الفهرس 
ANATOMY OF BREASTOnly 14 pages are availabe for public view
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Abstract
B
reast cancer is the most frequent cancer in women worldwide, It is considered to be the second after lung cancer as the most prevalent cause of death due to cancer in women.
It was ranked; the first most common malignancy among Egyptian females.
In the last decade there was gradual reduction in mortality in women with breast cancer, this reduction is attributable to the combined effect of early diagnosis and more effective treatment.
Currently, mammography is the breast imaging technique for both clinical and screening purposes and it is the primary imaging modality for the early detection of breast cancer, its limitations including mainly the superimposition of normal breast structures in the path of the X-ray beam leading to false positive results and its limited sensitivity in women with dense breast tissue.
The supplemental screening ultrasonography has the potential to depict early breast cancers not seen on MG especially in women with dense breast.
BI-RADS lexicon ordered the sonomammograpgic abnormalities into 5 categories: category 1 and 2 belong to benign finding and category 4 and 5 belong to malignant finding.
The BI-RADS 3 is the only group exhibiting similar likelihood for both malignant and benign lesions, so it is a major problem in daily practice as its work-up is either a biopsy or follow-up mammography after 6 months.
Breast MRI is emerging as problem solving modality in mammographic BI-RADS 3 lesions as through studying the kinematic characteristics of the injected contrast medium as well as the morphological information of the lesion it can determine and differentiate the type of pathology.
The current study evaluated the role of MRI in BI-RADS 3 breast lesions diagnosed by mammography and ultrasound examination.
Our study was conducted on 28 patients who underwent sonomammographic examination with classification of their findings according to BI-RADS and they were referred for further MRI examination. The findings were correlated with histopathological results.
In our study the overall sensitivity of mammography, US and MRM was 68, 56 and 99% respectively. Their specificity was 74, 58 and 100% respectively.
MRI was the most sensitive imaging method for differentiating benign from malignant pathology in BI-RADS 3 breast lesions, but its main limitation is cost effectiveness than sonomammography.
Conclusion:
Although sonomammography is the first imaging modality to detect breast pathology, DCE MRI produces more than one advantage over sonomammography especially in BI-RADS III patients group.
In addition to its multiplanner image and non-use of ionizing radiation it doesn’t only describe the morphological characteristics of the lesion but also it determines the dynamic flow characteristics of the contrast medium during wash in and wash out creating the signal intensity curve and this demonstrates the degree of vascularity inside the lesion. Also, it provides more accurate estimation of DCIS size and better identification of its surgical margin, as well as it has higher sensitivity in differentiating recurrence from postoperative changes.
However, its main limitations are cost effective and thus it can’t be used as a screening method yet.
Finally, to conclude according to our study DCE MRI should go hand by hand with sonomammogaphy especially in BI-RADS III patients group, patients with benign looking lesion six months follow up is recommended and those with malignant looking lesion biopsy should be done.