Detection and Clinical Significance of Sternal Lesions on Breast MRI

Amanda R Schaefer; Limin Yang; Jeong Mi Park; Jinhu Xiong; Laurie L Fajardo

doi:10.1111/tbj.12416

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Detection and Clinical Significance of Sternal Lesions on Breast MRI

Journal article

Open access

Peer reviewed

Detection and Clinical Significance of Sternal Lesions on Breast MRI

Amanda R Schaefer, Limin Yang, Jeong Mi Park, Jinhu Xiong and Laurie L Fajardo

The breast journal, Vol.21(4), pp.395-402

07/2015

DOI: 10.1111/tbj.12416

PMID: 25864435

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Abstract

The purpose of this study is to characterize sternal lesions detected on breast magnetic resonance imaging (MRI), compare MRI detection of sternal lesions with other imaging modalities (bone scan, positron emission tomography/computed tomography (PET/CT) and chest CT), and ascertain how often patient management is altered by discovery of sternal lesions. Retrospective review of 1143 breast MRIs between 2007 and 2012 identified 17 patients with sternal lesions including 15 patients with newly diagnosed breast cancer and two patients with remote history of breast cancer. Tumor size, histopathology, receptor status, nodal and distant metastasis, and images of breast MRI, and other modalities were reviewed. Sternal lesions in 9 of the 17 patients were determined to be malignant (metastasis) either by biopsy or presence of widespread metastases. Sternal lesions in 8 of the 17 were benign, confirmed by biopsy or presumed benign as not detected by other modalities. The malignant group had statistically significant larger breast cancer size (malignant: 6.4 cm; benign: 2.3 cm), a higher percentage of diffuse sternal lesions (malignant: 56%; benign: 0%), and more frequently showed rapid initial enhancing (malignant: 100%; benign: 63%) and delayed washout curves (malignant: 67%; benign: 13%). Although not statistically significant, the malignant group had a higher frequency of invasive lobular carcinoma (malignant: 44%; benign: 13%) and more lymph node involvement (malignant: 78%; benign: 50%). Breast MRI detected more sternal lesions than did bone scan, PET/CT and chest CT. Four of the 17 (24%) patients were upgraded to stage 4 due to unsuspected metastatic sternal lesions on breast MRI. In conclusion, breast MRI is more sensitive than other modalities in detecting sternal lesions. Sternal metastases occur more frequently in aggressive breast cancer and exhibit malignant-type dynamics on breast MRI. Detection of unsuspected sternal metastasis alters staging and improves patient management with more appropriate treatment.

Bone Neoplasms - diagnosis

Bone Neoplasms - diagnostic imaging

Humans

Middle Aged

Bone Neoplasms - secondary

Radiography

Magnetic Resonance Imaging

Breast Neoplasms - pathology

Sternum - pathology

Ultrasonography

Adult

Female

Breast Neoplasms - diagnosis

Retrospective Studies

Breast Neoplasms - diagnostic imaging

Neoplasm Staging

Details

Title: Subtitle: Detection and Clinical Significance of Sternal Lesions on Breast MRI
Creators: Amanda R Schaefer - Broadlawns Medical Center, Des Moines, Iowa
Limin Yang - Department of Radiology, University of Iowa, Iowa City, Iowa
Jeong Mi Park - Department of Radiology, University of Iowa, Iowa City, Iowa
Jinhu Xiong - Department of Radiology, University of Iowa, Iowa City, Iowa
Laurie L Fajardo - Department of Radiology, University of Iowa, Iowa City, Iowa
Resource Type: Journal article
Publication Details: The breast journal, Vol.21(4), pp.395-402
DOI: 10.1111/tbj.12416
PMID: 25864435
ISSN: 1075-122X
eISSN: 1524-4741
Language: English
Date published: 07/2015
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiology
Record Identifier: 9984083283802771

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