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Thoracic Manifestations of Breast Cancer and Its Therapy¹

¹ From the Department of Radiology, St Mary’s Hospital, College of Medicine, Catholic University of Korea, 62 Yeouido-dong, Youngdungpo-gu, Seoul 150–713, South Korea (J.I.J., S.H.P., S.W.S., M.H.C., H.S.K., K.J.K., M.I.A., S.T.H.); and the Department of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea (H.H.K., S.B.S.). Presented as an education exhibit at the 2002 RSNA scientific assembly. Received March 13, 2003; revision requested June 3 and final revision received December 19; accepted December 23. All authors have no financial relationships to disclose. Address correspondence to J.I.J. (e-mail: jijung@catholic.ac.kr).

Breast cancer is the second most common cause of cancer-related death in women. In most patients, imaging demonstrates thoracic changes resulting from either treatment, complications of treatment, or tumor recurrence or metastasis. The postsurgical imaging appearance of the chest wall depends on the surgical method used (radical mastectomy, modified radical mastectomy, breast-conserving surgery, breast reconstruction). The most common surgery-related complication is seroma. Radiation therapy frequently causes radiation pneumonitis, which occurs approximately 4–12 weeks after the completion of therapy and is characteristically limited to the field of irradiation. Chemotherapy-related complications include cardiotoxicity, pneumonitis, and infection. Ultrasonography and computed tomography are more sensitive than physical examination for detecting local and regional recurrence. The thorax is a common site of metastasis, which may affect the lymph nodes, bone, lung, pleura, or heart and pericardium. Bone metastasis is usually evaluated with bone scintigraphy and may cause spinal cord compression, a serious complication that requires early diagnosis. Intrapulmonary metastasis may manifest as single or multiple pulmonary nodules, airspace pattern metastasis, lymphangitic metastasis, or endobronchial metastasis. Pleural metastasis usually manifests as pleural effusion, with or without a pleural mass. Familiarity with the spectrum of radiologic findings in breast cancer patients allows accurate image interpretation and correct diagnosis.

© RSNA, 2004

Index Terms: Breast, diseases, 00.32 • Breast, surgery • Breast neoplasms, 00.32 • Breast neoplasms, metastases, 00.32 • Breast neoplasms, postoperative • Breast neoplasms, surgery • Breast neoplasms, therapy • Chemotherapy, complications • Lung neoplasms, metastases, 60.33 • Lymphatic system, neoplasms, 99.33 • Radiations, injurious effects • Surgery, complications, 00.458

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