MR imaging of the skin and nipple of the breast: differentiation between tumour recurrence and post-treatment change

Contrast-enhanced MR imaging of the breast has been found to be valuable in the assessment of local recurrence of previously treated breast cancer. We looked specifically at the appearances of the skin and nipple of the treat ed breast in order to describe the appearances of post-treatment change and recurrence in this region. Thirty-nine women treated for breast cancer had MR imaging of one or both breasts reviewed retrospectively with particular attention to the nipple and skin. The skin and chest wall were assessed fo r patients with mastectomies. All available histology of the skin and/or ni pple, obtained following MR imaging, was reviewed. In patients who did not undergo surgery following MR imaging, clinical follow-up was obtained. Six of 39 cases had nodular enhancing areas seen on MR imaging, which correlate d with histology demonstrating tumour recurrence within the skin and/or nip ple. Of the remaining 33 patients, changes of linear or diffuse enhancement were seen in the skin and/or nipple of 15 patients. These changes were sho wn to be benign post-treatment changes at surgery/biopsy in 4 cases or by c linical follow-up in the remainder. In this article we demonstrate differin g patterns of contrast enhancement within the skin and nipple in recurrent breast carcinoma vs post-treatment changes. This suggests that contrast-enh anced MR imaging of the breast may be a useful tool in differentiating tumo ur recurrence from post-treatment changes within the skin and nipple.