|LETTER TO THE EDITOR
|Year : 2016 | Volume
| Issue : 3 | Page : 413-414
Role of magnetic resonance spectroscopy as a noninvasive tool in characterization of breast lesions
Mansi N Jantre, Amit Kharat, Dhaval K Thakkar, Amarjit Singh
Department of Radio-diagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Maharashtra, India
|Date of Web Publication||17-May-2016|
Mansi N Jantre
Department of Radio-diagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jantre MN, Kharat A, Thakkar DK, Singh A. Role of magnetic resonance spectroscopy as a noninvasive tool in characterization of breast lesions. Med J DY Patil Univ 2016;9:413-4
We read with interest the article titled, histopathological and cytological correlation of tumors of the breast by Yalavarthi et al.  We would also further like to throw light on the role of magnetic resonance spectroscopy (MRS), as a noninvasive tool for characterizing a breast lesion as benign or malignant.
Breast cancer is the most common cause for cancer deaths in women worldwide.
In 2012, 1.7 million women were diagnosed with breast cancer, and there were 6.3 million women alive who had been diagnosed with breast cancer in the previous 5 years. Since the 2008 estimates, breast cancer incidence has increased by >20%, while mortality has increased by 14%. Breast cancer is also the most common cause of cancer death among women (522,000 deaths in 2012).  An early diagnosis can bring about a drastic decline in the fatality resulting from breast cancer. Moreover, prior surgical assessment of the pathologic type and extent of breast lesions has the potential to greatly improve the management of breast cancer.
One of the common diagnostic methods employed is the triple test, which comprises clinical examination, mammography, and fine needle aspiration cytology.  It has been estimated that between 5% and 15% of tumors are missed on mammography, and that the overall yield of breast cancers per biopsy (recommended on the basis of screening mammography) has been reported to be between only 10% and 50%.  While this yield may be moderately increased by the use of ultrasound for the differentiation of cystic versus solid masses, there continues to be a search for alternative or adjunctive screening techniques with both higher sensitivity and specificity. 
With the advent of MRS, a new noninvasive diagnostic tool can be adopted in diagnosing these lesions. Quantitative hydrogen 1-MRS (1 H-MRS) can provide us with useful information for characterizing various tumor types of breast cancer. High-resolution magnetic resonance imaging (MRI) and contrast-enhanced MRI have emerged as a standard tool for detection and diagnosis of breast lesions.
Recently, breast spectroscopy has been shown to improve cancer diagnosis based on elevated choline-containing compounds (tCho) metabolite peak. 1 H-MRS can be used to distinguish between benign and malignant lesions as owing to high cell membrane turnover, choline is only detectable in malignancies.
MRS is a rapidly developing field of neuroimaging that allows noninvasive in vivo analysis of metabolites, thus providing biochemical information about the tissue. Single voxel technique is preferred to multi-voxel as the scan area of interest is limited. 1 H MRS has proved to be a good affiliation to breast MRI in improving the specificity in differentiating benign and neoplastic lesions and also in monitor their response to chemotherapy.
A study conducted in 2007 for diagnostic value of 1 H-MRS at 1.5T in different histopathological types in breast cancer, presented with 100% specificity for diagnosis. The choline levels were found to be higher in invasive cancer compared to ductal carcinoma in situ (DCIS) or benign lesions, possibly associated with more aggressive behavior or faster cell replication in invasive cancer. 
Many studies that have been conducted using higher field strength magnets have shown that 1 H-MRS can be used to distinguish between benign and malignant tissues based on the principle that choline is only detectable in neoplastic tissues owing to increase metabolic activity in tumoral cells. , In total, these studies implied that this choline detectability criterion can identify malignancies with 89% sensitivity and 87% specificity.
The choline levels were found to be higher in invasive cancer compared to DCIS or other benign lesions, possibly indicating a more aggressive behavior or faster cell replication of tumor cells in invasive cancer.  MRS thus provides useful information for characterizing histopathological types in breast carcinoma.
There are studies that have suggested that 1 H-MRS can potentially cause a marked decrease in the number of biopsies of benign lesions recommended by MRI. Another area of interest for breast MRS is an evaluation of response to therapy in patients who are undergoing chemotherapy.  Choline-containing compounds are detected in metastatic lymph nodes. H-MRS can thus prove to be an important noninvasive tool for detection of axillary lymph node metastasis occurring in patients with breast cancer thus aiding evaluation of the sentinel node for prognostic and surgical planning purposes.  H-MRS can be of great value in evaluating conservatively treated breasts with a suspected tumor recurrence, as well as in differentiating local recurrence from other sequels that may occur following surgery which includes postoperative scarring. ,
Although a vast majority of MRS has been dedicated to studies of the central nervous system, there is growing interest in the application of MRS to other organ systems particularly true for areas such as breast cancer, where conventional diagnostic techniques have relatively limited sensitivity and specificity. Proton MRS is hence proving to be a promising diagnostic technique for breast cancer, which in particular for improving the specificity of breast MRI examinations. It can be readily performed within the same session as a breast MRI exam. It is low-risk in that it is noninvasive and does not involve radiation.
Histopathological and cytological correlation, although important tools, is invasive and involves a sufficient amount of time to arrive to a diagnosis MRS can thus prove to be a useful adjunct for early and accurate diagnosis of breast cancer.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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