DETECTION OF PRIMARY BREAST-CANCER IN WOMEN WITH KNOWN ADENOCARCINOMAMETASTATIC TO THE AXILLA - USE OF MRI AFTER NEGATIVE CLINICAL AND MAMMOGRAPHIC EXAMINATION

The purpose of this study was to evaluate the ability of MRI to identi fy a primary site of malignancy in the breast of patients who present clinically with ipsilateral lymph nodes containing metastatic carcinom a but whose physical and mammographic examination are negative, MRI of the breast was performed on four patients using a variety of imaging parameters, all with and without gadolinium contrast. All patients had biopsy-proven adenocarcinoma of the ipsilateral axilla, with negative physical and mammographic examinations. Foci of enhancement assessed visually on precontrast and postcontrast scans (n = 1) and on substrac tion studies (n = 3) were considered suspicious under the clinical cir cumstances defined for this study. Lesions identified on MRI were re-i dentified on ultrasound examination and either preoperative localizati on for excisional biopsy or tissue sampling was performed. Surgery was performed and histopathologic correlation was obtained in all cases. primary sites of breast carcinoma were identified in all four patients , with multiple sites of malignancy identified in three of four patien ts. Breast conservation therapy was made possible for three of four pa tients based on the results of the MRI study showing sites of malignan cy and no features of cancer elsewhere in the breast, Follow-up data o f 1, 2, and 5 years of these patients show no evidence of recurrent di sease, MRI of the breast is a useful technique for identifying primary sites of malignancy in patients presenting with ipsilateral lymph nod es positive for metastatic adenocarcinoma when the physical and mammog raphic examinations are negative.