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Li F, Zhu TW, Lin M, Zhang XT, Zhang YL, Zhou AL, Huang DY. Enhancing Ki-67 Prediction in Breast Cancer: Integrating Intratumoral and Peritumoral Radiomics From Automated Breast Ultrasound via Machine Learning. Acad Radiol 2024; 31:2663-2673. [PMID: 38182442 DOI: 10.1016/j.acra.2023.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 01/07/2024]
Abstract
RATIONALE AND OBJECTIVES Traditional Ki-67 evaluation in breast cancer (BC) via core needle biopsy is limited by repeatability and heterogeneity. The automated breast ultrasound system (ABUS) offers reproducibility but is constrained to morphological and echoic assessments. Radiomics and machine learning (ML) offer solutions, but their integration for improving Ki-67 predictive accuracy in BC remains unexplored. This study aims to enhance ABUS by integrating ML-assisted radiomics for Ki-67 prediction in BC, with a focus on both intratumoral and peritumoral regions. MATERIALS AND METHODS A retrospective analysis was conducted on 936 BC patients, split into training (n = 655) and testing (n = 281) cohorts. Radiomics features were extracted from intra- and peritumoral regions via ABUS. Feature selection involved Z-score normalization, intraclass correlation, Wilcoxon rank sum tests, minimum redundancy maximum relevance, and least absolute shrinkage and selection operator logistic regression. ML classifiers were trained and optimized for enhanced predictive accuracy. The interpretability of the optimized model was further augmented by employing Shapley additive explanations (SHAP). RESULTS Of the 2632 radiomics features in each patient, 15 were significantly associated with Ki-67 levels. The support vector machine (SVM) was identified as the optimal classifier, with area under the receiver operating characteristic curve values of 0.868 (training) and 0.822 (testing). SHAP analysis indicated that five peritumoral and two intratumoral features, along with age and lymph node status, were key determinants in the predictive model. CONCLUSION Integrating ML with ABUS-based radiomics effectively enhances Ki-67 prediction in BC, demonstrating the SVM model's strong performance with both radiomics and clinical factors.
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Affiliation(s)
- Fang Li
- Department of Ultrasound, The People's Hospital of Yuhuan, No. 18, Changle Rd, Yuhuan 317600, Zhejiang, China (F.L., X.Z., Y.Z., A.Z., D.H.)
| | - Tong-Wei Zhu
- Department of Ultrasound, Taizhou Hospital of Zhejiang Province, Linhai, Zhejiang, China (T.Z.)
| | - Miao Lin
- Second Department of General Surgery, The People's Hospital of Yuhuan, Yuhuan, Zhejiang, China (M.L.)
| | - Xiao-Ting Zhang
- Department of Ultrasound, The People's Hospital of Yuhuan, No. 18, Changle Rd, Yuhuan 317600, Zhejiang, China (F.L., X.Z., Y.Z., A.Z., D.H.)
| | - Ya-Li Zhang
- Department of Ultrasound, The People's Hospital of Yuhuan, No. 18, Changle Rd, Yuhuan 317600, Zhejiang, China (F.L., X.Z., Y.Z., A.Z., D.H.)
| | - Ai-Li Zhou
- Department of Ultrasound, The People's Hospital of Yuhuan, No. 18, Changle Rd, Yuhuan 317600, Zhejiang, China (F.L., X.Z., Y.Z., A.Z., D.H.)
| | - De-Yi Huang
- Department of Ultrasound, The People's Hospital of Yuhuan, No. 18, Changle Rd, Yuhuan 317600, Zhejiang, China (F.L., X.Z., Y.Z., A.Z., D.H.).
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Kuş CC, Güldoğan N, Yılmaz E, Soyder A, Arslan A, Arıbal ME. Can Supine Breast Magnetic Resonance Imaging After a Dynamic Contrast-Enhanced Breast Magnetic Resonance Imaging Provide Information for Supine Procedures? J Comput Assist Tomogr 2023:00004728-990000000-00169. [PMID: 36944155 DOI: 10.1097/rct.0000000000001461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
METHODS A retrospective analysis was conducted on 75 lesions in 50 patients with pathologically proven breast cancer who underwent MRI in prone and supine positions between December 2019 and December 2020. The transverse, anteroposterior, and craniocaudal dimensions (in millimeters) of the tumor in the x-, y-, and z-axes were measured. Distances from the center of the tumor to the chest wall and the adjacent skin were measured on transverse and reformatted sagittal images. In cases where multifocal lesions were present, the transverse, anteroposterior, and craniocaudal distances between the tumor centers in the x-, y-, and z-axes were measured. Differences between measurements in supine and prone MRI were evaluated with the Mann-Whitney U and the Wilcoxon tests. P values of less than 0.05 were considered to indicate a statistically significant difference. RESULTS The analysis revealed 31 MRIs with 1 and 20 with multifocal lesions. The x-axis dimension of the lesions in prone and supine positions did not significantly differ (P = 0.198) between the 2 positions. A significant difference in the y- and z-axes dimensions was observed between the prone and supine position (P = 0.00 for both). The distance from the tumor to the chest wall and the adjacent skin showed significant difference (P = 0.00 for both). For multifocal lesions, the distance between the lesions showed a significant difference on the y-axis (P = 0.00). CONCLUSIONS This study showed a significant difference in the tumor size, location, and tumor-to-tumor distances due to change of patient position, from the standard prone MRI to the supine position in the operating room, resulting in distortion, spatial repositioning, and convergence of the lesions. Supine MRI may be considered in providing a less extensive surgery.
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Affiliation(s)
- Ceyda Civan Kuş
- From the Department of Radiology, Marmara University Research and Education Hospital
| | | | | | | | - Aydan Arslan
- Department of Radiology, Ümraniye Research and Education Hospital
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Matsumoto H, Ishii A, Nakada N, Koki A, Unesoko M, Abe N, Zaha H. Predictive value of ductal carcinoma in situ with invasive breast cancer in core needle biopsies for final pathologic size of intraductal elements. Virchows Arch 2022; 480:739-748. [PMID: 34993592 DOI: 10.1007/s00428-021-03243-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/29/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
Preoperative evaluations of the size of ductal carcinoma in situ (DCIS) extension in invasive breast cancer (IBC) are problematic and markers of the actual size of DCIS remain elusive. This study aimed to quantify DCIS on core needle biopsy (CNB) and investigated its association with degree of DCIS extension on paired resection specimens, instead of with presence or absence of an extensive intraductal component or margin status as in earlier studies. This series examined 150 IBCs diagnosed from paired CNB and resection specimens. The DCIS/invasion ratio was calculated using the sum of each element size from CNB. In resection specimens, cases in which the greatest dimension of DCIS extension was longer than the greatest dimension of invasive size were defined as extended DCIS (Ext-DCIS). DCIS/invasion ratio level correlated positively with the degree of Ext-DCIS (P = 0.003). Using receiver operating characteristic curve analysis, setting cases with the subgroup of DCIS extension with greatest dimension > 2.5 times that of the invasive size in the resection specimen (Ext-DCIS > 2.5) as the positive class provided the best discrimination ability for DCIS/invasion ratio (0.375). In multivariate analysis, DCIS/invasion ratio > 0.375 was significantly associated with Ext-DCIS > 2.5 (P = 0.033). In conclusion, DCIS/invasion ratio > 0.375 in CNB was identified as a predictor of Ext-DCIS > 2.5 in resection specimens, suggesting that an approach combining DCIS/invasion ratio from CNB with preoperative staging may better predict the extent of DCIS and facilitate better surgical planning.
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Affiliation(s)
| | - Akiko Ishii
- Department of Pathology, Nakagami Hospital, Okinawa, 904-2195, Japan
| | - Norihiro Nakada
- Department of Pathology, Nakagami Hospital, Okinawa, 904-2195, Japan
| | - Ayako Koki
- Department of Breast Surgery, Nakagami Hospital, Okinawa, Japan
| | - Mikiko Unesoko
- Department of Breast Surgery, Nakagami Hospital, Okinawa, Japan
| | - Norie Abe
- Department of Breast Surgery, Nakagami Hospital, Okinawa, Japan
| | - Hisamitsu Zaha
- Department of Breast Surgery, Nakagami Hospital, Okinawa, Japan
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Guven S, Durur-Subasi I, Demirci E, Arikok AT, Karaman A, Han U, Hekimoglu B. Mass and non-mass breast MRI patterns: a radiologic approach to sick lobe theory. Acta Radiol 2021; 62:715-721. [PMID: 32693609 DOI: 10.1177/0284185120941825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND According to sick lobe theory, one or more lobes of the breast are more prone to the development of carcinoma. However, the implications of this theory in breast magnetic resonance imaging (MRI) are unknown. PURPOSE To evaluate the MRI appearance of mass type (multifocal and multicentric diseases) and non-mass type (non-mass enhancements) sick lobe patterns, together with the histopathology results. MATERIAL AND METHODS MRI reports of 2015 patients in two tertiary breast imaging centers between June 2012 and June 2018 were retrospectively reviewed for multifocal-multicentric diseases and segmental, linear, and regional enhancements. A total of 113 patients were included. The specimens obtained by thick needle, vacuum, excisional biopsy/lumpectomy or mastectomy after breast MRI scans were pathologically assessed. The pathologic results were categorized as invasive carcinoma, precursor, and benign proliferative lesions according to the 2012 World Health Organization Classification of Tumors. RESULTS The percentage of underlying benign and precursor invasive lesions was significantly different in patients with mass and non-mass MRI patterns. While the pathology results of mass type patterns were premalignant and malignant in all cases, nearly half of the underlying histologies were benign proliferative subtypes in patients with non-mass type patterns. CONCLUSION In this study, the mass and non-mass patterns derived from sick lobe theory were related to different risks of malignancy in the pathological examinations.
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Affiliation(s)
- Selda Guven
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Clinic of Radiology, Ankara, Turkey
| | - Irmak Durur-Subasi
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Clinic of Radiology, Ankara, Turkey
- Ataturk University, Faculty of Medicine, Department of Radiology, Erzurum, Turkey
- Istanbul Medipol University, Faculty of Medicine, Department of Radiology, Istanbul, Turkey
| | - Elif Demirci
- Ataturk University, Faculty of Medicine, Department of Pathology, Erzurum, Turkey
| | - Ata Turker Arikok
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Clinic of Pathology, Ankara, Turkey
| | - Adem Karaman
- Ataturk University, Faculty of Medicine, Department of Radiology, Erzurum, Turkey
| | - Unsal Han
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Clinic of Pathology, Ankara, Turkey
| | - Baki Hekimoglu
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Clinic of Radiology, Ankara, Turkey
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A multiparametric approach to diagnosing breast lesions using diffusion-weighted imaging and ultrafast dynamic contrast-enhanced MRI. Magn Reson Imaging 2020; 71:154-160. [DOI: 10.1016/j.mri.2020.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/06/2020] [Accepted: 04/12/2020] [Indexed: 12/30/2022]
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Kishimoto AO, Kataoka M, Iima M, Honda M, Miyake KK, Ohashi A, Ota R, Kataoka T, Sakurai T, Toi M, Togashi K. Evaluation of Malignant Breast Lesions Using High-resolution Readout-segmented Diffusion-weighted Echo-planar Imaging: Comparison with Pathology. Magn Reson Med Sci 2020; 20:204-215. [PMID: 32611938 PMCID: PMC8203479 DOI: 10.2463/mrms.mp.2020-0021] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE We aimed to investigate the performance of high resolution-diffusion-weighted imaging (HR-DWI) using readout-segmented echo-planar imaging in visualizing malignant breast lesions and evaluating their extent, using pathology as a reference. METHODS This retrospective study included patients who underwent HR-DWI with surgically confirmed malignant breast lesions. Two radiologists blinded to the final diagnosis evaluated HR-DWI independently and identified the lesions, measuring their maximum diameters. Another radiologist confirmed if those lesions were identical to the pathology. The maximum diameters of the lesions between HR-DWI and pathology were compared, and their correlations were calculated using Spearman's correlation coefficient. Apparent diffusion coefficient (ADC) values of the lesions were measured. RESULTS Ninety-five mass/64 non-mass lesions were pathologically confirmed in 104 females. Both radiologists detected the same 93 mass lesions (97.9%). Spearman's correlation coefficient for mass lesions were 0.89 and 0.90 (P < 0.0001 and 0001) for the two radiologists, respectively. The size differences within 10 mm were 90.3% (84/93) and 94.6% (88/93) respectively. One radiologist detected 35 non-mass lesions (54.7%) and another radiologist detected 32 non-mass lesions (50.0%), of which 28 lesions were confirmed as identical. Spearman's correlation coefficient for non-mass lesions were 0.59 and 0.22 (P = 0.0002 and 0.22), respectively. The mean ADC value of mass lesions and non-mass lesions were 0.80 and 0.89 × 10-3 mm2/s, respectively. CONCLUSION Using HR-DWI, malignant mass lesions were depicted with excellent agreement with the pathological evaluation. Approximately half of the non-mass lesions could not be identified, suggesting a current limitation of HR-DWI.
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Affiliation(s)
- Ayami Ohno Kishimoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Masako Kataoka
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Mami Iima
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University.,Institute for Advancement of Clinical and Translational Science (iACT), Kyoto University Hospital
| | - Maya Honda
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Kanae Kawai Miyake
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Akane Ohashi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Rie Ota
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | - Tatsuki Kataoka
- Department of Diagnostic Pathology, Kyoto University Hospital
| | - Takaki Sakurai
- Department of Diagnostic Pathology, Kyoto University Hospital
| | - Masakazu Toi
- Department of Breast Surgery, Kyoto University Hospital
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
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Romeo V, Picariello V, Pignata A, Mancusi V, Stanzione A, Cuocolo R, Di Crescenzo R, Accurso A, Staibano S, Imbriaco M. Influence of different post-contrast time points on dynamic contrast-enhanced (DCE) MRI T staging in breast cancer. Eur J Radiol 2020; 124:108819. [PMID: 31958631 DOI: 10.1016/j.ejrad.2020.108819] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 12/23/2019] [Accepted: 12/31/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE to assess whether MRI T stage of breast cancer lesions (BCLs) is affected by maximum diameter (MD) measured at different post-contrast time points (TPs) on different acquisition planes on dynamic contrast-enhanced (DCE) MRI sequence. METHODS 53 DCE-MRI examinations of patients with BCLs were retrospectively selected. MD of BCLs was measured on axial, coronal and sagittal planes on DCE images at five different post-contrast TPs. Friedman test followed by Bonferroni-adjusted Wilcoxon-signed rank test for post-hoc analysis was performed to evaluate differences among the five measurements. Reliability of the measurements was evaluated with the intraclass correlation coefficient analysis. Differences between pathological and MRI T stage assessed at each TP on each acquisition plane were assessed using the Wilcoxon-sign rank test; p values <0.05 were considered statistically significant. RESULTS on axial, coronal and sagittal planes, MD measured at TP1 was significantly different (p < 0.0001) compared to those obtained at the subsequent TPs. No significant differences were found between MD measured at TPs 3, 4 and 5. Intra and inter-observer reliability resulted as very good, with ICC ranging between 0.915-0.992 and 0.845-0.911, respectively. MRI T stage assessed at TP1 on axial and sagittal plane as well as at all TPs on coronal plane was significantly different from pathological T stage. CONCLUSION MRI T stage definition of BCLs is significantly affected by the TP used for lesions' MD measurement. TPs 3, 4 and 5 are the preferred TPs for the assessment of MRI T stage of BCLs on both axial and sagittal planes.
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Affiliation(s)
- Valeria Romeo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Valentina Picariello
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Alma Pignata
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Valeria Mancusi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Renato Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Rosa Di Crescenzo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Antonello Accurso
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Stefania Staibano
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy.
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The Japanese Breast Cancer Society Clinical Practice Guidelines for Breast Cancer Screening and Diagnosis, 2018 Edition. Breast Cancer 2019; 27:17-24. [PMID: 31734900 PMCID: PMC8134289 DOI: 10.1007/s12282-019-01025-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/09/2019] [Indexed: 12/14/2022]
Abstract
This article updates readers as to what is new in the Japanese Breast Cancer Society Clinical Practice Guidelines for Breast Cancer Screening and Diagnosis, 2018 Edition. Breast cancer screening issues are covered, including matters of breast density and possible supplemental modalities, along with appropriate pre-operative/follow-up diagnostic breast imaging tests. Up-to-date clinical practice guidelines for breast cancer screening and diagnosis should help to provide patients and clinicians with not only evidence-based breast imaging options, but also accurate and balanced information about the benefits and harms of intervention, which ultimately enables shared decision making about imaging test plans.
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Hamza A, Khawar S, Sakhi R, Alrajjal A, Miller S, Ibrar W, Edens J, Salehi S, Ockner D. Factors affecting the concordance of radiologic and pathologic tumor size in breast carcinoma. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2018; 27:45-54. [PMID: 30774698 DOI: 10.1177/1742271x18804278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 09/08/2018] [Indexed: 11/16/2022]
Abstract
Background Radiologic assessment of tumor size is an integral part of the work-up for breast carcinoma. With improved radiologic equipment, surgical decision relies profoundly upon radiologic/clinical stage. We wanted to see the concordance between radiologic and pathologic tumor size to infer how accurate radiologic/clinical staging is. Materials and methods The surgical pathology and ultrasonography reports of patients with breast carcinoma were reviewed. Data were collected for 406 cases. Concordance was defined as a size difference within ±2 mm. Results The difference between radiologic and pathologic tumor size was within ±2 mm in 40.4% cases. The mean radiologic size was 1.73 ± 1.06 cm. The mean pathologic size was 1.84 ± 1.24 cm. A paired t-test showed a significant mean difference between radiologic and pathologic measurements (0.12 ± 1.03 cm, p = 0.03). Despite the size difference, stage classification was the same in 59.9% of cases. Radiologic size overestimated stage in 14.5% of cases and underestimated stage in 25.6% of cases. The concordance rate was significantly higher for tumors ≤2 cm (pT1) (51.1%) as compared to those greater than 2 cm (≥pT2) (19.7%) (p < 0.0001). Significantly more lumpectomy specimens (47.5%) had concordance when compared to mastectomy specimens (29.8%) (p < 0.0001). Invasive ductal carcinoma had better concordance compared to other tumors (p = 0.02). Conclusion Mean pathologic tumor size was significantly different from mean radiologic tumor size. Concordance was in just over 40% of cases and the stage classification was the same in about 60% of cases only. Therefore, surgical decision of lumpectomy versus mastectomy based on radiologic tumor size may not always be accurate.
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Affiliation(s)
- Ameer Hamza
- St. John Hospital and Medical Center, Detroit, MI, USA
| | - Sidrah Khawar
- St. John Hospital and Medical Center, Detroit, MI, USA
| | - Ramen Sakhi
- St. John Hospital and Medical Center, Detroit, MI, USA
| | | | - Shelby Miller
- St. John Hospital and Medical Center, Detroit, MI, USA
| | - Warda Ibrar
- St. John Hospital and Medical Center, Detroit, MI, USA
| | - Jacob Edens
- St. John Hospital and Medical Center, Detroit, MI, USA
| | - Sajad Salehi
- St. John Hospital and Medical Center, Detroit, MI, USA
| | - Daniel Ockner
- St. John Hospital and Medical Center, Detroit, MI, USA
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Hamza A, Sakhi R, Alrajjal A, Ibrar W, Miller S, Salehi S, Edens J, Ockner D. Tumor Size in Breast Carcinoma: Gross Measurement Is Important! Int J Surg Pathol 2018; 26:494-499. [DOI: 10.1177/1066896918765663] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction. The staging of breast carcinoma is mainly dependent on tumor size and lymph node status. Small increments in tumor size upstage the patient. An accurate determination of the tumor size is therefore critically important. Although the final staging is based on microscopic size, pathologists rely on gross measurements in a considerable number of cases. Methods. We investigated the concordance between gross and microscopic measurements of breast carcinoma as well as factors affecting this concordance. This study is a retrospective review of surgical pathology reports of invasive breast carcinomas. Data were collected for 411 cases. Concordance was defined as a size difference within ±2 mm. Results. Gross and microscopic sizes were identical in 33.1% of cases. Gross and microscopic size difference was within ±2 mm in 56% of cases. Despite the size difference, stage classification ended up being the same in 68.6% of cases. Tumor stage was over estimated by gross measurement in 17.0% of cases and underestimated in 14.4% of cases. The concordance was significantly higher for those tumors in which final pathologic tumor (pT) size was greater than 2 cm (≥pT2) as compared with those less than or equal to 2 cm (≤pT1; P < .0001). A higher proportion of mastectomy specimens (61.4%) were concordant as compared with lumpectomy specimens (52.1%). Conclusion. Gross and microscopic tumor sizes were concordant in 56% of cases. Stage classification based on gross and microscopic tumor size was different in nearly one third (31.4%) of cases. Gross tumor size is critically important in accurate staging at least in cases where tumor size cannot be confirmed microscopically.
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Affiliation(s)
- Ameer Hamza
- St. John Hospital and Medical Center, Detroit, MI, USA
| | - Ramen Sakhi
- St. John Hospital and Medical Center, Detroit, MI, USA
| | | | - Warda Ibrar
- St. John Hospital and Medical Center, Detroit, MI, USA
| | - Shelby Miller
- St. John Hospital and Medical Center, Detroit, MI, USA
| | - Sajad Salehi
- St. John Hospital and Medical Center, Detroit, MI, USA
| | - Jacob Edens
- St. John Hospital and Medical Center, Detroit, MI, USA
| | - Daniel Ockner
- St. John Hospital and Medical Center, Detroit, MI, USA
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11
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Baek SH, Choi WJ, Cha JH, Kim HH, Shin HJ, Chae EY. Comparison of mammography, ultrasound, and MRI in size assessment of ductal carcinoma in situ with histopathologic correlation. Acta Radiol 2017; 58:1434-1441. [PMID: 28281788 DOI: 10.1177/0284185117698860] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background The ability to accurately assess tumor size in ductal carcinoma in situ (DCIS) is an important clinical issue when selecting the appropriate treatment plan. Purpose To compare the accuracy of using mammography, ultrasound (US), and magnetic resonance imaging (MRI) to assess DCIS tumor size based on imaging and histopathological findings. Material and Methods Fifty-six patients with DCIS were included. Mammography, US, and MRI were reviewed, and the accuracy of the measured tumor sizes were compared with the imaging and histopathological parameters. Results If visible, tumor measurements demonstrated high reliability with the pathologically determined size, with the best results obtained using US ( k = 0.851) followed by mammography ( k = 0.815) and MRI ( k = 0.738). Tumor size assessment was significantly more accurate when the lesion was shown as a mass on US ( P = 0.003) or MRI ( P < 0.001) with minimal and mild background parenchymal enhancement ( P = 0.016) on MRI. When mammography was used to assess tumor size, the tumors with positive estrogen receptor status and luminal A subtype demonstrated a significantly more accurate tumor size. Conclusion The combination of US and MRI, in addition to mammography, has an important role in assessing the exact tumor extent of DCIS.
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Affiliation(s)
- Soo Heui Baek
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Woo Jung Choi
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Joo Hee Cha
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Hak Hee Kim
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Hee Jung Shin
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Eun Young Chae
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
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12
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França LKL, Bitencourt AGV, Paiva HLS, Silva CB, Pereira NP, Paludo J, Graziano L, Guatelli CS, de Souza JA, Marques EF. Role of magnetic resonance imaging in the planning of breast cancer treatment strategies: comparison with conventional imaging techniques. Radiol Bras 2017; 50:76-81. [PMID: 28428649 PMCID: PMC5396996 DOI: 10.1590/0100-3984.2015.0124] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 02/13/2016] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVE To assess the role of magnetic resonance imaging (MRI) in the planning of breast cancer treatment strategies. MATERIALS AND METHODS The study included 160 women diagnosed with breast cancer, who underwent breast MRI for preoperative staging. Using Pearson's correlation coefficient (r), we compared the size of the primary tumor, as determined by MRI, by conventional imaging (mammography and ultrasound), and in the pathological examination (gold standard). The identification of lesions not identified in previous examinations was also evaluated, as was its influence on treatment planning. RESULTS The mean age of the patients was 52.2 years (range, 30-81 years), and the most common histological type was invasive ductal carcinoma (in 60.6% of the patients). In terms of the tumor size determined, MRI correlated better with the pathological examination than did mammography (r = 0.872 vs. 0.710) or ultrasound (r = 0.836 vs. 0.704). MRI identified additional lesions in 53 patients (33.1%), including malignant lesions in 20 (12.5%), which led to change in the therapeutic planning in 23 patients (14.4%). CONCLUSION Breast MRI proved to be more accurate than conventional imaging in determining the dimensions of the main tumor and was able to identify lesions not identified by other methods evaluated, which altered the therapeutic planning in a significant proportion of cases.
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Affiliation(s)
| | | | | | - Caroline Baptista Silva
- MD, Resident in Radiology and Diagnostic Imaging, A.C.Camargo
Cancer Center, São Paulo, SP, Brazil
| | - Nara Pacheco Pereira
- MD, Resident in Radiology and Diagnostic Imaging, A.C.Camargo
Cancer Center, São Paulo, SP, Brazil
| | - Jociana Paludo
- MD, Resident in Radiology and Diagnostic Imaging, A.C.Camargo
Cancer Center, São Paulo, SP, Brazil
| | - Luciana Graziano
- MD, Attending Physician, Imaging Department, A.C.Camargo Cancer
Center, São Paulo, SP, Brazil
| | - Camila Souza Guatelli
- MD, Attending Physician, Imaging Department, A.C.Camargo Cancer
Center, São Paulo, SP, Brazil
| | - Juliana Alves de Souza
- MD, Attending Physician, Imaging Department, A.C.Camargo Cancer
Center, São Paulo, SP, Brazil
| | - Elvira Ferreira Marques
- MD, Head of the Department of Breast Imaging, A.C.Camargo Cancer
Center, São Paulo, SP, Brazil
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The Accuracy of Breast MR Imaging for Measuring the Size of a Breast Cancer: Analysis of the Histopathologic Factors. Clin Breast Cancer 2016; 16:e145-e152. [DOI: 10.1016/j.clbc.2016.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/10/2016] [Accepted: 07/20/2016] [Indexed: 11/24/2022]
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Prediction Model For Extensive Ductal Carcinoma In Situ Around Early-Stage Invasive Breast Cancer. Invest Radiol 2016; 51:462-8. [DOI: 10.1097/rli.0000000000000255] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Masumoto N, Kadoya T, Amioka A, Kajitani K, Shigematsu H, Emi A, Matsuura K, Arihiro K, Okada M. Evaluation of Malignancy Grade of Breast Cancer Using Perflubutane-Enhanced Ultrasonography. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1049-1057. [PMID: 26895755 DOI: 10.1016/j.ultrasmedbio.2015.12.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/13/2015] [Accepted: 12/21/2015] [Indexed: 06/05/2023]
Abstract
Whether the contrast effects of perflubutane on contrast-enhanced ultrasonography can predict the malignancy grade of breast cancer is unknown. We analyzed associations between perfusion parameters created from time-intensity curves based on enhancement intensity and temporal changes in contrast-enhanced ultrasonography and clinicopathologic factors in 100 consecutive patients with invasive breast cancer. Values of perfusion parameters were significantly greater in estrogen receptor-negative than -positive tumors (peak intensity, p = 0.0002; ascending slope, p = 0.006; area under the curve, p = 0.0006). Variations in the peak intensity of Ki-67 were significantly correlated in all tumors (r = 0.54, p < 0.0001) and in luminal (r = 0.43, p = 0.0002), human epidermal growth factor receptor type 2-positive (r = 0.47, p = 0.047) and triple-negative (r = 0.55, p = 0.043) tumors. Perfusion parameters on contrast-enhanced ultrasonography can provide excellent predictive value for high-grade malignancy and might help to determine appropriate therapeutic strategies.
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Affiliation(s)
- Norio Masumoto
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Takayuki Kadoya
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Ai Amioka
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Keiko Kajitani
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Hideo Shigematsu
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Akiko Emi
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Kazuo Matsuura
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Koji Arihiro
- Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
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Szynglarewicz B, Maciejczyk A, Forgacz J, Matkowski R. Breast segmentectomy with rotation mammoplasty as an oncoplastic approach to extensive ductal carcinoma in situ. World J Surg Oncol 2016; 14:72. [PMID: 26956623 PMCID: PMC4784271 DOI: 10.1186/s12957-016-0825-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 02/29/2016] [Indexed: 12/21/2022] Open
Abstract
Background The aim of this study was to assess the usefulness of the breast segmentectomy with rotation mammoplasty (BSRMP) in conserving therapy for an extensive ductal carcinoma in situ (DCIS) with or without an invasive component. Methods Thirty-six women with DCIS visible as large area of microcalcifications distributed out of the retroareolar area regardless of the quadrant were studied prospectively. All the patients underwent BSRMP and axillary procedure (31 sentinel node biopsy, 5 axillary dissection) followed by radiotherapy. In each case, follow-up was carried out carefully and special effort was made to identify postoperative complications. Cosmetic result was judged 6 months after radiotherapy by the patient herself and two surgeons being rated as poor, mediocre, medium, good or excellent. Results Operation was completed without any difficulties in all the cases. Appropriate BSRMP was easily done after the skin marking. Regardless of the type of axillary approach, it was conveniently performed. Wound was healed by primary adhesion; skin or breast tissue necrosis did not develop. Neither haematoma nor surgical site infection was observed. In none of the patient, centralisation of the nipple-areola complex (NAC) was needed. Three patients (8.3 %) with close margins (1 mm or less) successfully underwent subsequent re-excision. The scar did not result in any impairment of arm movement. Cosmetic outcome was evaluated by the women as excellent and good in 55 (87 %) and 8 (13 %) cases, respectively, while by the surgeons as excellent, good and medium in 52 (82 %), 8 (13 %), and 3 cases (5 %), respectively. Conclusions BSRMP is a simple and safe technique achieving good cosmetic results without NAC centralisation and giving the wide and easy access to axilla for both sentinel node biopsy and lymphadenectomy. It can be helpful in cases of extensive, radially spreading tumours (in particular DCIS or invasive cancers with intraductal component), eccentric lesions, or superficially located cancers when the neighbouring skin is excised. However, due to its limitations (long incision, difficult subsequent mastectomy, possibility of scar placement in the visible area of decollete), a careful patients’ selection should be done. Further studies are needed to assess long-term cosmetic outcomes including delayed post-radiotherapy effects.
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Affiliation(s)
- Bartlomiej Szynglarewicz
- Breast Unit, Department of Surgical Oncology, Lower Silesian Oncology Centre, Plac Hirszfelda 12, 53-413, Wroclaw, Poland.
| | - Adam Maciejczyk
- Department of Radiotherapy, Lower Silesian Oncology Centre, Wroclaw, Poland
| | - Jozef Forgacz
- Breast Unit, Department of Surgical Oncology, Lower Silesian Oncology Centre, Plac Hirszfelda 12, 53-413, Wroclaw, Poland
| | - Rafal Matkowski
- Breast Unit, Department of Surgical Oncology, Lower Silesian Oncology Centre, Plac Hirszfelda 12, 53-413, Wroclaw, Poland.,Chair of Oncology, Wroclaw Medical University, Wroclaw, Poland
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Tang R, Saksena M, Coopey SB, Fernandez L, Buckley JM, Lei L, Aftreth O, Koerner F, Michaelson J, Rafferty E, Brachtel E, Smith BL. Intraoperative micro-computed tomography (micro-CT): a novel method for determination of primary tumour dimensions in breast cancer specimens. Br J Radiol 2015; 89:20150581. [PMID: 26568439 DOI: 10.1259/bjr.20150581] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Micro-CT is a promising modality to determine breast tumour size in three dimensions in intact lumpectomy specimens. We compared the accuracy of tumour size measurements using specimen micro-CT with measurements using multimodality pre-operative imaging. METHODS A tabletop micro-CT was used to image breast lumpectomy specimens. The largest tumour dimension on three-dimensional reconstructed micro-CT images of the specimen was compared with the measurements determined by pre-operative mammography, ultrasound and MRI. The largest dimension of pathologic invasive cancer size was used as the gold standard reference to assess the accuracy of imaging assessments. RESULTS 50 invasive breast cancer specimens in 50 patients had micro-CT imaging. 42 were invasive ductal carcinoma, 6 were invasive lobular carcinoma and 2 were other invasive cancer. Median patient age was 63 years (range 33-82 years). When compared with the largest pathologic tumour dimension, micro-CT measurements had the best correlation coefficient (r = 0.82, p < 0.001) followed by MRI (r = 0.78, p < 0.001), ultrasound (r = 0.61, p < 0.001) and mammography (r = 0.40, p < 0.01). When compared with pre-operative modalities, micro-CT had the best correlation coefficient (r = 0.86, p < 0.001) with MRI, followed by ultrasound (r = 0.60, p < 0.001) and mammography (r = 0.54, p < 0.001). Overall, mammography and ultrasound tended to underestimate the largest tumour dimension, while MRI and micro-CT overestimated the largest tumour dimension more frequently. CONCLUSION Micro-CT is a potentially useful tool for accurate assessment of tumour dimensions within a lumpectomy specimen. Future studies need to be carried out to see if this technology could have a role in margin assessment. ADVANCES IN KNOWLEDGE Micro-CT is a promising new technique which could potentially be used for rapid assessment of breast cancer dimensions in an intact lumpectomy specimen in order to guide surgical excision.
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Affiliation(s)
- Rong Tang
- 1 Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.,2 Division of Breast Surgery, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya Medical School of Central South University, Changsha, China
| | - Mansi Saksena
- 3 Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Suzanne B Coopey
- 1 Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Leopoldo Fernandez
- 1 Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Julliette M Buckley
- 1 Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Lan Lei
- 1 Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Owen Aftreth
- 1 Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Frederick Koerner
- 4 Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - James Michaelson
- 4 Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth Rafferty
- 3 Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Elena Brachtel
- 4 Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Barbara L Smith
- 1 Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
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Lafaye-Carré S, Collinet P, Vinatier D, Bendavid S, Place V, Pruvo JP, Faye N, Barranger E. Impact de l’IRM mammaire préopératoire sur la prise en charge chirurgicale des cancers du sein : expérience de deux centres hospitaliers universitaires. ACTA ACUST UNITED AC 2014; 42:686-91. [DOI: 10.1016/j.gyobfe.2014.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 06/02/2014] [Indexed: 10/24/2022]
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19
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Ozaki S, Ohara M. Endoscopy-assisted breast-conserving surgery for breast cancer patients. Gland Surg 2014; 3:94-108. [PMID: 25083503 DOI: 10.3978/j.issn.2227-684x.2013.12.04] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 12/17/2013] [Indexed: 12/15/2022]
Abstract
Breast-conserving surgery (BCS) combined with postoperative radiotherapy is a standard therapy for early-stage breast cancer patients. In addition, recent developments in oncoplastic surgery have improved cosmetic outcomes and patient satisfaction. Therefore, a breast surgeon's current role in BCS is not only to perform a curative resection of cancerous lesions with adequate surgical margins, but also to preserve the shape and appearance of the treated breast. Endoscopy-assisted breast-conserving surgery (EBCS), which has the advantage of a less noticeable scar, was developed more than ten years ago. Recently, some clinical studies have reported the feasibility, oncological outcomes, aesthetic outcomes, and patient satisfaction of EBCS. Herein, we will review the EBCS clinical studies that have been conducted so far and discuss current issues regarding this operative method.
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Affiliation(s)
- Shinji Ozaki
- Department of Surgical Oncology Research, Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Masahiro Ohara
- Department of Surgical Oncology Research, Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
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20
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Thomassin-Naggara I, Siles P, Trop I, Chopier J, Darai E, Bazot M, Uzan S. How to measure breast cancer tumoral size at MR imaging? Eur J Radiol 2013; 82:e790-800. [PMID: 24055186 DOI: 10.1016/j.ejrad.2013.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 07/12/2013] [Accepted: 08/01/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the accuracy of different MR sequences to measure tumor size. METHODS Eighty-six women (mean age: 53 years (30-78)) who underwent preoperative MRI for breast cancer were included. Maximal diameters of the index tumor (IT) and of the whole extent of the tumor (WET) were measured on T2-weighted (T2W) sequences, on dynamic contrast-enhanced (DCE) T1-weighted (T1W) sequences and on Maximal Intensity Projection (MIP) reconstructions. Agreements with pathological size were evaluated using concordance correlation coefficient (k). RESULTS Median pathological size of IT was 20mm (13-25 mm, interquartile range). Median pathological size of the WET was 29 mm (16-50mm, interquartile range). Measurement of IT showed a good concordance with pathological size, with best results using T2W (k = 0.690) compared to MIP (k = 0.667), early-subtracted DCE frame (k = 0.630) and early-native DCE frame (k = 0.588). IT was visible on T2W in 83.7% and accurately measured within 5mm in 69.9%. Measurement of WET was superior using early-subtracted DCE frame (k = 0.642) compared to late-native frame (k = 0.635), early-native frame (k = 0.631), late-subtracted frame (k = 0.620) and MIP (k = 0.565). However, even using early-subtracted frame, WET was accurately measured within 5mm only 39.3%. CONCLUSION If visible, IT size is best measured on T2W with a good accuracy (69%) whereas WET is best estimated on early-subtracted DCE frame. However, when adjacent additional sites exist around IT, suspected surrounding disease components need to be proved by pathological analysis.
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Affiliation(s)
- I Thomassin-Naggara
- Department of Radiology, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Institut Universitaire de Cancérologie (IUC) Pierre et Marie Curie, Cancer Est, Paris, France.
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Santamaría G, Velasco M, Farrús B, Caparrós FX, Fernández PL. Dynamic contrast-enhanced MRI reveals the extent and the microvascular pattern of breast ductal carcinoma in situ. Breast J 2013; 19:402-10. [PMID: 23758454 DOI: 10.1111/tbj.12135] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To report the role of magnetic resonance imaging (MRI) in assessing the extent of breast ductal carcinoma in situ (DCIS). To assess whether the microvascularity pattern in DCIS correlates with magnetic resonance enhancement. Eighty-five histologically proven DCIS (77 pure DCIS, eight microinvasive DCIS) were prospectively studied with MRI. The morphology of magnetic resonance enhancement and the kinetic curve was recorded. Histopathologically, intraductal lesions were classified according to Van Nuys score. Tumor microvascularity was immunohistochemically assessed in a subset of 24 DCIS evaluating the number of microvessels, microvascularity area, and microvascularity pattern (diffuse or periductal). On the mammogram, 74% of DCIS appeared as microcalcifications. On MRI, 70% of DCIS showed enhancement. Non-mass-like uptake was observed in 78% of cases. The mean size of nonenhancing carcinomas was significantly lower than that of enhancing carcinomas (p = 0.033). The diffuse pattern was more frequent than the periductal pattern. A significant relationship between the morphology of MR enhancement and the microvascularity pattern was observed (p = 0.036); thus, 90% of DCIS showing segmental enhancement on MRI displayed a diffuse pattern while all DCIS with ductal enhancement showed a periductal pattern. There was a significant relationship between the maximum area of microvascularity and the vascular pattern (p = 0.015); periductal patterns showed larger areas than diffuse patterns. The lesion size was significantly larger as the Van Nuys score increased (p < 0.001) and was also related to the number of microvessels (p = 0.012). The mean area of microvascularity of DCIS was significantly larger as the Van Nuys score increased (p = 0.02). Breast MRI helps depict the extent of DCIS and reveals its microvascular pattern.
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Affiliation(s)
- Gorane Santamaría
- Department of Radiology, Hospital Clínic and University of Barcelona School of Medicine, Barcelona, Spain.
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22
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Miyashita M, Amano G, Ishida T, Tamaki K, Uchimura F, Ono T, Yajima M, Kuriya Y, Ohuchi N. The Clinical Significance of Breast MRI in the Management of Ductal Carcinoma In Situ Diagnosed on Needle Biopsy. Jpn J Clin Oncol 2013; 43:654-63. [DOI: 10.1093/jjco/hyt055] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mann RM, Bult P, van Laarhoven HWM, Span PN, Schlooz M, Veltman J, Hoogerbrugge N. Breast cancer size estimation with MRI in BRCA mutation carriers and other high risk patients. Eur J Radiol 2013; 82:1416-22. [PMID: 23567481 DOI: 10.1016/j.ejrad.2013.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 03/02/2013] [Accepted: 03/10/2013] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To assess the value of breast MRI in size assessment of breast cancers in high risk patients, including those with a BRCA 1 or 2 mutation. Guidelines recommend invariably breast MRI screening for these patients and therapy is thus based on these findings. However, the accuracy of breast MRI for staging purposes is only tested in sporadic cancers. METHODS We assessed concordance of radiologic staging using MRI with histopathology in 49 tumors in 46 high risk patients (23 BRCA1, 12 BRCA2 and 11 Non-BRCA patients). The size of the total tumor area (TTA) was compared to pathology. In invasive carcinomas (n=45) the size of the largest focus (LF) was also addressed. RESULTS Correlation of MRI measurements with pathology was 0.862 for TTA and 0.793 for LF. TTA was underestimated in 8(16%), overestimated in 5(10%), and correctly measured in 36(73%) cases. LF was underestimated in 4(9%), overestimated in 5(11%), and correctly measured in 36(80%) cases. Impact of BRCA 1 or 2 mutations on the quality of size estimation was not observed. CONCLUSIONS Tumor size estimation using breast MRI in high risk patients is comparable to its performance in sporadic cancers. Therefore, breast MRI can safely be used for treatment planning.
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Affiliation(s)
- R M Mann
- Radboud University Nijmegen Medical Centre, Department of Radiology, Nijmegen, The Netherlands.
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Kim J, Yoo J, Lee J, Chang E, Suh K. Oncoplastic reconstruction with superior based lateral breast rotation flap after lower quadrant tumor resection. J Breast Cancer 2012; 15:350-5. [PMID: 23091549 PMCID: PMC3468790 DOI: 10.4048/jbc.2012.15.3.350] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 05/16/2012] [Indexed: 11/30/2022] Open
Abstract
Purpose Poor cosmetic outcome have been reported as a result of breast cancer operation due to lower quadrant breast tumors; this is particularly true for women with small, firm breasts. Herein, we report here on the use of superior based lateral breast rotation flap reconstruction to improve cosmetic outcome in patients with lower quadrant breast cancer. Methods We enrolled 33 patients with invasive breast cancer located in the lower quadrant of the breast, which were located more than 2 cm apart from the nipple. After completing a quadrantectomy, a single S-shaped or reverse S-shaped incision was made from axilla to tumor site. Two triangular skin islands, one on the axilla and one overlying the tumor were marked for excision. Once the fibroglandular tissues and the additional fatty tissue of the lateral chest wall were appropriately mobilized, the breast defect was closed at the mid-point of the parenchymal thickness in order to keep the natural position of the infra mammary fold. Results Median tumor size was 2.3 cm (range, 0.7-3.5 cm) and median resected volume was 35.5 g (range, 27.0-51.0 g). With a mean follow-up of 24.5 months (range, 9.0-33.5 months), cosmetic outcomes were good (94.0%) to fair (6.0%) at 6 months after the procedure, and there was no local or systemic recurrence during the short term follow-up period. Conclusion Clearly, this type of rotation flap reconstruction is an oncologically safe and a cosmetically sound procedure. Hopefully this rotation flap reconstruction technique will become more widely available and perhaps a standard procedure for lower quadrant breast tumors, especially for cosmetic treatment of small to medium-sized breasts.
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Affiliation(s)
- Jeryong Kim
- Department of Surgery, Research Institute for Medical Science, Chungnam National University College of Medicine, Daejeon, Korea
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25
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Tamaki K, Sasano H. Radiological diagnosis of breast cancer patients according to their corresponding histopathological features. BREAST CANCER MANAGEMENT 2012. [DOI: 10.2217/bmt.12.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Accurate correlation of radiological findings with corresponding histopathologic features is considered one of the pivotal aspects of image analysis of breast disorders. We previously examined the correlation between radiological findings including mammography, ultrasonography and multidetector row helical computed tomography, and the corresponding histopathology of patients with breast cancer. Classifying the radiological diagnoses according to their phenotypes – evaluated by histopathological and immunohistochemical analysis – did reveal distinct differences among different cancer subtypes. These proposed radiological diagnostic criteria, based on biological characteristics, may provide a more accurate prediction of the clinical and/or biological behavior of breast cancer.
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Affiliation(s)
- Kentaro Tamaki
- Department of Breast Surgery, Nahanishi Clinic, Naha, Okinawa, Japan
- Department of Pathology, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Hironobu Sasano
- Department of Pathology, Tohoku University Hospital, Sendai, Miyagi, Japan
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Ines Ramirez S, Scholle M, Buckmaster J, Paley RH, Kowdley GC. Breast Cancer Tumor Size Assessment with Mammography, Ultrasonography, and Magnetic Resonance Imaging at a Community Based Multidisciplinary Breast Center. Am Surg 2012. [DOI: 10.1177/000313481207800435] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Paramount to staging and patient management is accurately measuring the size of invasive breast cancers. We assessed the accuracy of mammography (MG), ultrasonography (US), and magnetic resonance imaging (MRI) at our community-based hospital in which multiple radiologists and imaging machines are used in the care of our patients. We performed a retrospective analysis of a prospectively maintained database of 277 patients seen at our breast center from 2009 to 2010. We tabulated MG, US, and MRI-reported tumor sizes in 161 women with pathology-proven invasive breast cancer and compared the preoperative size measurements with final pathologic tumor size. In the 161 patients, 169 lesions were identified. Imaging using all three modalities was available in 47 patients. When compared with final pathology, MRI had a correlation of r = 0.75 to mean tumor size as compared with US (r = 0.67) and MG (r = 0.76). Mean tumor size was 1.90 cm by MG, 1.87 cm by US, 2.40 cm by MRI, and 2.19 cm by pathology. We were able to achieve an excellent correlation of pathologic tumor size to preoperative imaging. The absolute differences in size between the modalities were small. MRI, in select patients, added to the assessment of tumor size based on US and MG.
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Affiliation(s)
| | - Max Scholle
- Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland
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27
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Tamaki K, Ishida T, Miyashita M, Amari M, Mori N, Ohuchi N, Tamaki N, Sasano H. Multidetector row helical computed tomography for invasive ductal carcinoma of the breast: correlation between radiological findings and the corresponding biological characteristics of patients. Cancer Sci 2012; 103:67-72. [PMID: 21981134 PMCID: PMC11164143 DOI: 10.1111/j.1349-7006.2011.02116.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The aim of this study is to evaluate the correlation between multidetector row helical computed tomography (MDCT) findings and the histopathological characteristics of patients with invasive ductal carcinoma. We retrospectively reviewed MDCT findings and the corresponding histopathological features of 442 women with invasive ductal carcinoma. We received informed consent from the patients and the protocol was approved by the Ethics Committee at Tohoku University. The median age was 53 years (26-89 years). We examined the MDCT findings based on mass shape classified into well, moderate, poorly and scattered demarcated shapes, the enhancement pattern classified into homogenous, heterogeneous, rim and poor, and mass density classified into high, intermediate or low. We subsequently compared these radiological findings with the histological characteristics and clinical outcome. Poorly demarcated types were higher in ER+/HER2- (P = 0.008), while the well-demarcated type was higher in ER-/HER2- and ER-/HER2+ (P < 0.001 and P = 0.010). Rim pattern was higher in ER-/HER2- (P < 0.001). Intermediate or low density was higher in ER-/HER2- (P < 0.001, respectively). Further analysis based on histological grade, mitotic counts and lymphovascular invasion demonstrated that the well-demarcated shape was higher in grade 2 and 3 (P = 0.006 and P < 0.001, respectively), and rim pattern was observed in grade 3 (P < 0.001). Regarding mitotic counts, poorly and scattered demarcated shapes were observed in score 1 (P = 0.008 and P = 0.014), while well-demarcated shape and rim enhancement were observed in score 3 (P < 0.001, respectively). Lymphovascular invasion correlated with a moderate demarcated shape (P = 0.029). Regarding recurrence rates, there were statistically significant differences between well and moderate, poorly or scattered demarcated shapes (P = 0.007, 0.028 and 0.035, respectively). These proposed MDCT diagnostic criteria based on biological characteristics contribute to more accurately predicting the biological behavior of breast cancer patients.
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Affiliation(s)
- Kentaro Tamaki
- Department of Surgical Oncology, Tohoku University Graduate School of Medicine, Miyagi, Japan.
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Eggemann H, Ignatov A, Krocker J, Neuss K, Elling D, John J, Costa SD. Comparative study of surgical margins and cosmetic outcome in lumpectomy versus segmental resection in breast cancer. Eur Surg Res 2011; 47:231-9. [PMID: 22056494 DOI: 10.1159/000333090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 07/20/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the present retrospective study was to compare two breast-conserving techniques, segmental resection and standard lumpectomy, for the treatment of breast cancer regarding their oncological safety. Quality of life aspects were evaluated by assessing the respective postsurgical cosmetic results. PATIENTS AND METHODS 190 women with breast cancer located in the superior and lateral quadrant were included in the study. Sixty patients were treated with segmental resection (group 1), whereas 130 underwent standard lumpectomy (group 2). Tumor sizes were determined and excised tissue specimens were analyzed for positive or negative resection margins. Patients were given a 16-item questionnaire for the postsurgical self-assessment of the cosmetic outcome. RESULTS No statistically significant difference was found concerning the number of positive resection margins between the groups (25 vs. 30%, p = 0.46). Exceptions were ventral margins, which predominated in group 2 (p = 0.016). Group 1 revealed a significantly larger maximum tumor size with negative margins as compared to group 2 (26.6 vs. 17.0 mm). General satisfaction with the cosmetic results was comparable between groups. CONCLUSIONS Segmental resection surgery, as a method of breast conservation therapy, can be used to treat larger breast lesions as compared to standard lumpectomy.
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Affiliation(s)
- H Eggemann
- Department of Obstetrics and Gynecology, Otto-von-Guericke University, Magdeburg, Germany.
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Precise correlation between MRI and histopathology - exploring treatment margins for MRI-guided localized breast cancer therapy. Radiother Oncol 2010; 97:225-32. [PMID: 20826026 DOI: 10.1016/j.radonc.2010.07.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 07/04/2010] [Accepted: 07/18/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is more often considered to guide, evaluate or select patients for partial breast irradiation (PBI) or minimally invasive therapy. Safe treatment margins around the MRI-visible lesion (MRI-GTV) are needed to account for surrounding subclinical occult disease. PURPOSE To precisely compare MRI findings with histopathology, and to obtain detailed knowledge about type, rate, quantity and distance of occult disease around the MRI-GTV. METHODS AND MATERIALS Patients undergoing MRI and breast-conserving therapy were prospectively included. The wide local excision specimens were subjected to detailed microscopic examination. The size of the invasive (index) tumor was compared with the MRI-GTV. The gross tumor volume (GTV) was defined as the pre-treatment visible lesion. Subclinical tumor foci were reconstructed at various distances to the MRI-GTV. RESULTS Sixty-two patients (64 breasts) were included. The mean size difference between MRI-GTV and the index tumor was 1.3mm. Subclinical disease occurred in 52% and 25% of the specimens at distances ≥10mm and ≥20mm, respectively, from the MRI-GTV. CONCLUSIONS For MRI-guided minimally invasive therapy, typical treatment margins of 10mm around the MRI-GTV may include occult disease in 52% of patients. When surgery achieves a 10mm tumor-free margin around the MRI-GTV, radiotherapy to the tumor bed may require clinical target volume margins >10mm in up to one-fourth of the patients.
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Breast magnetic resonance imaging. Breast Cancer 2010. [DOI: 10.1017/cbo9780511676314.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Grimsby GM, Gray R, Dueck A, Carpenter S, Stucky CC, Aspey H, Giurescu ME, Pockaj B. Is there concordance of invasive breast cancer pathologic tumor size with magnetic resonance imaging? Am J Surg 2009; 198:500-4. [PMID: 19800455 DOI: 10.1016/j.amjsurg.2009.07.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 07/06/2009] [Accepted: 07/06/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND In the era of breast conservation therapy, preoperative imaging is imperative in planning a single definitive surgical treatment. METHODS We performed a retrospective review of a prospectively collected database of patients treated at a single institution for invasive breast cancer over 5 years. Clinical and pathologic variables were analyzed with respect to magnetic resonance imaging (MRI) and pathologic tumor size using analysis of variance F tests and chi-square tests. RESULTS Of 190 patients, 53% had concordance of MRI and pathologic cancer size within .5 cm. MRI overestimated 33% and underestimated 15% of tumors. Neoadjuvant chemotherapy and lymph node status were associated with discordance. Among tumors overestimated by MRI, 65% had additional significant findings in the breast tissue around the main lesion: satellite lesions, ductal carcinoma in situ, and/or lymphovascular invasion. CONCLUSIONS Breast MRI is concordant with pathologic tumor size within .5 cm among 53% of patients. Most patients with tumors overestimated by MRI have significant findings in the surrounding breast tissue, the excision of which would be expected to benefit the patient.
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Affiliation(s)
- Gwen M Grimsby
- Department of Surgery, The Mayo Clinic Arizona, 5777 East Mayo Blvd., Phoenix, AZ 85054, USA.
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Role of [F-18] 2-Deoxy-2-Fluoro-d-Glucose PET and PET/CT in Staging and Follow-Up of Breast Cancer. PET Clin 2009; 4:391-404. [DOI: 10.1016/j.cpet.2009.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wasif N, Garreau J, Terando A, Kirsch D, Mund DF, Giuliano AE. MRI versus Ultrasonography and Mammography for Preoperative Assessment of Breast Cancer. Am Surg 2009. [DOI: 10.1177/000313480907501024] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mammography and ultrasonography are traditional for preoperative estimation of breast cancer size; magnetic resonance imaging (MRI) is more recent but not as well studied. We compared ultrasonography, mammography, and MRI for preoperative imaging of primary breast cancer presenting as a mass in patients treated at our center over a 2-year period. Of the 61 breast cancers with all three imaging modalities performed, 52 were infiltrating ductal cancer, 5 were infiltrating lobular cancer, 2 were ductal carcinoma in situ, and 2 were other histologic types. When pathologic size was used to determine the accuracy of imaging assessments, the Pearson correlation coefficient was better for MRI (r = 0.80) than ultrasonography (r = 0.57) or mammography (r = 0.26). Mean tumor size was 2.1 cm by mammography, 1.73 cm by ultrasonography, 2.65 cm by MRI, and 2.76 cm by pathology. MRI-based tumor size was within 1 cm of pathologic size in 44 (72%) tumors, > 1 cm above pathologic size in 6 (10%) tumors, and > 1 cm below pathologic size in 11 (18%) tumors. We conclude that MRI is more accurate than either ultrasonography or mammography for assessment of the size of primary breast cancer presenting as a mass.
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Affiliation(s)
- Nabil Wasif
- From the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
| | - Jennifer Garreau
- From the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
| | - Alicia Terando
- From the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
| | - Daniel Kirsch
- From the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
| | - Debra F. Mund
- From the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
| | - Armando E. Giuliano
- From the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
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Fuster D, Duch J, Paredes P, Velasco M, Muñoz M, Santamaría G, Fontanillas M, Pons F. Preoperative Staging of Large Primary Breast Cancer With [18F]Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Compared With Conventional Imaging Procedures. J Clin Oncol 2008; 26:4746-51. [PMID: 18695254 DOI: 10.1200/jco.2008.17.1496] [Citation(s) in RCA: 194] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose To evaluate the utility of positron emission tomography (PET) and [18F]fluorodeoxyglucose in the initial staging of large primary breast tumors. Patients and Methods This prospective study was approved by the ethics committee, and all patients gave their informed consent before enrollment. Sixty consecutive patients with large (> 3 cm) primary breast cancer diagnosed by clinical examination and breast magnetic resonance imaging (MRI) were entered onto the study. The mean age was 57 ± 13 years. Chest computed tomography (CT), liver ultrasonography, bone scan, and PET/CT were performed in all patients. All findings were histologically confirmed, and/or at least 1 year of follow-up was required. Correlation between parameters was calculated using Pearson's correlation coefficient. P < .05 was considered statistically significant. Results Primary tumor was identified by both PET/CT and MRI in all patients. Multifocal and/or multicentric tumors were found in 19 patients by MRI. Axillary lymph node metastases were found in 20 of 52 patients. Extra-axillary metastatic lymph nodes were also found in three patients. One patient showed an infiltrated lymph node in the contralateral axilla. The sensitivity and specificity for PET/CT to detect axillary lymph nodes metastases were 70% and 100%, respectively. PET/CT diagnosed all extra-axillary lymph nodes. The overall sensitivity and specificity of PET/CT in detecting distant metastases were 100% and 98%, respectively; whereas the sensitivity and specificity of conventional imaging were 60% and 83%, respectively. PET led to a change in the initial staging in 42% of patients. Conclusion PET/CT underestimates locoregional lymph node staging in large primary breast cancer patients. PET/CT is a valuable tool to discard unsuspected extra-axillary lymph nodes and distant metastases.
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Affiliation(s)
- David Fuster
- From the Nuclear Medicine Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joan Duch
- From the Nuclear Medicine Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Pilar Paredes
- From the Nuclear Medicine Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Martín Velasco
- From the Nuclear Medicine Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Montserrat Muñoz
- From the Nuclear Medicine Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Gorane Santamaría
- From the Nuclear Medicine Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Francesca Pons
- From the Nuclear Medicine Department, Hospital Clínic de Barcelona, Barcelona, Spain
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Taira N, Ohsumi S, Takabatake D, Hara F, Takashima S, Aogi K, Takashima S, Inoue T, Sugata S, Nishimura R. Contrast-enhanced CT Evaluation of Clinically and Mammographically Occult Multiple Breast Tumors in Women with Unilateral Early Breast Cancer. Jpn J Clin Oncol 2008; 38:419-25. [DOI: 10.1093/jjco/hyn040] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Grobmyer SR, Mortellaro VE, Marshall J, Moore Higgs G, Hochwald SN, Mendenhall NP, Copeland EM, Cance WG. Is There a Role for Routine Use of MRI in Selection of Patients for Breast-Conserving Cancer Therapy? J Am Coll Surg 2008; 206:1045-50; discussion 1050-2. [DOI: 10.1016/j.jamcollsurg.2007.12.039] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Accepted: 12/03/2007] [Indexed: 11/15/2022]
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Preoperative MRI of pure intraductal breast carcinoma—A valuable adjunct to mammography in assessing cancer extent. Breast 2008; 17:186-94. [PMID: 17964786 DOI: 10.1016/j.breast.2007.09.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Revised: 08/22/2007] [Accepted: 09/15/2007] [Indexed: 11/22/2022] Open
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Significance of irradiation in breast-conserving treatment: comparison of local recurrence rates in irradiated and nonirradiated groups. Int J Clin Oncol 2008; 13:12-7. [PMID: 18307014 DOI: 10.1007/s10147-007-0723-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Indexed: 10/22/2022]
Abstract
Breast-conserving treatment (BCT) is a standard therapy for early breast cancer. Many reports have described the effectiveness of post-BCT radiation therapy. However, the post-BCT local recurrence rate of only 5% to 10% indicates that radiation therapy may be unnecessary in many cases. To accurately select those patients who do not require post-BCT radiation therapy, we investigated the significance of irradiation in BCT by comparing local recurrence rates in irradiated and nonirradiated patients, grouped according to clinicopathological criteria that we evaluated. The patients were divided into two groups: a previous-criteria group and a present-criteria group. The former group included 85 patients in whom only two factors were considered as the criteria for radiation therapy: margin-positivity and lymphatic metastasis-positivity. The latter group included 318 patients in whom three additional factors were also considered: lymphatic invasion, intraductal extension, and metachronous/synchronous bilateral breast cancer. The use of five clinicopathological factors rather than two as the criteria for irradiation led to an increase in the irradiation ratio from 47.1% to 63.2% and a decrease in local recurrence from 12.9% to 2.2%. Because of the short average follow-up period of this study, further careful, regular follow-up and randomized comparative studies are required. It may also be necessary to include the patient age and margin condition as mandatory criteria for irradiation.
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Peters NHGM, Borel Rinkes IHM, Mali WPTM, van den Bosch MAAJ, Storm RK, Plaisier PW, de Boer E, van Overbeeke AJ, Peeters PHM. Breast MRI in nonpalpable breast lesions: a randomized trial with diagnostic and therapeutic outcome - MONET - study. Trials 2007; 8:40. [PMID: 18045470 PMCID: PMC2222222 DOI: 10.1186/1745-6215-8-40] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 11/28/2007] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In recent years there has been an increasing interest in MRI as a non-invasive diagnostic modality for the work-up of suspicious breast lesions. The additional value of Breast MRI lies mainly in its capacity to detect multicentric and multifocal disease, to detect invasive components in ductal carcinoma in situ lesions and to depict the tumor in a 3-dimensional image. Breast MRI therefore has the potential to improve the diagnosis and provide better preoperative staging and possibly surgical care in patients with breast cancer. The aim of our study is to assess whether performing contrast enhanced Breast MRI can reduce the number of surgical procedures due to better preoperative staging and whether a subgroup of women with suspicious nonpalpable breast lesions can be identified in which the combination of mammography, ultrasound and state-of-the-art contrast-enhanced Breast MRI can provide a definite diagnosis. METHODS/DESIGN The MONET - study (MR mammography Of Nonpalpable BrEast Tumors) is a randomized controlled trial with diagnostic and therapeutic endpoints. We aim to include 500 patients with nonpalpable suspicious breast lesions who are referred for biopsy. With this number of patients, the expected 12% reduction in surgical procedures due to more accurate preoperative staging with Breast MRI can be detected with a high power (90%). The secondary outcome is the positive and negative predictive value of contrast enhanced Breast MRI. If the predictive values are deemed sufficiently close to those for large core biopsy then the latter, invasive, procedure could possibly be avoided in some women. The rationale, study design and the baseline characteristics of the first 100 included patients are described. TRIAL REGISTRATION Study protocol number NCT00302120.
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Affiliation(s)
- Nicky HGM Peters
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, E01.132 3584 CX Utrecht, The Netherlands
| | - Inne HM Borel Rinkes
- Department of Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, G04.228 3584 CX Utrecht, The Netherlands
| | - Willem PTM Mali
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, E01.132 3584 CX Utrecht, The Netherlands
| | - Maurice AAJ van den Bosch
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, E01.132 3584 CX Utrecht, The Netherlands
| | - Remmert K Storm
- Department of Radiology, Albert Schweitzer Ziekenhuis, van der Steenhovenplein 1 3300 AK Dordrecht, The Netherlands
| | - Peter W Plaisier
- Department of Surgery, Albert Schweitzer Ziekenhuis, van der Steenhovenplein 1 3300 AK Dordrecht, The Netherlands
| | - Erwin de Boer
- Department of Radiology, Meander Medisch Centrum, lokatie Lichtenberg, Utrechtseweg 1603813 ES Amersfoort, The Netherlands
| | - Adriaan J van Overbeeke
- Department of Surgery, Meander Medisch Centrum, lokatie Lichtenberg, Utrechtseweg 1603813 ES Amersfoort, The Netherlands
| | - Petra HM Peeters
- Clinical epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, STR 6.131 3584 CX Utrecht, The Netherlands
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Peters NHGM, Borel Rinkes IHM, Zuithoff NPA, Mali WPTM, Moons KGM, Peeters PHM. Meta-analysis of MR imaging in the diagnosis of breast lesions. Radiology 2007; 246:116-24. [PMID: 18024435 DOI: 10.1148/radiol.2461061298] [Citation(s) in RCA: 378] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To determine, in a meta-analysis, the diagnostic performance of contrast material-enhanced magnetic resonance (MR) imaging in patients with breast lesions. MATERIALS AND METHODS Studies to assess the diagnostic performance of MR imaging in patients suspected of having breast cancer who underwent MR imaging and biopsy from January 1985 through March 2005 were reviewed for inclusion. A summary receiver operating characteristic curve was constructed, and pooled weighted estimates of sensitivity and specificity were calculated by using the recently developed bivariate approach for diagnostic meta-analysis. RESULTS Of 251 eligible studies, 44 were included in the meta-analysis (sample size range, 14-821; cancer prevalence, 23%-84%). Pooled weighted estimates of sensitivity and specificity were 0.90 (95% confidence interval: 0.88, 0.92) and 0.72 (95% confidence interval: 0.67, 0.77), respectively. The performance of breast MR imaging was influenced by the prevalence of cancer in the studied population (P = .05) and by whether two criteria (ie, morphology, enhancement, and kinetic enhancement pattern)--versus one or three criteria--were used to differentiate benign from malignant lesions (P = .02). CONCLUSION MR imaging of the breast has high sensitivity and lower specificity in the evaluation of breast lesions. SUPPLEMENTAL MATERIAL http://radiology.rsnajnls.org/cgi/content/full/2461061298/DC1.
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Affiliation(s)
- Nicky H G M Peters
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, E01.132, 3584 CX Utrecht, The Netherlands
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Alderliesten T, Schlief A, Peterse J, Loo C, Teertstra H, Muller S, Gilhuijs K. Validation of Semiautomatic Measurement of the Extent of Breast Tumors Using Contrast-Enhanced Magnetic Resonance Imaging. Invest Radiol 2007; 42:42-9. [PMID: 17213748 DOI: 10.1097/01.rli.0000248849.99014.7e] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to assess whether the semiautomatic measurement of breast-tumor extent using contrast-enhanced magnetic resonance imaging (CE-MRI) decreases measurement variation compared with manual evaluation and increases precision with respect to tumor extent measured at histopathology. MATERIALS AND METHODS Forty-three patients who underwent breast-conserving therapy for 46 tumors were consecutively included. Extended histopathology analysis was performed on the excision specimens. Two experienced breast-MR radiologists independently manually assessed the largest diameter of the tumors at preoperative CE-MRI. Two observers used a semiautomatic segmentation technique to independently obtain the largest diameter and the volume of the tumors. RESULTS Semiautomatic volumetric measurement of tumor volume was more accurately correlated with histopathology (adjusted R-square 0.84 and 0.81) compared with conventional measurement (adjusted R-square 0.56 and 0.70) and semiautomatic measurement (adjusted R-square 0.63 and 0.60) of the largest diameter of the tumor. The interobserver variability between the volumetric measurements was significantly smaller than the interobserver variability between the largest-diameter measurements of tumor extent obtained by the radiologists (P < 0.001). CONCLUSIONS Semiautomatic volumetric measurement of breast-tumor extent at CE-MRI provides a more accurate assessment of tumor extent with respect to histopathology and reduces measurement variation compared with manual assessment of the largest diameter. Automated volumetric measurement thus provides potential for increased precision in establishing response to treatment.
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Affiliation(s)
- Tanja Alderliesten
- Department of Radiology and Pathology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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MRI accuracy in residual disease evaluation in breast cancer patients treated with neoadjuvant chemotherapy. Clin Radiol 2006; 61:946-53. [PMID: 17018307 DOI: 10.1016/j.crad.2006.07.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Revised: 06/15/2006] [Accepted: 07/03/2006] [Indexed: 10/24/2022]
Abstract
AIM To assess the accuracy of magnetic resonance imaging (MRI) in evaluating residual disease after neoadjuvant chemotherapy in patients with large breast cancers. MATERIALS AND METHODS Forty-five women with large breast cancers underwent MRI mammography before and after neoadjuvant chemotherapy (three or six cycles). Dynamic MRI was performed using a 1.5 T unit using three-dimensional FSPGR sequences. For each patient tumour size, tumour volume and dynamic curve were obtained before and after neoadjuvant treatment. Residual tumour sizes obtained using MRI were compared with pathological findings to assess the accuracy of MRI in detecting and in measuring residual tumour. RESULTS The sensitivity, specificity and accuracy of MRI in detecting residual disease was 90.5, 100, and 91.3%, respectively. The mean of largest diameters measured at histology and at MRI were 26 and 28.2mm, respectively. The tumour size correlation coefficient between MRI and pathology measurements was very high: r(2)=0.9657 (p<0.0001). The interclass correlation coefficient between preoperative imaging measurements and pathological measurements of residual disease was 0.944 (95% CI: 0.906-0.982). CONCLUSION The presence and size of residual disease in breast patients treated with neoadjuvant chemotherapy could be accurately evaluated using MRI.
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Doihara H, Fujita T, Takabatake D, Takahashi H, Ogasawara Y, Shimizu N. Clinical Significance of Multidetector-Row Computed Tomography in Breast Surgery. Breast J 2006; 12:S204-9. [PMID: 16959003 DOI: 10.1111/j.1075-122x.2006.00323.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Several reports support the association of higher ipsilateral breast tumor recurrence rates with positive or intermediate margins compared with negative pathologic margins. Precise evaluation of tumor extension and adequate surgical margin are important factors affecting tumor recurrence after breast-conserving surgery (BCS). Many studies have reported the utility of magnetic resonance imaging (MRI) for diagnosing the tumor extension of breast cancer, but few have evaluated the utility of multidetector-row computed tomography (MDCT). The results of this study show the clinical significance of MDCT for detecting cancer extension and demonstrate the clinical role of MDCT in BCS. Subjects comprised 136 patients grouped into two categories based on whether or not tumor extension was evaluated with MDCT preoperatively. The positive surgical margin rate and breast conservation rate were analyzed in each group and the clinical role of MDCT in BCS was evaluated. Moreover, evaluation of intraductal extension was done both with MDCT and histologically, and computed tomography (CT)-pathologic correlations were examined retrospectively. Finally, the margin-positive cases were analyzed in relation to their clinical characteristics. Sensitivity, specificity, positive predictive value, and negative predictive value for detection of the intraductal component were 71.8%, 85.7%, 82.1%, and 76.9%, respectively. The positive surgical margin rate and conservation rate are 7.46% and 81.9%, respectively, for those who were diagnosed with MDCT preoperatively; their corresponding rates without MDCT were 16.67% and 67.9%. Most margin-positive patients have remarkable lymphatic space invasion. Positive surgical margins were often recognized toward the nipple. For diagnosing the intraductal extension, MDCT shows sufficient diagnosability. Moreover, MDCT can provide appropriate information for the determination of adequate surgical margins and contribute to increases in breast conservation rates.
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Affiliation(s)
- Hiroyoshi Doihara
- Department of Cancer and Thoracic Surgery, Okayama University School of Medicine, Okayama City, Japan.
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Deurloo EE, Klein Zeggelink WFA, Teertstra HJ, Peterse JL, Rutgers EJT, Muller SH, Bartelink H, Gilhuijs KGA. Contrast-enhanced MRI in breast cancer patients eligible for breast-conserving therapy: complementary value for subgroups of patients. Eur Radiol 2005; 16:692-701. [PMID: 16328447 DOI: 10.1007/s00330-005-0043-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Revised: 09/19/2005] [Accepted: 09/27/2005] [Indexed: 10/25/2022]
Abstract
The aim of this study was to identify patients prior to breast-conserving therapy (BCT) who have complementary value of contrast-enhanced magnetic resonance imaging (MRI) over conventional imaging in the assessment of tumor extent. All patients were eligible for BCT according to conventional imaging, and underwent preoperative MRI as part of this study. One hundred and sixty-five patients (166 tumors) were included. MRI was defined to have complementary value if conventional imaging underestimated or overestimated tumor extent (by more than 10 mm compared to histology) and MRI assessed the extent accurately. Logistic regression was employed to identify characteristics that are predictive of the complementary value of preoperative MRI. MRI had complementary value in 39 cases (23%). Patients <58 years old with irregular lesion margins at mammography and discrepancy in tumor extent by more than 10 mm between mammography and ultrasonography had a 3.2x higher chance of accurate assessment at MRI (positive predictive value 50%, negative predictive value 84%, p=0.0002). Preoperative MRI in patients eligible for BCT is more accurate than conventional imaging in the assessment of tumor extent in approximately one out of four patients. Subgroups of patients in whom MRI has complementary value may be defined by the differences in clinical and imaging features.
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Affiliation(s)
- Eline E Deurloo
- Department of Radiology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
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45
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Kepple J, Layeeque R, Klimberg VS, Harms S, Siegel E, Korourian S, Gusmano F, Henry-Tillman RS. Correlation of magnetic resonance imaging and pathologic size of infiltrating lobular carcinoma of the breast. Am J Surg 2005; 190:623-7. [PMID: 16164936 DOI: 10.1016/j.amjsurg.2005.06.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2005] [Revised: 06/10/2005] [Accepted: 06/10/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Determining the extent of infiltrating lobular carcinoma (ILCA) in the breast is difficult. This study was designed to determine if the size of ILCA on magnetic resonance imaging (MRI) correlated with final pathology. METHODS Retrospective study of patients between 1998 and 2004, who were evaluated for extent of ILCA prior to definitive treatment, was conducted. Demographic data and radiology and pathology results were obtained. Spearman correlation coefficient was used. RESULTS Twenty-nine patients (median age 62 years) had MRI of breast. Fourteen patients (48%) had contralateral MRIs; 13 (45%) normal; 1 (8%) prompted core biopsy; 6 of 13 patients underwent contralateral mastectomies, which were benign. The distribution of tumor size was: T1 = 15 (52%); T2 = 7 (24%); T3 = 5 (17%); T4 = 2 (7%). Spearman correlation coefficient between tumor size on ultrasound and MRI with pathology was .19 (P = .5) and .88 (P < .001), respectively. CONCLUSION MRI provided superior correlation between tumor size and pathology.
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Affiliation(s)
- Julie Kepple
- Department of Surgery, Division of Breast Surgical Oncology, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 725, Little Rock, AR 72205, USA
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46
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Abstract
Women with a strong family history of breast cancer are at increased risk of developing the disease themselves. Mammographic surveillance is recommended in the over 40 age group but the evidence of benefit from this strategy is limited until the individual reaches age 50 years. There is increasing evidence from the trials of breast magnetic resonance imaging that women at high risk may benefit from this technique as sensitivity is not dependent on breast density. The Dutch and Canadian studies have reported the sensitivity of MRI to be 71% and 77% compared to mammography which was 40% and 36%, respectively, in asymptomatic high risk cohorts.
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Affiliation(s)
- F J Gilbert
- Department of Radiology, University of Aberdeen, Aberdeen, Scotland, UK.
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47
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Abstract
Oncoplastic surgery refers to several surgical techniques by which segments of malignant breast tissue are removed to achieve wide surgical margins while the remaining glandular tissue is transposed to achieve the best possible cosmetic outcome. We summarise the general approach to oncoplastic lumpectomy for surgeons who recognise the limitations of standard lumpectomy for large breast cancers, and review different cancer distributions in the breast and their associated imaging characteristics. Full-thickness fibroglandular excision of the mass and surrounding breast tissue allows resection with wide surgical margins. Subsequent breast-flap advancement (mastopexy) results in closure of the resulting surgical defect with good or excellent cosmetic closure. These approaches can improve both the aesthetic outcome of breast cancer resections and the likelihood of surgeons obtaining wide surgical margins in preparation for breast-conserving radiotherapy. Advanced volume-displacement techniques, which are based on the key principles of breast reductive surgery, can greatly increase the options for breast conservation in complex cancer cases.
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Takeda M, Ishida T, Ohnuki K, Suzuki A, Kiyohara H, Moriya T, Ohuchi N. Breast conserving surgery with primary volume replacement using a lateral tissue flap. Breast Cancer 2005; 12:16-20. [PMID: 15657518 DOI: 10.2325/jbcs.12.16] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Breast conserving surgery (BCS) is now a standard surgical treatment for early breast cancer. The number of patients with tumors under 3 cm who underwent breast conserving surgery overtook the number of patients who underwent total mastectomy for the first time in Japan in 2003. We have been employing breast conserving surgery with primary reconstruction using a lateral tissue flap (LTF), and have performed breast conserving surgery for 266 patients from 1990 to 2002. The incidence of local relapse was 5.6%. Although we did not irradiate a low risk group of 101 patients, our method is not inferior to other reports in which all cases underwent irradiation. Primary reconstruction with LTF has three advantages. The first is that we can avoid poly-surgery for breast reconstruction. The second is that the volume of the graft is maintained longer than reconstruction with a musculo-cutaneous flap. The third is that patients can avoid allergic reactions or granulomas as seen with artificial prosthesies. In conclusion, breast conserving surgery with immediate volume replacement with a LTF is a reasonable surgical procedure and has the advantage of avoiding unnecessary surgical procedures for reconstruction and surgical invasion without delaying the diagnosis of local relapse. Moreover, an adequate assessment of risk can spare low risk groups irradiation.
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Affiliation(s)
- Motohiro Takeda
- Division of Surgical Oncology, Tohoku University Graduate School of Medicine 1-1, Seiryo-Machi, Aoba-ku Sendai, 980-8574 Japan
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Fujita T, Doihara H, Takabatake D, Takahashi H, Yoshitomi S, Ishibe Y, Ogasawara Y, Shimizu N. Multidetector row computed tomography for diagnosing intraductal extension of breast carcinoma. J Surg Oncol 2005; 91:10-6. [PMID: 15999347 DOI: 10.1002/jso.20275] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Several reports supported the association of higher ipsilateral breast tumor recurrence rates with positive or intermediate margins compared with negative pathologic margins. Precise evaluation of intraductal component and adequate surgical margin are important factors affecting the tumor recurrence after breast conserving surgery. Numerous studies have reported the utility of magnetic resonance imaging for diagnosing developing intraductal extension of breast cancer, but few have investigated multidetector-row computed tomography (MD-CT). The present study evaluated the clinical utility of MD-CT for detecting intraductal extension of breast carcinoma, and analyzed clinical parameters affecting the detection of intraductal extension under MD-CT. METHODS Subjects comprised 44 patients grouped into three categories according to degree of intraductal extension of the main tumor under MD-CT (Intraductal spread grade 1 approximately 3: IDS 1 approximately 3). Tumors were also categorized histopathologically (p-IDS 0 approximately 3), and CT-pathological correlations were examined retrospectively. Clinical parameters were evaluated to determine the affect on detection of intraductal components. RESULTS MD-CT detected 44 breast lesions (100%). Sensitivity for detection of intraductal component was 81.2%, specificity was 67.8%, and accuracy was 72.7%. Regarding extent of intraductal components, significant correlations were found between histopathological and MD-CT findings. A strong correlation was found in postmenopausal women between T2 tumor and high histological grade. CONCLUSIONS MD-CT findings of intraductal extension from breast carcinoma correlate with histological degree of intraductal extension, and MD-CT may be useful for preoperative assessment of breast-conserving surgery, particularly for postmenopausal women with histological high nuclear grade and T2 tumor.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Female
- Humans
- Mastectomy, Segmental
- Middle Aged
- Neoplasm Invasiveness
- Neoplasm Staging
- Postmenopause
- Premenopause
- Retrospective Studies
- Sensitivity and Specificity
- Tomography, X-Ray Computed
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Affiliation(s)
- Takeo Fujita
- Department of Cancer and Thoracic Surgery, Okayama University Graduate School of Medicine and Dentistry, Okayama-City, Japan
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Boetes C, Veltman J, van Die L, Bult P, Wobbes T, Barentsz JO. The role of MRI in invasive lobular carcinoma. Breast Cancer Res Treat 2004; 86:31-7. [PMID: 15218359 DOI: 10.1023/b:brea.0000032921.10481.dc] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To determine the value of MR imaging in the detection and measurement of tumor size in patients with invasive lobular carcinoma (ILC) compared to mammography and ultrasound. MATERIALS AND METHODS From 36 cases of ILC in 34 patients who were surgically treated, the pre-operative imaging measurements, being mammography, ultrasound and contrast enhanced MR, were retrospectively re-evaluated for tumor detection and size. Findings were compared with pathology. Two radiologists were used for evaluation of the mammograms, the other imaging modalities were only evaluated by one radiologist. The Pearsons correlation test was used to determine the correlation between histopathological and imaging measurements for each imaging modality. RESULTS For mammography, ultrasound and MRI the false negative scores were respectively 14%, 3% and 0%. The percentage for underestimated, correctly estimated and overestimated measurements on imaging were 56%, 33% and 11% for radiologist 1 and 50%, 33% and 17% for radiologist 2 on mammography. For ultrasound and MRI these percentages were respectively 53%, 47%, 0% and 14%, 75%, 11%. The correlation coefficients for mammography were respectively r = 0.34 (p < 0.05) and r = 0.27 (p > 0.05) for both radiologists, for Ultrasound r = 0.24 (p > 0.05) and for MRI r = 0.81 (p < 0.01). CONCLUSION Of the three imaging modalities contrast enhanced MR has the lowest false negative rate in detecting ILC and has the highest accuracy in measuring the size of the ILC. MR could play a key role in the pre-operative work-up for accurate tumor size determination.
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Affiliation(s)
- Carla Boetes
- Department of Radiology, University Medical Center Nijmegen, Nijmegen, The Netherlands.
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