The value of breast MRI may be impaired by unspecific enhancement. This may leave patients with difficult-to-assess breast tissue with an uncertain diagnosis. We examined whether this unspecific enhancement (which is mostly due to proliferative or hyperplastic changes of benign breast tissue) may be suppressed by antiestrogen medication.
Methods
In a trial of treatment, 10 peri- or postmenopausal patients who exhibited diffuse and/or focal enhancement on breast MRI before tamoxifen medication agreed to undergo a short-term tamoxifen treatment. MRI monitoring was performed 2, 4 and 8 weeks after onset of antiestrogen therapy (tamoxifen, 30 mg per day).
Results
Six patients showed a significant decrease of enhancement. Unchanged (n = 3) or increased (n = 1) enhancement was seen in 4 patients. One of the three patients with unchanged enhancement proved to have diffuse lobular carcinoma in situ.
Conclusions
Part of the unspecific enhancement seen on breast MRI can probably be suppressed by short-term antiestrogen medication.
BoetesC., BarentszJ.O., MusR.D., Van der SluisR.F., Van ErningL.J., HendriksJ.H., HollandR., RuysS.H.: MR characterisation of suspicious breast lesions with a gadolinium-enhanced Turbo FLASH subtraction technique. Radiology, 193: 777–781, 1994.
2.
Heywang-KöbrunnerS.H., BeckR.: Contrast-enhanced MRI of the breast.Springer, Berlin, Heidelberg, New York, 1996.
3.
LiuP.F., DebatinJ.F., CaduffR.F., KaclG., GarzoliE., KrestinG.P.: Improved diagnostic accuracy in dynamic contrast enhanced MRI of the breast by combined quantitative and qualitative analysis. Br J Radiol, 71: 501–509, 1998.
4.
SinhaS., Lucas-QuesadaF.A., DeBruhlN.D., SayreJ., FarriaD., GorczycaD.P., BassettL.W.: Multi-feature analysis of Gd-enhanced MR images of breast lesions. J Magn Reson Imaging, 7: 1016–1026, 1997.
5.
KuhlC.K., MielcareckP., KlaschikS., LeutnerC., WardelmannE., GiesekeJ., SchildH.H.: Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions?Radiology, 211: 101–110, 1999.
6.
LeongC.S., DanielB.L., HerfkensR.J., BirdwellR.L., JeffreyS.S., IkedaD.M., Sawyer-GloverA.M., GloverG.H.: Characterisation of breast lesion morphology with delayed 3DSSMT: an adjunct to dynamic breast MRI. J Magn Reson Imaging, 11: 87–96, 2000.
7.
Heywang-KobrunnerS.H., BickU., BradleyW.G.Jr., BoneB., CasselmanJ., CoulthardA., FischerU., Muller-SchimpfleM., OellingerH., PattR., TeubnerJ., FriedrichM., NewsteadG., HollandR., SchauerA., SicklesE.A., TabarL., WaismanJ., WerneckeK.D.: International investigation of breast MRI: results of a multi-centre study (11 sites) concerning diagnostic parameters for contrast-enhanced MRI based on 519 histopathologically correlated lesions. Eur Radiol, 11: 531–546, 2001.
8.
ViehwegP., LampeD., BuchmannJ., Heywang-KobrunnerS.H.: In situ and minimally invasive breast cancer: morphologic and kinetic features on contrast-enhanced MRI. MAGMA (Magnetic resonance materials in physics, biology and medicine), 11: 311–314, 2000.
9.
BeckR., Heywang-KöbrunnerS.H., UntchM.: Contrast-enhancement of proliferative dysplasia in MRI of the breast due to the menstruation cycle. In: European Congress of Radiology, PetersP.E. (Ed), pp 151, Springer, Berlin, Heidelberg, New York, 1993.
10.
Müller-SchimpfleM., OhmenhauserK., ClaussenC.D.: Effect of age and menstrual cycle on mammography and MR mammography. Radiologe, 37: 718–725, 1997.
11.
KuhlC.K., BielingH.B., GiesekeJ., KreftB.P., SommerT., LutterbeyG., SchildH.H.: Healthy pre-menopausal breast parenchyma in dynamic contrast-enhanced MR imaging of the breast: normal contrast medium enhancement and cyclical-phase dependency. Radiology, 203: 137–144, 1997.
NazarioA.C., De LimaG.R., SimoesM.J., NovoN.F.: Cell kinetics of the human mammary lobule during the proliferative and secretory phase of the menstrual cycle. Bull Assoc Anat (Nancy), 79: 23–27, 1995.
14.
NevenP., ShepherdJ.H., LoweD.G.: Tamoxifen and the gynaecologist. Br J Obstet Gynaecol, 10: 893–897, 1993.
15.
SoderqvistG., IsakssonE., von SchoultzB., CarlstromK., TaniE., SkoogL.: Proliferation of breast epithelial cells in healthy women during menstrual cycle. Am J Obstet Gynecol, 176: 123–128, 1997.
16.
JordanV.C., MurphyC.S.: Endocrine pharmacology of anti-estrogens as anti-tumour agents. Endocrine Rev, 4: 578–610, 1990.
17.
JordanV.C.: Growth factor regulation by tamoxifen is demonstrated in patients with breast cancer. Cancer, 72: 1–2, 1993.
18.
NoguchiS., MotomuraK., InajiH., ImaokaS., KoyamaH.: Down regulation of transforming growth factor alpha by tamoxifen in human breast cancer. Cancer, 72: 131–136, 1993.
19.
DecensiA., BonanniB., Guerrieri-GonzagaA., GandiniS., RobertsonC., JohanssonH., TravagliniR., SandriM.T., TessadrelliA., FaranteG., SalinaroF., BettegaD., BarrecaA., BoyleP., CostaA., VeronesiU.: Biologic activity of tamoxifen at low doses in healthy women. J Natl Cancer Inst, 90: 1461–1467, 1998.
