Fig 1.
Inclusion and exclusion criteria for patient selection.
Table 1.
MRI protocol.
Table 2.
Characteristics of patients.
Table 3.
Detectability of recurrent breast cancer by imaging modality.
Fig 2.
A 40-year-old female patient with an early recurrent breast cancer detected 8 months after BCT.
The patient who underwent BCT for left breast cancer (invasive breast cancer, stage II) complained of discomfort in left axilla at the time of postoperative surveillance. Through mammography and ultrasound, an enlarged lymph node was noted. It was confirmed as metastasis by ultrasound-guided core needle biopsy. (a) MRI after confirmed metastatic lymph node in left axilla. A large lymph node, which was confirmed as metastasis, is noted at left axillary level I. (b) At first dynamic phase after contrast enhancement, there is a focal non-mass enhancement (open arrow) at 3 o’clock direction of left breast, anterior to the previous excision site (white arrow). (c), (d) Mammography and ultrasound of the same patient show an enlarged lymph node in left axilla, but there is no significant suspicious finding at excision site on both mammography and ultrasound. (e) On second look ultrasound by breast expert to find non-mass enhancement lesion detected on MRI, an indistinct isoechoic non-mass like lesion (white star) is noted. This lesion was confirmed to be recurrent invasive carcinoma after re-excision with ultrasound-guided needle localization.
Table 4.
MR characteristics of early and late recurrent lesions.
Fig 3.
A 43-year-old female patient with a late recurrent breast cancer detected 20 months after BCT.
(a) MRI of a 43-year-old patient who underwent BCT for right breast cancer (invasive ductal carcinoma, stage II). The patient underwent BCT alone and refused radiation therapy and chemotherapy after surgery. On the second annual postoperative MR surveillance, a small (0.6cm) sized enhancing nodule is detected at the upper outer quadrant of right breast (10 o’clock direction, open arrow). (b), (c) Mammography and ultrasound of the same patient for routine postoperative surveillance. There is no suspicious finding on mammography. On the second look ultrasound, there is a small hypoechoic nodule at the possible concordant location with the MR detected lesion. This lesion was underestimated before MRI examination due to multiple hypoechoic nodules at upper outer quadrant of right breast. It was confirmed as recurrent invasive ductal carcinoma by core needle biopsy.
Fig 4.
A 35-year-old female patient with a late recurrent breast cancer detected 30 months after BCT.
(a), (b) MRI after recurrent ductal carcinoma in situ of right breast was confirmed through ultrasound-guided biopsy. Only hematoma is detected at right subareolar region on pre-contrast fat saturated T1WI (a), and no definite enhancement is noted on subtracted early dynamic phase of contrast enhanced fat saturated T1WI (b). (c) Mammography of the same patient for routine postoperative surveillance. Mammography showed linearly distributed fine pleomorphic microcalcifications (open arrow) at right subareolar region, adjacent to previous BCT site. (d) Ultrasound of the same patient for routine postoperative surveillance. Ultrasound showed intraductal echogenic foci (white arrow) at right subareolar region and nipple.
Fig 5.
A 62-year-old female patient with an early recurrent breast cancer detected 12 months after BCT.
(a) MIP image of postoperative MRI after 12 months from BCT for left breast cancer. There is a prominent nodular enhancement at upper inner quadrant of left breast (open arrow). (b) On subtracted early dynamic phase of contrast enhanced T1WI, a brightly enhancing nodule is noted adjacent to previous BCT site (open arrow). (c) There is no abnormal finding on mammography of the same day as breast MRI. (d) Second look ultrasound for biopsy shows oval parallel, indistinct isoechoic lesion (white star) mimicking normal parenchymal pattern at corresponding site of enhancing lesion detected on MRI. This lesion was not detected on breast ultrasound performed at the same day as breast MRI.