Metastases to the Breast from Non-mammary Malignancies

Rationale and Objectives

Most secondary intramammary tumors occur as metastatic involvement from the contralateral breast. Breast metastases (BM) from nonmammary malignancies are very rare. The aims of this study were to estimate retrospectively the prevalence of BM from nonmammary malignancies and to describe their radiologic appearance.

Materials and Methods

BM were identified in 51 patients, including 43 women and eight men with a median age of 61 years (range, 24–84 years). Computed tomography of the thoracic region identified 108 lesions in 38 patients. Mammography was available for 37 patients (54 lesions). Ultrasound evaluation was performed in 43 patients (71 lesions). In 24 patients (93 lesions), magnetic resonance imaging of the breast was done. Images were reviewed in consensus by two radiologists according to the Breast Imaging Reporting and Data System lexicon.

Results

The prevalence of BM in several tumors ranged from 0.12% to 4.92%. On computed tomography, most metastases were round or oval in shape with marked or moderate enhancement. On mammography, solitary or multiple round or oval masses with circumscribed margins were the most common pattern of BM. Ten percent showed microcalcifications. On ultrasound, most BM were hypoechoic, oval or round in shape, with microlobulated or circumscribed margins, and posterior acoustic enhancement. Doppler imaging showed hypervascularity in 39% of BM. On magnetic resonance imaging, most lesions demonstrated marked homogenous contrast enhancement. Type 1 kinetic curve was seen in 18%, type 2 in 52%, and type 3 in 30%.

Conclusions

The radiologic features reported in this study should be taken into consideration in the differential diagnosis of breast lesions.

Most secondary intramammary tumors occur as metastatic involvement from the contralateral breast . Breast metastases (BM) from nonmammary malignancies are very rare . This may related to the fact that the breast contains large areas of fibrous tissue with a relatively poor blood supply .

Alva and Shetty-Alva found in their review of the literature that most BM arise from malignant melanomas, sarcomas, lung cancers, ovarian tumors, renal carcinomas, and thyroid tumors in decreased order of frequency . Some single-institution studies have suggested, however, that BM from ovarian and renal carcinomas are very rare .

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Materials and methods

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Patients

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Imaging and Review

Computed Tomography

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Mammography

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Ultrasound

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MRI

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initial SI(%)=(SI1−3min−SIP)/SIP×100%. initial SI

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100

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postinitial SI(%)=(SIpeak−SIend)/SIpeak×100%. postinitial SI

(

)

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peak

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100

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Histologic Analysis

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Statistical Analysis

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Results

Primary Tumors and Number and Prevalence of BM

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Table 1

Prevalence of BM in Metastasizing Oncologic Diseases

Malignant Disease Prevalence of BM (%) Malignant melanoma of skin 4.92 Carcinoma of ovary 4.43 Carcinoma of stomach 1.47 Renal cell carcinoma 1.17 Sarcoma 1.13 Carcinoma of bronchus and lung 0.89 Carcinoma of larynx 0.77 Carcinoma of cervix uteri 0.76 Seminoma of testis 0.52 Carcinoma of prostate 0.24 Carcinoma of thyroid gland 0.22 Carcinoma of colon 0.12

BM, breast metastases.

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Clinical Findings

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Radiologic Features

Computed Tomography

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Table 2

Computed Tomographic Findings of Breast Metastases

Characteristics n (%) Lesions 108 (100) Shape Oval 18 (17) Round 82 (76) Lobulated 8 (7) Margin Circumscribed 101 (94) Lobulated 7 (6) Enhancement High 56 (52) Moderate 40 (37) Low 12 (11)

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Mammography

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Table 3

Mammographic Findings in 37 Patients with Breast Metastases

Characteristic Patients Pattern Mass 27 (73%) Architectural distortion 2 (5%) No abnormalities 8 (22%) Mass features (n = 52) Lesions Shape Round 37 (71%) Oval 9 (17%) Lobular 6 (12%) Margin Circumscribed 46 (88%) Microlobulated 6 (12%) Density High 24 (46%) Isodense 28 (54%) Calcifications Yes 5 (10%) No 47 (90%) ACR 1 31% 2 31% 3 12% 4 26% BI-RADS 0 20% 3 14% 4 37% 5 29%

ACR, American College of Radiology; BI-RADS, Breast Imaging Reporting and Data System.

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Ultrasound

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Table 4

Ultrasound Findings of Breast Metastases

Characteristic Patients Pattern Mass 41 (95%) Architectural distortion (diffuse infiltration) 2 (5%) Mass features (n = 68) Lesions Shape Round 30 (44%) Oval 28 (41%) Lobular 10 (15%) Margin Microlobulated 34 (50%) Circumscribed 18 (26%) Indistinct 16 (24%) Echo pattern Anechoic 13 (19%) Hypoechoic 35 (52%) Mixed hypoechoic to hyperechoic 20 (29%) Posterior phenomena Enhancement 52 (76%) None 11 (16%) Shadowing 4 (6%) Mixed 1 (2%)

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Table 5

Doppler Findings of 42 Breast Metastases in 20 Patients

Hypervascularity n (%) None 25 (61) Light 10 (24) Moderate 2 (5) High 4 (10)

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MRI

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Table 6

Magnetic Resonance Findings of Breast Metastases

Characteristics Patients Pattern Mass 22 (92%) Diffuse infiltration 2 (8%) Mass features (n = 91) Lesions Shape Round 54 (59%) Oval 32 (35%) Lobular 5 (6%) Margin Smooth 84 (92%) Irregular 7 (8%) Signal intensity (T1W images) Hypointense 10 (11%) Isointense 79 (87%) Mixed isointense to hyperintense 2 (2%) Signal intensity (T2W images) Isointense 76 (84%) Hyperintense 15 (16%) Internal mass enhancement Homogenous 73 (80%) Inhomogenous 7 (8%) Rim enhancement 11 (12%) Time–signal intensity curve pattern Type 1 11 (18%) Type 2 32 (52%) Type 3 19 (30%)

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Diagnosis and Follow-Up

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Discussion

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Table 7

Comparison of Reported Studies Regarding Radiologic Findings of Breast Metastases

Study Patients Radiologic Investigations (Patients) CT Mammography Ultrasound Doppler MRI Bohman et al ∗ 11 — 11 — — — McCrea et al ∗ 8 — 8 — — — Derchi et al 6 — — 6 — — Hebert et al 21 — 5 — — — Vergier et al 8 — 8 8 — — Muttarak et al 7 — 7 6 — — Yeh et al 15 — — 11 — — Noguera et al ∗ 22 4 18 11 — 1 Present study 51 38 37 43 20 24

CT, computed tomography; MRI, magnetic resonance imaging.

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Conclusions

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Metastases to the Breast from Non-mammary Malignancies

Rationale and Objectives

Materials and Methods

Results

Conclusions

Materials and methods

Patients

Imaging and Review

Computed Tomography

Mammography

Ultrasound

MRI

Histologic Analysis

Statistical Analysis

Results

Primary Tumors and Number and Prevalence of BM

Clinical Findings

Radiologic Features

Computed Tomography

Mammography

Ultrasound

MRI

Diagnosis and Follow-Up

Discussion

Conclusions

References

Further Reading

A Dedicated General Competencies Curriculum for Radiology Residents

A Quantitative Description of the Percentage of Breast Density Measurement Using Full-field Digital Mammography

An Anthropomorphic Breast Model for Breast Imaging Simulation and Optimization