Possibilities of MRI in the differential diagnosis of non-lactative mastitis and cancer

Non-lactational mastitis is an inflammatory process in the breast tissue that is not associated with lactation. The detection of a malignant transformation during inflammation process is often difficult, because it has similar clinical manifestations. Medical approach depends on the characteristics of the processes which are received from the data obtained from radiation diagnostic methods: whether or not there is a nodular formation or infiltrate, cystic cavities, dilatation of the ducts, how the axillary lymph nodes are changed. Diagnostic errors in inflammatory breast diseases are quite common; according to the literature, errors in the interpretation of clinical, mammographic, and ultrasound signs of cancer during inflammation account for up to 53.1% of cases. Inflammation, as well as cancer, in majority of cases is accompanied by a visually detectable increase in blood flow due to proliferation and neoangiogenesis. Magnetic resonance imaging with dynamic contrast enhancement (MRI) is highly sensitive in detecting areas with increased vascularization and makes it possible to assess their nature with a high degree of probability during any changes in the structure of the breast tissue, including edema and inflammatory infiltration. MR signs that allow to make differential diagnosis are a combination of pathological accumulation and lymphadenopathy, which are coded by the BIRADS system as category 4 and only the absence of contrast agent accumulation may suggest an inflammatory nature of the changes. According to the literature, MRI-DCE is a highly sensitive diagnostic method of identifying cancer during inflammation processes. The results of 85 MR studies with clinical manifestations of non-lactational mastitis were analyzed.

The purpose of study: is to evaluate the possibilities of magnetic resonance mammography in making a differential diagnosis of non-lactational mastitis and breast cancer.

1. Gostischev V.K. Clinical operative purulent surgery: A guide for doctors. M.: GEOTAR-Media, 2016. 448 p. (In Russian)

2. Giess C.S., Golshan M., Flaherty K., Birdwell R.L. Clinical experience with aspiration of breast abscesses based on size and etiology at an academic medical center. J. Clin. Ultrasound. 2014; 42 (9): 513–521. https://doi.org/10.1002/jcu.2219

3. Serebryakova S.V., Trufanov G.E., Fokin V.A., Yukhno E.A. Magnetic resonance imaging with contrast enhancement in the differential diagnosis of nodular formations. Visualization in Medicine. 2016; 1: 10–21. (In Russian)

4. Cha E., Smith R.L., Kristensen A.R. et al. The value of pathogen information in treating clinical mastitis. J. Dairy. Res. 2016; 83 (4): 456–446. https://doi.org/10.1017/S0022029916000625

5. Tan H., Li R., Peng W. et al. Radiological and clinical features of adult non-puerperal mastitis. Br. J. Radiol. 2013; 86 (1024): 20120657. https://doi.org/10.1259/bjr.20120657

6. Chernaya A.V., Reva A.V., Ulianova R.K., Shevkunov L.N., Krivorotko P.V., Tyatkov S.A., Gharibyan S.A., Danilov V.V., Petrova A.S., Zhiltsova E.K., Krzhivitskii P.I., Smirnova V.O., Zaitsev A.N. Difficulties of Differential Diagnostics of Idiopathic Granulomatous Mastitis with Contrast Enhanced Visualization Methods. Journal of Oncology: Diagnostic Radiology and Radiotherapy. 2020; 3 (3): 83. https://doi.org/10.37174/2587-7593-2020-3-3-83–92 (In Russian)

7. Tahmasebi S., Karami M.Y., Maalhagh M. Granulomatous Mastitis: Time to Introduce New Weapons. Wld J. Surg. 2016; 40 (11): 2827–2828. https://doi.org/10.1007/s00268-016-3438-9

8. Jahanfar S., Teng C.L. Antibiotics for mastitis in breastfeeding women. San Paulo Med. J. 2016; 134 (3): 273. https://doi.org/10.1002/14651858.CD005458.pub3

9. Bazhenova D.A., Mershina E.A., Puchkova O.S., Sennikov I.S., Filatova D.A. Modern view on the principles of breast cancer diagnosis according to contrast mammography (literature review). Medical Visualization. 2022; 26 (1): 40–47. https://doi.org/10.24835/1607-0763-1090 (In Russian)

10. Cardoso F., Kyriakides S., Ohno S. Early Breast Cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann. Oncol. 2019; 30 (8): 1194–1220.

11. Portnoy S.M. The main risks of breast cancer and suggestions for its prevention. Tumors of the female reproductive system. 2018; 14 (3): 25–39. (In Russian)

12. Zhang X.-H., Xiao C. Diagnostic Value of Nineteen Different Imaging Methods for Patients with Breast Cancer: a Network Meta-Analysis. Cell. Physiol. Biochem. 2018; 46 (5): 2041–2055. https://doi.org/10.1159/000489443

13. Taffurelli M., Pellegrini A., Santini D. et al. Recurrent periductal mastitis: Surgical treatment. Surgery. 2016; 160 (6): 1689–1692. https://doi.org/10.1016/j.surg.2016.06.048

14. Fischer U., Kopka L., Grabbe E. Breast carcinoma: effect of preoperative contrast-enhanced MR imaging on the therapeutic approach. Radiology. 1999; 213 (3): 881–888. https://doi.org/10.1148/radiology.213.3.r99dc01881

15. Kaiser W.A., Zeitler E. MR imaging of the breast: fast imaging sequences with and without Gd-DTPA-preliminary observations. Radiology. 1989; 170 (3, Pt 1): 681–686. https://doi.org/10.1148/radiology.170.3.2916021

16. Shumakova T.A., Solntseva I.A., Safronova O.B., Savello V.E., Serebryakova S.V. Application of the international classification of BI-RADS in mammological practice. SPb., ELBI-SPb., 2018. 208 p. (In Russian)

17. D'Alfonso T.M., Ginter P.S., Shin S.J. A Review of Inflammatory Processes of the Breast with a Focus on Diagnosis in Core Biopsy Samples. J. Pathol. Transl. Med. 2015; 49 (4): 279–287. https://doi.org/10.4132/jptm.2015.06.11