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Purpose: To correlate histopathologic and magnetic resonance (MR) imaging findings of ductal carcinoma in situ (DCIS)., Materials and Methods: Thirty-six women with DCIS underwent preoperative contrast material-enhanced subtraction dynamic MR imaging. Concomitant early contrast enhancement in the breast parenchyma with normal vessels was considered a positive finding. The size and shape of early enhancement were correlated with the size and density packing of ducts involved by DCIS. Tumor angiogenesis in the stroma that surrounded the ducts was evaluated with immunoperoxidase staining., Results: Early contrast enhancement was demonstrated in 34 patients with DCIS but not in two patients with comedo-type DCIS. Tumor angiogenesis was demonstrated in the stroma. The size and morphology of contrast-enhanced lesions significantly correlated with the size (P = .0085) and density packing of ducts involved by DCIS (P = .012)., Conclusion: Contrast enhancement on dynamic MR images of DCIS may be due to the presence of tumor angiogenesis in the stroma.

Purpose: To analyze the histologic appearance of mammographically detected lesions suspected of being radial scars., Materials and Methods: Mammographic and pathologic findings in 40 patients with a preoperative diagnosis of radial scar were reviewed retrospectively., Results: Pathologic examination revealed 20 pure radial scars, 12 pure carcinomas, and eight malignant lesions (seven tubular carcinomas and one infiltrating ductal carcinoma) associated with a radial scar. At mammography, no difference was noted between benign and malignant lesions according to size and shape of the spicule, size of the central core, and the presence of calcifications., Conclusion: Because of the association of radial scars with borderline and malignant lesions, a spiculated lesion suggestive of a radial scar found at mammography must always be surgically removed. The surgeon and pathologist must be aware of the mammographic aspects of radial scar, however, to avert excessive surgery, because all cancers in this study had a good prognosis.

Purpose: To determine a histopathologic explanation for focal areas of increased opacity on mammograms of ductal carcinoma in situ of the comedo type (comedocarcinoma)., Materials and Methods: From January 1991 to January 1993, mammograms from 36 patients with comedocarcinomas were reviewed. Each mammogram was screened for microcalcifications and/or any focal area of increased opacity. The presence or absence of infiltrating components was confirmed at pathologic examination, with particular emphasis placed on the search for any stromal reaction., Results: The clinical examination revealed a palpable tumor in five patients (14%) and a bloody discharge from the nipple in two (5%). Isolated clusters of microcalcifications were seen at mammography in 24 patients (67%). Nine patients (25%) had clusters associated with focal areas of increased opacity; three patients (8%) had no microcalcifications. Histologic analysis demonstrated an intense, periductal, inflammatory reaction in all 12 patients with focal areas of increased opacity., Conclusion: Focal areas of increased opacity are not always indicative of an infiltrating component and may merely represent intense stromal reaction.

Purpose: To determine the accuracy of contrast material-enhanced subtraction dynamic magnetic resonance (MR) imaging in the diagnosis of nonpalpable breast tumors., Materials and Methods: One hundred forty-three patients underwent surgical biopsy of a nonpalpable breast lesion. Their mammograms showed microcalcifications (n = 80), opacity (n = 52), architectural distortion (n = 10), or asymmetric density (n = 1). All patients underwent a preoperative gadolinium tetraazacyclododecanetetraacetic acid-enhanced subtraction dynamic study. Any early contrast enhancement in the breast parenchyma was considered pathologic., Results: At histologic analysis, 27 intraductal carcinomas, 37 invasive carcinomas, and 79 benign lesions were found. Dynamic MR studies showed early contrast enhancement in 61 of 64 breast cancers (sensitivity, 95%) and in 37 of 79 benign lesions (specificity, 53%). Two invasive lobular carcinomas and one tubular carcinoma showed no early contrast enhancement., Conclusion: Subtraction dynamic MR imaging may be helpful to rule out malignancy in nonpalpable breast tumors.

Purpose: To determine the value of contrast material-enhanced subtraction magnetic resonance (MR) imaging in assessment of response to chemotherapy in locally advanced breast cancer., Materials and Methods: Eighteen women treated with chemotherapy because of locally advanced breast cancer underwent preoperative MR examination including both routine and dynamic MR sequences after injection of gadolinium tetraazacyclododecanetetraacetic acid. Any early contrast enhancement, concomitant with early vascular enhancement during the dynamic MR study, was considered pathologic., Results: Dynamic MR studies showed early contrast enhancement in all women with residual tumor except one with nodular residual tumor. Histopathologic analysis and dynamic MR images of contrast-enhanced lesions correlated well, but in one patient, intraductal extension was not seen on MR images, and in another, additional isolated tumor cells were seen in the histologic specimen. Subtraction images always facilitated visualization of vascular and pathologic contrast enhancement., Conclusion: Dynamic MR contrast-enhanced subtraction studies are useful in assessment of residual tumor after chemotherapy.

Purpose: To describe the mammographic features of apocrine carcinoma and assess the patterns of calcifications associated with these lesions., Materials and Methods: Clinical and mammographic features from 17 patients with apocrine carcinoma were retrospectively reviewed. Special attention was paid to the presence of mixed form, diffusely scattered microcalcifications on mammograms., Results: Patients were referred for clinical (n = 10), mammographic (n = 2), or both clinical and mammographic (n = 5) abnormalities. Findings at clinical examination included a palpable breast mass (n = 12), multiple breast masses (n = 1), and bloody nipple discharge (n = 2); two patients had normal findings. Fourteen patients had opacities at mammography. These opacities were associated with microcalcifications in 10 cases. Three patients had microcalcifications without opacities; one of those three patients exhibited a mixed form of diffusely scattered calcifications., Conclusion: Clinical and mammographic features of apocrine carcinoma do not differ from those of invasive ductal carcinoma.

Purpose: To present magnetic resonance (MR) imaging findings from 511 follow-up examinations of aggressive soft-tissue tumors., Materials and Methods: One hundred eighty-two patients with aggressive soft-tissue tumours underwent postoperative T1- and T2-weighted imaging; 41 also underwent 51 gadolinium-enhanced T1-weighted examinations, and five underwent dynamic gadolinium-enhanced subtraction imaging., Results: Twenty-four of 25 patients (101 of 102 examinations) without high signal intensity (HSI) at T2-weighted imaging had no recurrence. Among 79 patients (321 examinations) who demonstrated HSI without a mass, only two tumors recurred within 1 year. An HSI mass was found in 88 studies of 78 patients and represented recurrence (n = 60), hygroma (n = 24), or a radiation-induced pseudomass (n = 4). Hygromas did not enhance, while recurrences enhanced at 1-3 minutes and postirradiation change enhanced at 4-7 minutes., Conclusion: T2-weighted imaging can be used to identify possible recurrence of aggressive soft-tissue tumors, while gadolinium-enhanced imaging can be used to differentiate recurrences from hygromas and inflammatory change.

Local relapse was suspected in 26 women treated conservatively for breast cancer. All women underwent routine magnetic resonance (MR) imaging and a dynamic MR subtraction study after injection of gadolinium-tetraazacyclododecanetetra-acetic acid. Twelve women had no local relapse. Surgical biopsy enabled confirmation of recurrence in 14 patients. Routine MR imaging did not allow differentiation of recurrence from glandular or scar tissue. Except for one case of fat necrosis, patients without local relapse showed no contrast enhancement 1 minute 34 seconds after injection. At dynamic MR imaging, all recurrences showed contrast enhancement 1 minute 34 seconds after injection. Nodular enhancement (n = 11) was found in invasive carcinoma, whereas linear enhancement was seen in intraductal carcinoma (n = 3). Subtraction of precontrast from postcontrast images always allowed better visualization of contrast enhancement. Contrast-enhanced subtraction dynamic MR imaging may prove to be accurate in diagnosis of local relapses of breast cancer.

Pathologists have associated calcium oxalate dihydrate (weddellite) in breast biopsy specimens with benign or borderline lesions and rarely with malignancy. These microcalcifications may have a polyhedral shape in histologic specimens owing to their crystalline structure. A retrospective radiologic-histologic correlation study was performed on 300 clusters of microcalcifications to determine if microcalcifications with a polyhedral shape could be found at mammography. In 19 cases (6.3%), polyhedral microcalcifications (PMs) were detected by two radiologists. In 12 of these 19 cases, weddellite crystals were found in the histologic specimen under polarized light; in seven cases, no calcification was found. Although rare, PMs can be found at mammography by radiologists aware of their existence. They are due to weddellite crystals and in this series were associated with benign disease in 89% of cases. Prospective studies are required to determine the frequency of PMs on screening mammograms and to evaluate their negative predictive value.