Preoperative CT evaluation of intraductal spread of breast cancer and surgical treatment

Multi-detector row CT-guided marking technique for breast-conserving therapy of early breast cancer: margin positivity and local control rates

BACKGROUND

In breast-conserving surgery (BCS), image-guided marking of the tumor border is important for preventing local recurrence and achieving a good cosmetic outcome. The purpose of this study was to evaluate the usefulness of multi-detector row computed tomography (MDCT)-guided marking technique before BCS in patients in whom ultrasound (US)-guided marking was not feasible.

METHODS

Between 2004 and 2010, 94 lesions underwent contrast-enhanced MDCT-guided marking. Margin positivity and local control rates were compared with those of 149 lesions undergoing US-guided marking during the same period.

RESULTS

In 21 lesions undergoing CT marking (22 %) and 20 lesions undergoing US marking (13 %), a negative resection margin could not be achieved, and hence the marking was judged as unsuccessful. Eighty-four lesions of the CT marking group and 119 of the US marking group received postoperative radiotherapy with 50 Gy in 25 fractions with or without an additional 10-Gy boost to the tumor bed. The remaining 10 and 30 patients, respectively, did not receive radiotherapy. The median follow-up period was 54 and 51 months for patients with CT marking and those with US marking, respectively. At 4 postoperative years, the local control rate was 96.5 % for patients with CT marking and 97.3 % for those with US marking (P = 0.89).

CONCLUSIONS

The MDCT marking technique appears to be a valuable tool for determining the surgical margin for BCS in patients in whom ultrasound marking cannot be performed. Combining this technique with appropriate postoperative radiation therapy is expected to yield reasonably high local control rates.

Effectiveness of multi-detector row computed tomography in detection of the presence and extent of ductal carcinoma in situ

BACKGROUND

As ductal carcinoma in situ (DCIS) lesions can spread widely in the ductal-lobular segment, often without palpable tumor, complete resection of the lesion in breast-conserving surgery requires establishment of the precise location and extent of the lesion during preoperative imaging studies. We investigated the potential of multi-detector row computed tomography (MDCT) in detecting and delineating DCIS lesions.

METHODS

Overall, 74 patients with 75 DCIS lesions underwent breast MDCT. The size of the DCIS lesion in each patient was measured in the volume rendering images and compared to the size obtained by pathological mapping. The differences between the actual tumor size and that obtained from MDCT (L-Path and L-CT) were calculated, and the relationships between these differences and tumor characteristics were investigated.

RESULTS

DCIS was detected fully or partially in 64 (84.9 %) of 75 lesions, whereas the detection rate of magnetic resonance imaging (MRI) was 90 %. The detection rate was not influenced by comedo/non-comedo status, but the detection rate of higher nuclear grade DCIS lesions tended to be higher than that of low grade lesions (p = 0.089), while the estimated size was also more accurate in the former (p = 0.046). Hormone receptor and Her2 status did not affect MDCT findings.

CONCLUSION

MDCT is highly effective for detecting DCIS, especially the more aggressive types of DCIS. Moreover, the patient's position during MDCT imaging is more similar to that during surgery than that during MRI, making MDCT a highly useful presurgical imaging technique for the assessment of DCIS.