title: MR imaging-guided sonography followed by fine-needle aspiration cytology in occult carcinoma of the breast.
abstract: OBJECTIVE
  In patients with axillary metastases as clinical evidence of possible occult breast cancer, a combined approach of MR imaging, sonography, and aspiration biopsy cytology was evaluated.
  
  
  METHODS
  Thirty-one women with metastatic adenocarcinoma in their axillary lymph nodes originating from an unknown primary site underwent MR imaging of the breast because physical examination and mammography findings were normal. Twenty of the 31 women had no history of malignancy, 10 had been previously treated for contralateral breast cancer, and one patient had nodal metastases in the contralateral axilla at the time breast cancer was detected. When a contrast-enhancing lesion was revealed on MR imaging of the breast, sonography and fine-needle aspiration cytology were also performed.
  
  
  RESULTS
  MR imaging revealed the primary breast cancer in eight (40%) of the 20 patients without a history of malignancy. MR imaging of the breast revealed a second primary cancer in three (27%) of the 11 patients with previous or simultaneous breast cancer. All lesions were identified with sonography and verified by cytology and histology.
  
  
  CONCLUSIONS
  In women with axillary lymph node metastases from adenocarcinoma, MR imaging of the breast should be added to clinical examination and mammography before defining the breast cancer as occult. The combined approach of MR imaging, sonography, and aspiration fine-needle cytology is a good alternative to the MR imaging-guided biopsy.
authors.affiliation: Department of Radiology, Dr. Daniel den Hoed Cancer Center, University Hospital Rotterdam, The Netherlands.
authors.forename: I M
authors.initials: IM
authors.lastname: Obdeijn
authors.forename: E M
authors.initials: EM
authors.lastname: Brouwers-Kuyper
authors.forename: M M
authors.initials: MM
authors.lastname: Tilanus-Linthorst
authors.forename: T
authors.initials: T
authors.lastname: Wiggers
authors.forename: M
authors.initials: M
authors.lastname: Oudkerk
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000556:secondary; D000328:Adult; D000368:Aged; D001365:Axilla; D001707:Biopsy, Needle / Q000379:methods; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000000981:diagnostic imaging / Q000473:pathology*; D014463:Ultrasonography