疗，1例未接受手术。
MR成像对于检测伴有恶性腋窝腺病患者的乳腺钼靶和临床隐匿性乳腺癌非常敏感。对于这些患者，MR成像不仅有助于癌症检测，还能对乳腺内的癌症进行分期，这可能有助于治疗方案的制定。
