1
|
Wooldrik SM, Riks L, Struik GM, Hulsebosch F, Verhoef C, Klem TMAL. Additional breast lesions on MRI in patients with small early stage luminal type breast cancer: Important consequences for future thermal ablation treatment. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109715. [PMID: 40023019 DOI: 10.1016/j.ejso.2025.109715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2025] [Revised: 02/14/2025] [Accepted: 02/19/2025] [Indexed: 03/04/2025]
Abstract
In this study, data from 50 postmenopausal women with unilateral cT1N0 breast cancer, who underwent MRI as part of the THERMAC trial for a thermal ablation protocol, were analyzed. Additional MRI findings were classified as benign or malignant based on histopathology. Results showed that 30 % of patients had additional MRI findings, with 40 % of those being malignant, which led to exclusion from the trial and altered surgical management. Malignant lesions included lobular carcinoma, NST tumors, and multifocal/multicentric disease, while benign findings were predominantly fibroadenomas, cysts, and mastopathy. Malignant lesions required changes in the treatment approach, including exclusion from the ablation protocol, wider excisions, and in some cases, mastectomy. The study highlights the significant role of MRI in patient selection and treatment planning, emphasizing the need for further investigation into the long-term oncological outcomes in early-stage breast cancer patients.
Collapse
Affiliation(s)
- Sophie M Wooldrik
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, the Netherlands; Department of Surgical Oncology, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
| | - Linda Riks
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, the Netherlands; Department of Surgical Oncology, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Gerson M Struik
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, the Netherlands; Department of Surgical Oncology, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Frank Hulsebosch
- Department of Radiology, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Taco M A L Klem
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, the Netherlands
| |
Collapse
|
2
|
Wang X, He Y, Wang L. Diagnostic value of shear wave elastography combined with super microvascular imaging for BI-RADS 3-5 nodules. Front Oncol 2023; 13:1192630. [PMID: 37731632 PMCID: PMC10508847 DOI: 10.3389/fonc.2023.1192630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/22/2023] [Indexed: 09/22/2023] Open
Abstract
Background To investigate the diagnostic value of shear wave elastography (SWE) and super microvascular imaging (SMI) integrated with the traditional ultrasound breast imaging reporting and data system (BI-RADS) classification in differentiating between benign and malignant breast nodules. Methods For analysis, 88 patients with 110 breast nodules assessed as BI-RADS 3-5 by conventional ultrasound were selected. SWE and SMI evaluations were conducted separately, and all nodules were verified as benign or malignant ones by pathology. Receiver operating characteristic (ROC) curves were plotted after obtaining quantitative parameters of different shear waves of nodules, including maximum (Emax), mean (Emean), minimum (Emin) Young's modulus, modulus standard deviation (SD), and modulus ratio (Eratio). The best cut-off value, specificity, sensitivity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for diagnosing malignant nodules employing Emax were obtained, and the diagnostic value of combining Emax and BI-RADS classification was compared. SMI graded nodule based on the Alder blood flow grading standard, whereas the BI-RADS classification was based on microvascular morphology. We assessed the diagnostic value of SMI for breast nodules and investigated the diagnostic efficacy of SWE combined with SMI in differentiating benign and malignant breast nodules with BI-RADS classification 3-5. Results The adjusted the BI-RADS classification using SMI and SWE technologies promoted the sensitivity, specificity, and accuracy of discriminating benign and malignant breast nodules (P < 0.05). The combination of traditional ultrasound BI-RADS classification with SWE and SMI technologies offered high sensitivity, specificity, accuracy, PPV, and NPV for identifying benign and malignant breast lesions. Moreover, combining SWE and SMI technologies with the adjusted BI-RADS classificationhad the best diagnostic efficacy for distinguishing benign and malignant breast nodules with BI-RADS 3-5. Conclusion The combination of SWE and SMI with the adjusted BI-RADS classification is a promising diagnostic method for differentiating benign and malignant breast nodules.
Collapse
Affiliation(s)
| | | | - Liangyu Wang
- Department of Ultrasound, Shantou Central Hospital, Shantou, Guangdong, China
| |
Collapse
|
3
|
Gleckler L, Roy N, Bernstein M, Balija TM, LaPlaca C, Nevid DR, Lee JH, Port E, Bernik SF. Impact of Preoperative Extramammary Findings in Patients with Newly Diagnosed Breast Cancer. J Am Coll Surg 2023; 236:1047-1053. [PMID: 36719075 DOI: 10.1097/xcs.0000000000000605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Breast MRI has been associated with significant rates of false positive findings. We aimed to determine the frequency of extramammary findings (EMFs) in newly diagnosed breast cancer patients on breast MRI with contrast and assess the significance of these findings and need for additional imaging and follow-up. STUDY DESIGN A retrospective review of patients diagnosed with breast cancer from October 2018 to October 2019 was performed. Clinicopathologic features were collected, including type of breast cancer, size, stage, and whether the patients had a breast MRI. Those who had MRI were included, and the MRI was reviewed to determine if EMFs were identified. Further imaging and follow-up were assessed and recorded. RESULTS Of the 480 patients included in this cohort, 353 (74%) had invasive cancer, and the remainder had ductal carcinoma in situ. Two hundred ninety patients (60%) underwent MRI, and 53 of 290 (18%) had EMFs on MRI. Of these, 28 of 53 (53%) underwent additional imaging to further evaluate findings. Two invasive procedures were performed (fine needle aspiration and thymectomy), and 1 malignancy was identified in the thymus. No metastatic breast cancer was identified in any patient. CONCLUSIONS MRIs are frequently obtained for newly diagnosed breast cancer patients, and additional findings, especially extramammary, can be stressful for patients, and potentially lead to treatment delay if further evaluation is warranted. Our results demonstrate that incidental EMFs discovered via breast MRI are common and often lead to additional imaging studies. However, no metastatic lesions were found, and only 1 separate malignancy was identified, which did not affect breast cancer management. In patients with early-stage breast cancer, EMFs yield a very low rate of malignancy, providing high levels of reassurance and supporting the option of proceeding with surgery or treatment without delay.
Collapse
Affiliation(s)
| | - Nikita Roy
- Icahn School of Medicine at Mount Sinai (Roy, LaPlaca), New York, NY
| | - Michelle Bernstein
- Columbia University College of Dental Medicine, New York, NY (Bernstein)
| | - Tara M Balija
- Mount Sinai Hospital West, New York, NY (Balija, Bernik)
| | - Caroline LaPlaca
- Icahn School of Medicine at Mount Sinai (Roy, LaPlaca), New York, NY
| | - Daniella R Nevid
- From the Division of Breast Surgery (Gleckler, Port)
- Icahn School of Medicine at Mount Sinai (Roy, LaPlaca), New York, NY
- Columbia University College of Dental Medicine, New York, NY (Bernstein)
- Mount Sinai Hospital West, New York, NY (Balija, Bernik)
| | - Jean Hee Lee
- From the Division of Breast Surgery (Gleckler, Port)
- Icahn School of Medicine at Mount Sinai (Roy, LaPlaca), New York, NY
- Columbia University College of Dental Medicine, New York, NY (Bernstein)
- Mount Sinai Hospital West, New York, NY (Balija, Bernik)
| | - Elisa Port
- From the Division of Breast Surgery (Gleckler, Port)
| | | |
Collapse
|
4
|
Lee HJ, Nguyen AT, Ki SY, Lee JE, Do LN, Park MH, Lee JS, Kim HJ, Park I, Lim HS. Classification of MR-Detected Additional Lesions in Patients With Breast Cancer Using a Combination of Radiomics Analysis and Machine Learning. Front Oncol 2021; 11:744460. [PMID: 34926256 PMCID: PMC8679659 DOI: 10.3389/fonc.2021.744460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/08/2021] [Indexed: 01/02/2023] Open
Abstract
ObjectiveThis study was conducted in order to investigate the feasibility of using radiomics analysis (RA) with machine learning algorithms based on breast magnetic resonance (MR) images for discriminating malignant from benign MR-detected additional lesions in patients with primary breast cancer.Materials and MethodsOne hundred seventy-four MR-detected additional lesions (benign, n = 86; malignancy, n = 88) from 158 patients with ipsilateral primary breast cancer from a tertiary medical center were included in this retrospective study. The entire data were randomly split to training (80%) and independent test sets (20%). In addition, 25 patients (benign, n = 21; malignancy, n = 15) from another tertiary medical center were included for the external test. Radiomics features that were extracted from three regions-of-interest (ROIs; intratumor, peritumor, combined) using fat-saturated T1-weighted images obtained by subtracting pre- from postcontrast images (SUB) and T2-weighted image (T2) were utilized to train the support vector machine for the binary classification. A decision tree method was utilized to build a classifier model using clinical imaging interpretation (CII) features assessed by radiologists. Area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, and specificity were used to compare the diagnostic performance.ResultsThe RA models trained using radiomics features from the intratumor-ROI showed comparable performance to the CII model (accuracy, AUROC: 73.3%, 69.6% for the SUB RA model; 70.0%, 75.1% for the T2 RA model; 73.3%, 72.0% for the CII model). The diagnostic performance increased when the radiomics and CII features were combined to build a fusion model. The fusion model that combines the CII features and radiomics features from multiparametric MRI data demonstrated the highest performance with an accuracy of 86.7% and an AUROC of 91.1%. The external test showed a similar pattern where the fusion models demonstrated higher levels of performance compared with the RA- or CII-only models. The accuracy and AUROC of the SUB+T2 RA+CII model in the external test were 80.6% and 91.4%, respectively.ConclusionOur study demonstrated the feasibility of using RA with machine learning approach based on multiparametric MRI for quantitatively characterizing MR-detected additional lesions. The fusion model demonstrated an improved diagnostic performance over the models trained with either RA or CII alone.
Collapse
Affiliation(s)
- Hyo-jae Lee
- Department of Radiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Anh-Tien Nguyen
- Department of Radiology, Chonnam National University Hospital, Gwangju, South Korea
| | - So Yeon Ki
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-gun, South Korea
| | - Jong Eun Lee
- Department of Radiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Luu-Ngoc Do
- Department of Radiology, Chonnam National University, Gwangju, South Korea
| | - Min Ho Park
- Department of Radiology, Chonnam National University, Gwangju, South Korea
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun-gun, South Korea
| | - Ji Shin Lee
- Department of Radiology, Chonnam National University, Gwangju, South Korea
- Department of Pathology, Chonnam National University Hwasun Hospital, Hwasun-gun, South Korea
| | - Hye Jung Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Ilwoo Park
- Department of Radiology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Radiology, Chonnam National University, Gwangju, South Korea
- Department of Artificial Intelligence Convergence, Chonnam National University, Gwangju, South Korea
- *Correspondence: Ilwoo Park, ; Hyo Soon Lim,
| | - Hyo Soon Lim
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-gun, South Korea
- Department of Radiology, Chonnam National University, Gwangju, South Korea
- *Correspondence: Ilwoo Park, ; Hyo Soon Lim,
| |
Collapse
|
5
|
Paluch-Shimon S, Cardoso F, Partridge AH, Abulkhair O, Azim HA, Bianchi-Micheli G, Cardoso MJ, Curigliano G, Gelmon KA, Harbeck N, Merschdorf J, Poortmans P, Pruneri G, Senkus E, Spanic T, Stearns V, Wengström Y, Peccatori F, Pagani O. ESO-ESMO 4th International Consensus Guidelines for Breast Cancer in Young Women (BCY4). Ann Oncol 2020; 31:674-696. [PMID: 32199930 DOI: 10.1016/j.annonc.2020.03.284] [Citation(s) in RCA: 167] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/07/2020] [Indexed: 12/16/2022] Open
Abstract
The 4th International Consensus Conference for Breast Cancer in Young Women (BCY4) took place in October 2018, in Lugano, Switzerland, organized by the European School of Oncology (ESO) and the European Society of Medical Oncology (ESMO). Consensus recommendations for the management of breast cancer in young women were updated from BCY3 with incorporation of new evidence to inform the guidelines. Areas of research priorities were also identified. This article summarizes the ESO-ESMO international consensus recommendations, which are also endorsed by the European Society of Breast Specialists (EUSOMA).
Collapse
Affiliation(s)
| | - F Cardoso
- Breast Unit Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal
| | - A H Partridge
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - O Abulkhair
- King Abdulaziz Medical City for National Guard, Riyadh, Saudi Arabia
| | - H A Azim
- School of Medicine, Monterrey Institute of Technology, Monterrey, MX
| | | | - M-J Cardoso
- Breast Unit Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal; Nova Medical School Lisbon, Portugal
| | - G Curigliano
- European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - K A Gelmon
- British Columbia Cancer, Vancouver, Canada
| | - N Harbeck
- Breast Center, Dept. OB&GYN, University of Munich (LMU), Munich, Germany
| | | | - P Poortmans
- Institut Curie, Department of Radiation Oncology & Paris Sciences & Lettres - PSL University, Paris, France
| | - G Pruneri
- National Cancer Institute, IRCCS Foundation, Milan, Italy
| | - E Senkus
- Medical University of Gdansk, Gdansk, Poland
| | - T Spanic
- Europa Donna Slovenia, Ljubljana, Slovenia
| | - V Stearns
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, USA
| | - Y Wengström
- Department of Neurobiology Cancer Science and Society, Karolinska Institute and Theme Cancer Karolinska University Hospital, Sweden
| | - F Peccatori
- European Institute of Oncology IRCCS & European School of Oncology, Milan, Italy
| | - O Pagani
- Oncology Institute of Southern Switzerland and Breast Unit of Southern Switzerland, Geneva University Hospitals, Swiss Group for Clinical Cancer Research (SAKK), Bellinzona, Switzerland
| |
Collapse
|
6
|
Evaluation of MRI accuracy after primary systemic therapy in breast cancer patients considering tumor biology: optimizing the surgical planning. Radiol Oncol 2019; 53:171-177. [PMID: 31104001 PMCID: PMC6572491 DOI: 10.2478/raon-2019-0023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 04/18/2019] [Indexed: 01/16/2023] Open
Abstract
Background We analyzed the accuracy of magnetic resonance imaging (MRI) after primary systemic therapy (PST) according to tumor subtype. Patients and methods Two-hundred and four breast cancer patients treated with PST were studied. MRI findings after PST were compared with pathologic findings, and results were stratified based on tumor subtype. Results Of the two-hundred and four breast cancer patients, eighty-four (41.2%) achieved a pathologic complete response (pCR) in the breast. The MRI accuracy for predicting pCR was highest in triple-negative (TN) and HER2-positive (non-luminal) breast cancer (83.9 and 80.9%, respectively). The mean size discrepancy between MRI-measured and pathologic residual tumor size was lowest in TN breast cancer and highest in luminal B-like (HER2-negative) breast cancer (0.45cm vs. 0.98 cm, respectively; p = 0.003). After breast conserving surgery (BCS), we found a lower rate of positive margins in TN breast cancer and a higher rate of positive margins in luminal B-like (HER2-negative) breast cancer (2.4% vs. 23.6%, respectively). Conclusions If tumor response after PST is assessed by MRI, tumor subtype should be considered when BCS is planned. The accuracy of MRI is highest in TN breast cancer.
Collapse
|
7
|
Clinical findings and outcomes of MRI staging of breast cancer in a diverse population. Breast Cancer Res Treat 2018; 174:315-324. [PMID: 30542816 DOI: 10.1007/s10549-018-05084-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 12/03/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND The performance of magnetic resonance imaging (MRI), the effect of patient factors, and resulting surgical management in underserved and ethnically diverse breast cancer (BC) patient populations have been understudied. METHODS We retrospectively analyzed the data of 1116 consecutive patients who were newly diagnosed with in situ or invasive BC with preoperative staging MRI. Non-index lesions (NILs) were defined as abnormal MRI findings with BI-RADS score of 4 or 5 in breast or axillary nodes not previously detected by conventional imaging. Occult cancers (OCs) were NILs found to be malignant by biopsy or surgery. Logistic regression was used to examine associations between probabilities of NILs or OCs and patient characteristics. RESULTS Staging MRI detected NILs and OCs in 24% and 7.5% of patients, respectively. Of 1116 patients, 271 (24%) had 327 NILs, and 84 (7.5%) had 87 OCs. Follow-up information was available for 306 NILs. Ipsilateral breast NILs (n = 124) were seen in 115 patients (10.3%), with OCs (n = 51) seen in 48 patients (4.4%). Contralateral breast NILs (n = 134) were seen in 118 (10.6%) patients, with OCs (n = 20) seen in 20 patients (1.8%). Laterality (p < 0.001) and disease stage (p = 0.018) were associated with probability of OC. Patients without BRCA mutations had a significantly higher probability of having NILs (p = 0.003) but not OCs. CONCLUSIONS Our study provides useful estimates of the rates of NILs and OCs anticipated in a younger, uninsured, ethnically diverse population. Prospective trials and larger pooled retrospective analyses are needed to define the long-term impacts of MRI staging after a BC diagnosis.
Collapse
|
8
|
Adesoye T, Schumacher JR, Neuman HB, Edge S, McKellar D, Winchester DP, Francescatti AB, Greenberg CC. Use of Breast Imaging After Treatment for Locoregional Breast Cancer (AFT-01). Ann Surg Oncol 2018; 25:1502-1511. [PMID: 29450753 DOI: 10.1245/s10434-018-6359-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Annual mammography is recommended after breast cancer treatment. However, studies suggest its under-utilization for Medicare patients. Utilization in the broader population is unknown, as is the role of breast magnetic resonance imaging (MRI). Understanding factors associated with imaging use is critical to improvement of adherence to recommendations. METHODS A random sample of 9835 eligible patients receiving surgery for stages 2 and 3 breast cancer from 2006 to 2007 was selected from the National Cancer Database for primary data collection. Imaging and recurrence data were abstracted from patients 90 days after surgery to 5 years after diagnosis. Factors associated with lack of imaging were assessed using multivariable repeated measures logistic regression with generalized estimating equations. Patients were censored for death, bilateral mastectomy, new cancer, and recurrence. RESULTS Of 9835 patients, 9622, 8702, 8021, and 7457 patients were eligible for imaging at surveillance years 1 through 4 respectively. Annual receipt of breast imaging declined from year 1 (69.5%) to year 4 (61.0%), and breast MRI rates decreased from 12.5 to 5.8%. Lack of imaging was associated with age 80 years or older and age younger than 50 years, black race, public or no insurance versus private insurance, greater comorbidity, larger node-positive hormone receptor-negative tumor, excision alone or mastectomy, and no chemotherapy (p < 0.005). Receipt of breast MRI was associated with age younger than 50 years, white race, higher education, private insurance, mastectomy, chemotherapy, care at a teaching/research facility, and MRI 12 months before diagnosis (p < 0.05). CONCLUSION Under-utilization of mammography after breast cancer treatment is associated with sociodemographic and clinical factors, not institutional characteristics. Effective interventions are needed to increase surveillance mammography for at-risk populations. ClinicalTrials.gov Identifier: NCT02171078.
Collapse
Affiliation(s)
- Taiwo Adesoye
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Jessica R Schumacher
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Heather B Neuman
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.,University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Daniel McKellar
- American College of Surgeons, Commission On Cancer, Chicago, IL, USA
| | | | | | - Caprice C Greenberg
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA. .,University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | | |
Collapse
|
9
|
Kaiser C, Kehrer C, Keyver-Paik MD, Hecking T, Ayub TH, Leutner C, Schild H, Kuhn W. Preoperative breast MRI-examination for all patients with histologically proven breast cancer? A concept for a prospective multicenter trial. Horm Mol Biol Clin Investig 2017; 32:/j/hmbci.ahead-of-print/hmbci-2017-0041/hmbci-2017-0041.xml. [PMID: 29127760 DOI: 10.1515/hmbci-2017-0041] [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: 06/11/2017] [Accepted: 09/06/2017] [Indexed: 11/15/2022]
Abstract
Background A published retrospective data of our study group demonstrated that premenopausal women, patients with lobular invasive breast cancer or patients with high breast density [American College of Radiology (ACR) classification 3+4] significantly benefit from magnetic resonance imaging (MRI) leading to additional detection of malignant foci of 20.2% in the index and 2.5% in the contralateral breast, which would otherwise not be detected by routine imaging. Critics of preoperative MRI focus on higher false-positive rates leading to unnecessary surgical procedures and mastectomies. Therefore, MRI in preoperative imaging remains controversial. Methods To validate our retrospective data we initiate a prospective one-armed multicenter trial for patients with histologically confirmed breast cancer performing routine imaging by ultrasound and mammography followed by MRI imaging based on menopause status, histologic subtype, ACR and Breast Imaging Reporting and Data System (BIRADS)-classification. Primary endpoint is the rate of additional findings and change of treatment strategy, secondary endpoints are local recurrence-free, distant recurrence-free and overall survival. Additional MRI findings are calculated to be above 10% with a number of 100 patients recruited and a power of 80%. Conclusion MRI is detecting more tumor foci than conventional imaging but remains controversial in primary breast cancer for preoperative imaging because of the fear of over-diagnosis and the increased morbidity of additional potentially unnecessary surgical procedures. This planned one-armed prospective multicenter trial is designed to confirm our retrospectively revealed data defining subgroups with significant benefit of preoperative MRI to come to a consensus avoiding over-diagnosis and false-positive results leading to clinically beneficial and cost-effective use of preoperative MRI.
Collapse
Affiliation(s)
- Christina Kaiser
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Straße 25, 53127 Bonn, Germany, Phone: 0049/228 287 15449, Fax: 0049/228 287 11489
| | - Christina Kehrer
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Straße 25, 53127 Bonn, Germany, Phone: 0049/228 287 15449, Fax: 0049/228 287 11489
| | - Mignon-Denise Keyver-Paik
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Bonn, Germany
| | - Thomas Hecking
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Bonn, Germany
| | - Tiyasha Hosne Ayub
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Bonn, Germany
| | - Claudia Leutner
- Department of Radiology, Centre for Integrated Oncology (CIO), University of Bonn, Bonn, Germany
| | - Hans Schild
- Department of Radiology, Centre for Integrated Oncology (CIO), University of Bonn, Bonn, Germany
| | - Walther Kuhn
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Bonn, Germany
| |
Collapse
|
10
|
Oldrini G, Fedida B, Poujol J, Felblinger J, Trop I, Henrot P, Darai E, Thomassin-Naggara I. Abbreviated breast magnetic resonance protocol: Value of high-resolution temporal dynamic sequence to improve lesion characterization. Eur J Radiol 2017; 95:177-185. [PMID: 28987664 DOI: 10.1016/j.ejrad.2017.07.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 07/25/2017] [Accepted: 07/31/2017] [Indexed: 01/03/2023]
Abstract
PURPOSE To evaluate the added value of ULTRAFAST-MR sequence to an abbreviated FAST protocol in comparison with FULL protocol to distinguish benign from malignant lesions in a population of women, regardless of breast MR imaging indication. MATERIALS AND METHODS From March 10th to September 22th, 2014, we retrospectively included a total of 70 consecutive patients with 106 histologically proven lesions (58 malignant and 48 benign) who underwent breast MR imaging for preoperative breast staging (n=38), high-risk screening (n=7), problem solving (n=18), and nipple discharge (n=4) with 12 time resolved imaging of contrast kinetics (TRICKS) acquisitions during contrast inflow interleaved in a regular high-resolution dynamic MRI protocol (FULL protocol). Two readers scored MR exams as either positive or negative and described significant lesions according to Bi-RADS lexicon with a TRICKS images (ULTRAFAST), an abbreviated protocol (FAST) and all images (FULL protocol). Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for each protocol and compared with McNemar's test. RESULTS For all readers, the combined FAST-ULTRAFAST protocol significantly improved the reading with a specificity of 83.3% and 70.8% in comparison with FAST protocol or FULL protocol, respectively, without change in sensitivity. By adding ULTRAFAST protocol to FAST protocol, readers 1 and 2 were able to correctly change the diagnosis in 22.9% (11/48) and 10.4% (5/48) of benign lesions, without missing any malignancy, respectively. Both interpretation and image acquisition times for combined FAST-ULTRAFAST protocol and FAST protocol were shorter compared to FULL protocol (p<0.001). CONCLUSION Compared to FULL protocol, adding ULTRAFAST to FAST protocol improves specificity, mainly in correctly reclassifying benign masses and reducing interpretation and acquisition time, without decreasing sensitivity.
Collapse
Affiliation(s)
- Guillaume Oldrini
- Service d'imagerie, Institut de cancérologie de Lorraine, Nancy, France
| | - Benjamin Fedida
- Sorbonne Universités, UPMC Univ Paris 06, Institut Universitaire de Cancérologie, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Tenon, Service d'Imagerie, 4 rue de la Chine, Paris 75020, France
| | - Julie Poujol
- IADI U947, INSERM, Université de Lorraine, Nancy, France
| | | | - Isabelle Trop
- Department of Radiology, Hôtel-Dieu de Montréal, Centre Hospitalier de l'Université de Montréal, Montréal, QC H2W 1T8, Canada
| | | | - Emile Darai
- Sorbonne Universités, UPMC Univ Paris 06, CALG Cancer Associé à La Grossesse, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Tenon, Service de Gynécologie et Obstétrique, 4 rue de la Chine, Paris, France
| | - Isabelle Thomassin-Naggara
- Sorbonne Universités, UPMC Univ Paris 06, Institut Universitaire de Cancérologie, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Tenon, Service d'Imagerie, 4 rue de la Chine, Paris 75020, France.
| |
Collapse
|
11
|
Song SE, Cho N, Han W. Post-clip placement MRI following second-look US-guided core biopsy for suspicious lesions identified on breast MRI. Eur Radiol 2017; 27:5196-5203. [PMID: 28687909 DOI: 10.1007/s00330-017-4924-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/21/2017] [Accepted: 06/01/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate whether the post-clip placement MRI following second-look ultrasound (US)-guided core biopsy is useful to confirm the adequate sampling of suspicious lesions identified on breast MRI. METHODS Between 2014 and 2016, 31 consecutive women with 34 suspicious lesions that had not been identified on previous mammography or US were detected using MRI. Among them, 26 women with 29 lesions (mean size 1.5 cm, range 0.5-5.8 cm) found by second-look US underwent US-guided biopsy, subsequent clip insertion and post-clip placement MRI. Five women with five lesions that were not found by second-look US underwent MRI-guided biopsy. The technical success rate and lesion characteristics were described. RESULTS The technical success rate was 96.6% (28/29). One failure case was a benign, 1.1-cm non-mass enhancement. Of the 28 success cases, 23 (82.1%) were masses and 5 (17.9%) were non-mass enhancements; 17 (60.7%) were benign, 4 (14.3%) were high-risk and 7 (25.0%) were malignant lesions. The technical success rate was 100% (28/28) for masses and 83.3% (5/6) for non-mass enhancements. CONCLUSIONS Post-clip placement MRI following US-guided biopsy is useful in confirming the adequate sampling of lesions identified on MRI. This method could be an alternative to MRI-guided biopsy for lesions visible on US. KEY POINTS • Post-clip MRI is useful for confirming adequate sampling of US-guided biopsy. • Post-clip MRI following US-guided biopsy revealed a 96.6 % technical success rate. • One technical failure case was a benign, 1.1-cm non-mass enhancement. • The technical success rate of US-guided biopsy for non-mass enhancements was 83.3 %.
Collapse
Affiliation(s)
- Sung Eun Song
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Nariya Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea. .,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Institute of Radiation Medicine, Seoul National University Medical Research Centre, Seoul, Republic of Korea.
| | - Wonshik Han
- Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
12
|
[Performances of breast magnetic resonance imaging in the context of neoadjuvant chemotherapy for breast cancer to predict pathological complete response]. J Gynecol Obstet Hum Reprod 2017; 46:147-154. [PMID: 28403971 DOI: 10.1016/j.jogoh.2016.11.003] [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: 06/07/2016] [Revised: 10/29/2016] [Accepted: 11/09/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE The objective of this work was to estimate the reliability of MRI after neoadjuvant chemotherapy (NAC) for breast cancer to detect a residual tumour by comparing the tumoral size measured by MRI with the histological size. We also estimated the concordance of diagnosis of complete pathological response between histological examination and MRI. MATERIALS AND METHODS We included all the patients who received a neoadjuvant chemotherapy for breast cancer in the university hospital of Tours from January, 2008 to December 31st, 2012 and in the comprehensive cancer centre of Rennes from January, 2008 till May 31st 201. We considered that the pathological response was complete (pCR) when there was no residual invasive tumour in the mammary surgical specimen. RESULTS Two hundred and fifty-one women who received NAC for a non-metastatic breast cancer were included in the study: 103 in Tours and 148 in Rennes. Two women (0.8%) refused breast surgery whatever the type. One hundred and twenty-three (49%) women had a breast conservative surgery. One hundred and fifteen (45.8%) had a mastectomy and 11 (4.4%) had breast conservative surgery followed by mastectomy for positive margins. A complete pathological response was present in 54 cases (21.5%). We did not found any significant difference between characteristics of patients with pCR or not. CONCLUSION Breast MRI remains the most performing examination to evaluate the initial tumoral size and the residual tumour after NAC, but does not add any value at mid or at the end of treatment for the patients to whom a mastectomy is decided at presentation. The correlation between the breast MRI and the histology size is not perfect, but at the moment, MRI stills of the most performing examination to predict the pCR.
Collapse
|
13
|
Brennan ME, McKessar M, Snook K, Burgess I, Spillane AJ. Impact of selective use of breast MRI on surgical decision-making in women with newly diagnosed operable breast cancer. Breast 2017; 32:135-143. [DOI: 10.1016/j.breast.2017.01.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 01/02/2023] Open
|
14
|
Cheon H, Kim HJ, Lee SW, Kim DH, Lee CH, Cho SH, Shin KM, Lee SM, Kim GC, Kim WH. Internal mammary node adenopathy on breast MRI and PET/CT for initial staging in patients with operable breast cancer: prevalence and associated factors. Breast Cancer Res Treat 2016; 160:523-530. [DOI: 10.1007/s10549-016-4022-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 10/13/2016] [Indexed: 12/23/2022]
|
15
|
Mukherjee SD, Hodgson N, Lovrics PJ, Dhamanaskar K, Minuk T, Chambers S, Sussman J. A Retrospective Study Evaluating the Impact of Preoperative Breast MRI on Surgical Decision-Making in Young Patients (≤50 Years) with Invasive Breast Cancer. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2016; 10:53-60. [PMID: 27226720 PMCID: PMC4871200 DOI: 10.4137/bcbcr.s38432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/28/2016] [Accepted: 03/30/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Breast magnetic resonance imaging (MRI) is considered a more sensitive diagnostic test for detecting invasive breast cancer than mammography or breast ultrasound. Breast MRI may be particularly useful in younger premenopausal women with higher density breast tissue for differentiating between dense fibroglandular breast tissue and breast malignancies. The main objective of this study was to determine the impact of preoperative breast MRI on surgical decision-making in young women with breast cancer. METHODS A retrospective review of patients with newly diagnosed invasive breast cancer and age of ≤50 years was performed. All patients underwent physical examination, preoperative mammogram, breast ultrasound, and bilateral breast MRI. Two breast cancer surgeons reviewed the preoperative mammogram report, breast ultrasound report, and physical examination summary and were asked if they would recommend a lumpectomy, a quandrantectomy, or a mastectomy. A few weeks later, the two surgeons were shown the same information with the breast MRI report and were asked what type of surgery they would now recommend. In each case, MRI was classified by two adjudicators as having affected the surgical outcome in a positive, negative, or neutral fashion. A positive impact was defined as the situation where breast MRI detected additional disease that was not found on physical examination, mammogram, or breast ultrasound and led to an appropriate change in surgical management. A negative impact was defined as the situation where breast MRI led the surgeon to recommend more extensive surgery, with less extensive disease actually found at pathology. No impact was defined as the situation where MRI findings did not alter surgical recommendations or outcomes. RESULTS Of 37 patients whose charts were reviewed, five patients were deemed to be ineligible due to having received neoadjuvant chemotherapy, having previous breast implants, or having had their tumor fully excised during biopsy. In total, 32 patients met the inclusion criteria of this study and were appropriate for analysis. The median age of our study patient population was 42 years. The pathologic diagnosis was invasive ductal carcinoma in 91% (29/32) of patients and invasive lobular carcinoma in 9% (3/32) of patients. For surgeon A, clinical management was altered in 21/32 (66%) patients, and for surgeon B, management was altered in 13/32 (41%) patients. The most common change in surgical decision-making after breast MRI was from breast-conserving surgery to a mastectomy. Mastectomy rates were similar between both surgeons after breast MRI. After reviewing the pathology results and comparing them with the breast MRI results, it was determined that breast MRI led to a positive outcome in 13/32 (41%) patients. Breast MRI led to no change in surgical management in 15/32 (47%) patients and resulted in a negative change in surgical management in 4/32 (13%) patients. Bilateral breast MRI detected a contralateral breast cancer in 2/32 (6%) patients. CONCLUSIONS Preoperative breast MRI alters surgical management in a significant proportion of younger women diagnosed with breast cancer. Prospective studies are needed to confirm these findings and to help determine if this change in surgical decision-making will result in improved local control.
Collapse
Affiliation(s)
- Som D Mukherjee
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Nicole Hodgson
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Peter J Lovrics
- Department of Surgery, McMaster University, Hamilton, ON, Canada.; St. Joseph's Hospital, Hamilton, ON, Canada
| | | | - Terry Minuk
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Shelley Chambers
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Jonathan Sussman
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
16
|
Debald M, Abramian A, Nemes L, Döbler M, Kaiser C, Keyver-Paik MD, Leutner C, Höller T, Braun M, Kuhl C, Kuhn W, Schild HH. Who may benefit from preoperative breast MRI? A single-center analysis of 1102 consecutive patients with primary breast cancer. Breast Cancer Res Treat 2015; 153:531-7. [PMID: 26323190 DOI: 10.1007/s10549-015-3556-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 08/22/2015] [Indexed: 02/03/2023]
Abstract
Several authors question the potential benefit of preoperative magnetic resonance imaging (MRI) against the background of possible overdiagnosis, false-positive findings, and unnecessary resections in patients with newly diagnosed breast cancer. In order to reveal a better selection of patients who should undergo preoperative MRI after histological confirmed breast cancer, the present analysis was implemented. We aimed to evaluate the influence of preoperative breast MRI in patients with newly diagnosed breast cancer to find subgroups of patients that are most likely to benefit from preoperative MRI by the detection of occult malignant foci. A total of 1102 consecutive patients who underwent treatment for primary breast cancer between 2002 and 2013 were retrospectively analyzed. All patients underwent triple assessment by breast ultrasound, mammography, and bilateral breast MRI. MRI findings not seen on conventional imaging that suggested additional malignant disease was found in 344 cases (31.2 %). Histological confirmed malignant foci were found in 223 patients (20.2 %) within the index breast and in 28 patients (2.5 %) in the contralateral breast. The rate of false-negative biopsies was 31 (2.8 %) and 62 (5.6 %), respectively. Premenopausal women (p = 0.024), lobular invasive breast cancer (p = 0.02) as well as patients with high breast density [American College of Radiology (ACR) 3 + 4; p = 0.01] were significantly associated with additional malignant foci in the index breast. Multivariate analysis confirmed lobular histology (p = 0.041) as well as the co-factors "premenopausal stage" and "high breast density (ACR 3+4)" (p = 0.044) to be independently significant. Previous studies revealed that breast MRI is a reliable tool for predicting tumor extension as well as for the detection of additional ipsilateral and contralateral tumor foci in histological confirmed breast cancer. In the present study, we demonstrate that especially premenopausal patients with high breast density as well as patients with lobular histology seem to profit from preoperative MRI.
Collapse
Affiliation(s)
- Manuel Debald
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Alina Abramian
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Lisa Nemes
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Michael Döbler
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Christina Kaiser
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Mignon-Denise Keyver-Paik
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Claudia Leutner
- Department of Radiology, Centre for Integrated Oncology, University of Bonn, Bonn, Germany
| | - Tobias Höller
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University of Bonn, Bonn, Germany
| | - Michael Braun
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.,Department of Gynecology, Red Cross Women's Clinic Munich, Munich, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, University of Aachen RWTH, Aachen, Germany
| | - Walther Kuhn
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Hans H Schild
- Department of Radiology, Centre for Integrated Oncology, University of Bonn, Bonn, Germany
| |
Collapse
|
17
|
Kaplan JA, Grinstaff MW, Bloch BN. Polymer film-nanoparticle composites as new multimodality, non-migrating breast biopsy markers. Eur Radiol 2015; 26:866-73. [DOI: 10.1007/s00330-015-3852-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/26/2015] [Accepted: 05/13/2015] [Indexed: 11/30/2022]
|
18
|
Oztekin PS, Kosar PN. Magnetic resonance imaging of the breast as a problem-solving method: to be or not to be? Breast J 2014; 20:622-31. [PMID: 25200378 DOI: 10.1111/tbj.12334] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The use of dynamic magnetic resonance imaging (MRI) of the breast as a complementary problem-solving tool was explored in a heterogeneous population sample. A total of 3,076 patients that underwent breast MRI examination between January 2008 and June 2012 in our center were screened retrospectively. Of these, 868 met the following inclusion criteria and were considered eligible for the study: available data on clinical signs, symptoms and on the results of mammography and ultrasound examinations in medical records; at least 1 year of follow-up; and documented pathology findings. Lesions with a stable course over a follow-up period of at least 12 months were considered benign. MRI was suggestive of a suspicious abnormality (BI-RADS 4) or highly suggestive of malignancy (BI-RADS 5) in 129 (15%) of 868 patients, leading to a biopsy examination in these cases. On the other hand, MRI findings were considered normal in 739 (85%) subjects based on normal (BI-RADS 1), benign (BI-RADS 2) or probably benign (BI-RADS 3) findings. Of the 129 patients undergoing a histopathologic examination based on MRI findings, 63 were diagnosed with cancer, and in 66, the biopsy proved to be benign. Forty of the 63 patients (40/63) with a diagnosis of malignancy and 34 of the 66 patients (34/66) with a benign diagnosis had been categorized as BI-RADS 4 with conventional methods. A total of 23 patients with BI-RADS category of 0 to 3 according to conventional methods were diagnosed as having cancer with MRI. In six of these, the family history was positive. The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of MRI for the detection of cancer were 100%, 92%, 52%, and 100%, respectively. In cases with inconclusive findings on conventional imaging studies or in patients with clinical/radiological suspicion of malignancy, MRI should be more effectively used as a problem-solving approach owing to its high sensitivity and NPV in this condition. Use of MRI as a problem-solving method in such cases may decrease rather than increase unnecessary biopsy procedures and patient anxiety.
Collapse
Affiliation(s)
- Pelin Seher Oztekin
- Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey
| | | |
Collapse
|
19
|
Park VY, Kim MJ, Kim EK, Moon HJ. Second-look US: how to find breast lesions with a suspicious MR imaging appearance. Radiographics 2014; 33:1361-75. [PMID: 24025929 DOI: 10.1148/rg.335125109] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Breast magnetic resonance (MR) imaging has high sensitivity in breast cancer diagnosis. The probability of malignancy for additional detected lesions is higher in patients with breast cancer than in the population without malignancy, which is why biopsy or further study should be considered for additional detected lesions. Because of the shortcomings of MR imaging-guided biopsy, second-look ultrasonography (US) may be the preferred next step. Detecting target lesions at second-look US and correlating lesions between the two modalities may be challenging. Using axial MR imaging to localize the lesion with respect to the nipple and the lesion-to-nipple distance can narrow the scan range at US. Evaluating the lesion's location relative to the mammary zones and surrounding tissues, as well as noting its depth, characteristics, and nearby landmarks, will aid in lesion correlation. Doppler imaging, tissue harmonic imaging, and other US techniques can be used to identify subtle lesions. Although malignant breast lesions may appear probably benign at second-look US, decision making for biopsy must be based primarily on MR imaging findings. In sonographically occult, MR imaging-detected lesions with suspicious MR imaging features, the probability of malignancy is much higher than 2%, and MR imaging-guided biopsy must be performed.
Collapse
Affiliation(s)
- Vivian Youngjean Park
- Department of Radiology, Research Institute of Radiological Science, Yonsei University, College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
| | | | | | | |
Collapse
|
20
|
CHEN JEONHOR, BAHRI SHADFAR, MEHTA RITAS, CARPENTER PHILIPM, MCLAREN CHRISTINEE, CHEN WENPIN, FWU PETERT, HSIANG DAVIDJB, LANE KARENT, BUTLER JOHNA, SU MINYING. Impact of factors affecting the residual tumor size diagnosed by MRI following neoadjuvant chemotherapy in comparison to pathology. J Surg Oncol 2014; 109:158-67. [PMID: 24166728 PMCID: PMC4005994 DOI: 10.1002/jso.23470] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 09/26/2013] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND OBJECTIVES To investigate accuracy of magnetic resonance imaging (MRI) for measuring residual tumor size in breast cancer patients receiving neoadjuvant chemotherapy (NAC). METHODS Ninety-eight patients were studied. Several MRI were performed during NAC for response monitoring, and the residual tumor size was measured on last MRI after completing NAC. Covariates, including age, tumor characteristics, biomarkers, NAC regimens, MRI scanners, and time from last MRI to operation, were analyzed. Univariate and Multivariate linear regression models were used to determine the predictive value of these covariates for MRI-pathology size discrepancy as the outcome measure. RESULTS The mean (±SD) of the absolute difference between MRI and pathological residual tumor size was 1.0 ± 2.0 cm (range, 0-14 cm). Univariate regression analysis showed tumor type, morphology, HR status, HER2 status, and MRI scanner (1.5 T or 3.0 T) were significantly associated with MRI-pathology size discrepancy (all P < 0.05). Multivariate regression analyses demonstrated that only tumor type, tumor morphology, and biomarker status considering both HR and HER-2 were independent predictors (P = 0.0014, 0.0032, and 0.0286, respectively). CONCLUSION The accuracy of MRI in evaluating residual tumor size depends on tumor type, morphology, and biomarker status. The information may be considered in surgical planning for NAC patients.
Collapse
Affiliation(s)
- JEON-HOR CHEN
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California
- Department of Radiology, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
| | - SHADFAR BAHRI
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California
| | - RITA S. MEHTA
- Department of Medicine, University of California, Irvine, California
| | | | | | - WEN-PIN CHEN
- Chao Family Comprehensive Cancer Center, University of California, Irvine, California
| | - PETER T. FWU
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California
| | | | - KAREN T. LANE
- Department of Surgery, University of California, Irvine, California
| | - JOHN A. BUTLER
- Department of Surgery, University of California, Irvine, California
| | - MIN-YING SU
- Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California
| |
Collapse
|
21
|
Avoiding preoperative breast MRI when conventional imaging is sufficient to stage patients eligible for breast conserving therapy. Eur J Radiol 2014; 83:273-8. [DOI: 10.1016/j.ejrad.2013.10.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 10/07/2013] [Accepted: 10/13/2013] [Indexed: 11/20/2022]
|
22
|
Fayanju OM, Stoll CRT, Fowler S, Colditz GA, Jeffe DB, Margenthaler JA. Geographic and temporal trends in the management of occult primary breast cancer: a systematic review and meta-analysis. Ann Surg Oncol 2013; 20:3308-16. [PMID: 23975301 PMCID: PMC3922044 DOI: 10.1245/s10434-013-3157-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Management of occult primary breast cancer (OPBC), including the role of magnetic resonance imaging (MRI), is controversial. We conducted a pooled analysis of OPBC patients and a meta-analysis of MRI accuracy in OPBC in order to elucidate current practices. METHODS A literature search yielded 201 studies. Patient-level data for clinically/mammographically OPBC from studies published after 1993 and from our institution were pooled; logistic regression examined associations between patient/study data and outcomes, including treatments and recurrence. We report adjusted odds ratios (OR) and 95 % confidence intervals (95 % CI) significant at 2-tailed p < 0.05. Meta-analysis included data for patients who received MRIs for workup of clinically/mammographically OPBC. We report pooled sensitivity and specificity with 95 % CIs. RESULTS The pooled analysis included 92 patients (15 studies [n = 85] plus our institution [n = 7]). Patients from Asia were more likely to receive breast surgery (OR = 5.98, 95 % CI = 2.02-17.65) but not chemotherapy (OR = 0.32, 95 % CI = 0.13-0.82); patients from the United States were more likely to receive chemotherapy (OR = 13.08, 95 % CI = 2.64-64.78). Patients from studies published after 2003 were more likely to receive radiotherapy (OR = 3.86, 95 % CI = 1.41-10.55). Chemotherapy recipients were more likely to have distant recurrence (OR = 9.77, 95 % CI = 1.10-87.21). More patients with positive MRIs received chemotherapy than patients with negative MRIs (10 of 12 [83.3 %] vs 5 of 13 [38.5 %]; p = 0.0414). In the MRI-accuracy meta-analysis (10 studies, n = 262), pooled sensitivity and specificity were 96 % (95 % CI = 91-98 %) and 63 % (95 % CI = 42-81 %), respectively. CONCLUSIONS OPBC management varied geographically and over time. We recommend establishing an international OPBC patient registry to facilitate longitudinal study and develop global treatment standards.
Collapse
|
23
|
Abstract
In patients with primary breast cancer, preoperative MRI identifies additional foci of tumor in the ipsilateral or contralateral breast that are not evident with standard imaging. Breast cancer patients who are otherwise deemed suitable candidates for breast-conserving surgery might, therefore, be urged to undergo mastectomy or even bilateral mastectomy following staging with preoperative breast MRI. The effect of preoperative breast MRI on clinical end points (rates of ipsilateral breast tumor recurrence) and surgical end points (rates of reoperation) have been assessed in several large studies. These studies indicate that the routine use of preoperative breast MRI is not beneficial. The additional occult foci of tumor detected with preoperative breast MRI seem to either have no clinical significance, or can be adequately treated with radiotherapy and/or systemic therapy. This article reviews these studies and highlights the potential harms associated with the routine use of preoperative MRI in patients with primary breast cancer.
Collapse
Affiliation(s)
- Ismail Jatoi
- Division of Surgical Oncology, MC 7738, University of Texas Health Sciences Center, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
| | | |
Collapse
|
24
|
Fayanju OM, Jeffe DB, Margenthaler JA. Occult primary breast cancer at a comprehensive cancer center. J Surg Res 2013; 185:684-9. [PMID: 23890400 DOI: 10.1016/j.jss.2013.06.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 05/29/2013] [Accepted: 06/07/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Management of occult primary breast cancer (OPBC), that is, breast cancer that first presents through regional nodal or distant disease without clinical or mammographic evidence of disease in the breast, has been controversial and inconsistent. Here, we review OPBC patients treated at our institution. METHODS We conducted a retrospective review of women diagnosed with a first primary breast cancer between March 1999 and September 2010 to identify patients who presented with isolated axillary lymphadenopathy proven to be histologically consistent with primary breast malignancy but had no evidence of a breast mass on physical examination, mammography, or ultrasound. Descriptions of treatments received, recurrence, morbidity, and mortality as of October 2012 are reported. RESULTS Of 5533 patients reviewed, seven (0.1%) patients were identified. The median age was 65 y old (range, 40-72), and the median length of follow-up was 86 mo (range, 42-124). Four patients underwent modified radical mastectomy, one patient had a lumpectomy and axillary lymph node dissection, and two patients had axillary lymph node dissection without breast surgery. Four patients received adjuvant radiation therapy. All seven patients received chemotherapy. Three patients received endocrine therapy, and two patients received anti-HER2 therapy. At the last follow-up, all seven patients were alive with no evidence of disease. CONCLUSIONS Although there was some variation in the management of OPBC at our institution, our patients had excellent outcomes after multimodal treatment. Our results support a curative intent approach to the treatment of OPBC and illustrate the need for individualized treatment algorithms based on tumor biology and extent of the disease at diagnosis.
Collapse
|
25
|
Chen JH, Su MY. Clinical application of magnetic resonance imaging in management of breast cancer patients receiving neoadjuvant chemotherapy. BIOMED RESEARCH INTERNATIONAL 2013; 2013:348167. [PMID: 23862143 PMCID: PMC3687601 DOI: 10.1155/2013/348167] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 05/17/2013] [Indexed: 12/21/2022]
Abstract
Neoadjuvant chemotherapy (NAC), also termed primary, induction, or preoperative chemotherapy, is traditionally used to downstage inoperable breast cancer. In recent years it has been increasingly used for patients who have operable cancers in order to facilitate breast-conserving surgery, achieve better cosmetic outcome, and improve prognosis by reaching pathologic complete response (pCR). Many studies have demonstrated that magnetic resonance imaging (MRI) can assess residual tumor size after NAC, and that provides critical information for planning of the optimal surgery. NAC also allows for timely adjustment of administered drugs based on response, so ineffective regimens could be terminated early to spare patients from unnecessary toxicity while allowing other effective regimens to work sooner. This review article summarizes the clinical application of MRI during NAC. The use of different MR imaging methods, including dynamic contrast-enhanced MRI, proton MR spectroscopy, and diffusion-weighted MRI, to monitor and evaluate the NAC response, as well as how changes of parameters measured at an early time after initiation of a drug regimen can predict final treatment outcome, are reviewed. MRI has been proven a valuable tool and will continue to provide important information facilitating individualized image-guided treatment and personalized management for breast cancer patients undergoing NAC.
Collapse
Affiliation(s)
- Jeon-Hor Chen
- Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, CA 92697-5020, USA
- Department of Radiology, E-Da Hospital and I-Shou University, Kaohsiung 82445, Taiwan
| | - Min-Ying Su
- Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, CA 92697-5020, USA
| |
Collapse
|
26
|
Fusco R, Filice S, Granata V, Mandato Y, Porto A, D’Aiuto M, Rinaldo M, Bonito MD, Sansone M, Sansone C, Rotondo A, Petrillo AP. Can semi-quantitative evaluation of uncertain (type II) time-intensity curves improve diagnosis in breast DCE-MRI? ACTA ACUST UNITED AC 2013. [DOI: 10.4236/jbise.2013.63a052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
27
|
Moser EC, Vrieling C. Accelerated partial breast irradiation: the need for well-defined patient selection criteria, improved volume definitions, close follow-up and discussion of salvage treatment. Breast 2012; 21:707-15. [PMID: 23127279 DOI: 10.1016/j.breast.2012.09.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 08/17/2012] [Accepted: 09/23/2012] [Indexed: 12/24/2022] Open
Abstract
Breast-conserving therapy, including whole breast irradiation, has become a well-established alternative to mastectomy in early-stage breast cancer patients, with similar survival rates and better cosmetic outcome. However, many women are still treated with mastectomy, due to logistical issues related to the long course of radiotherapy (RT). To reduce mastectomy rates and/or omission of RT after breast-conserving surgery, shorter, hypofractionated RT treatments have been introduced. More recently, the necessity of routinely treating the entire breast in all patients has been questioned, leading to the development of partial breast radiotherapy. With accelerated partial breast irradiation (APBI) these two approaches have been combined: the tumor bed with a 1-2 cm margin is irradiated either intra-operatively (single fraction) or postoperatively over 5-15 days. Different techniques have been developed, including interstitial brachytherapy, intra-cavity brachytherapy, intra-operative radiotherapy and external beam radiotherapy. These techniques are being evaluated in several ongoing phase III studies. Since its introduction, APBI has been the subject of continuous debate. ASTRO and GEC-ESTRO have published guidelines for patient selection for APBI, and strongly recommend that APBI be carried out within ongoing clinical trials. Recently, the patient selection criteria for APBI have also been up for debate, following the publication of results from different groups that do/do not confirm a difference in recurrence risk among the ASTRO defined risk groups. This paper reviews the different APBI techniques, current recommendations for patient selection, available clinical data and ongoing clinical trials. A case report is included to illustrate the need for careful follow-up of patients treated with APBI.
Collapse
Affiliation(s)
- Elizabeth C Moser
- Breast Unit/Department of Radiotherapy, Champalimaud Cancer Centre, Lisbon, Portugal.
| | | |
Collapse
|
28
|
Olsen ML, Morton MJ, Stan DL, Pruthi S. Is there a role for magnetic resonance imaging in diagnosing palpable breast masses when mammogram and ultrasound are negative? J Womens Health (Larchmt) 2012; 21:1149-54. [PMID: 23046046 DOI: 10.1089/jwh.2012.3735] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The use of breast magnetic resonance imaging (MRI) for screening high-risk patients is well established. However, the role of MRI as a diagnostic problem-solving tool is less well studied. With the increasing availability of MRI, its use for problem solving has increased. This small retrospective study examines the use and utility of breast MRI in evaluating palpable breast masses with negative diagnostic mammogram and ultrasound studies. METHODS We reviewed our breast MRI database, selecting breast MRI studies performed to assess palpable abnormalities with negative mammogram and ultrasound findings. Evidence of cancer was determined by biopsy. RESULTS Seventy-seven studies were included, comprising 1.3% of all breast MRI studies performed at our institution during the study period (2005-2011). Twenty-two patients underwent biopsy, and 55 were followed clinically without biopsy. Approximately half (27 of 55) of the patients without biopsy were lost to follow-up after negative MRI, and the rest had no evidence of cancer on imaging or clinical examination at 1 year. Of the 22 patients who underwent biopsy, 2 were diagnosed with cancer, both with positive MRI studies. Sensitivity of MRI when compared to tissue diagnosis was 100%, and specificity was 70%. Positive and negative predictive values were 25% and 100%, respectively. CONCLUSIONS When used for evaluation of a palpable breast mass with negative traditional imaging, breast MRI likely offers low yield of cancer diagnosis and low specificity. Negative MRI results may cause a low compliance rate for recommended follow-up. Because a biopsy is indicated for persistent palpable masses, the addition of diagnostic MRI only adds another step, with associated costs and burdens.
Collapse
Affiliation(s)
- Molly L Olsen
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | |
Collapse
|
29
|
Options for Surgical Prophylaxis and Reconstruction. CURRENT BREAST CANCER REPORTS 2012. [DOI: 10.1007/s12609-012-0079-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
30
|
Conditional non-independence of radiographic image features and the derivation of post-test probabilities – A mammography BI-RADS example. Radiography (Lond) 2012. [DOI: 10.1016/j.radi.2012.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
31
|
Kuzucan A, Chen JH, Bahri S, Mehta RS, Carpenter PM, Fwu PT, Yu HJ, Hsiang DJB, Lane KT, Butler JA, Feig SA, Su MY. Diagnostic performance of magnetic resonance imaging for assessing tumor response in patients with HER2-negative breast cancer receiving neoadjuvant chemotherapy is associated with molecular biomarker profile. Clin Breast Cancer 2012; 12:110-8. [PMID: 22444717 DOI: 10.1016/j.clbc.2012.01.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 01/24/2012] [Accepted: 01/25/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study aimed to evaluate the influence of hormone receptor (HR) and Ki-67 proliferation markers in predicting the accuracy of magnetic resonance imaging (MRI) for measuring residual tumor size in patients with HER2-negative (HER2(-)) breast cancer receiving neoadjuvant chemotherapy (NAC). PATIENTS AND METHODS Fifty-four women were studied. Patients received AC (doxorubicin (Adriamycin)/cyclophosphamide) and/or taxane-based regimens. The accuracy of MR-determined clinical complete response (CCR) was compared to pathological complete response (pCR). The size of detectable residual tumor on MRI was correlated with pathologically diagnosed tumor size using the Pearson correlation. RESULTS MRI correctly diagnosed 16 of the 17 cases of pCR. There were 8 false-negative diagnoses: 7 HR(+) and 1 HR(-). The overall sensitivity, specificity, and accuracy of MRI were 78%, 94%, and 83%, respectively. The positive predictive value was 97% and the negative predictive value was 67%. For MRI vs. pathologically determined tumor size correlation, HR(-) cancers showed a higher correlation (R = 0.79) than did HR(+) cancers (R = 0.58). A worse MRI/pathology size discrepancy was found in HR(+) cancer than in HR(-)cancer (1.6 ± 2.8 cm vs. 0.56 ± 0.9 cm; P = .05). Tumors with low Ki-67 proliferation (< 40%) showed a larger size discrepancy than did those with high Ki-67 proliferation (≥ 40%) (1.2 ± 2.0 cm vs. 0.4 ± 0.8 cm; P = .05). CONCLUSIONS The results showed that the diagnostic performance of MRI for patients with breast cancer undergoing NAC is associated with a molecular biomarker profile. Among HER2(-)tumors, the accuracy of MRI was worse in HR(+)cancers than in HR(-)cancers and was also worse in low-proliferation tumors than in high-proliferation tumors. These findings may help in surgical planning.
Collapse
Affiliation(s)
- Aida Kuzucan
- John Tu and Thomas Yuen Center for Functional Onco Imaging of Department of Radiological Sciences, University of California, Irvine, California, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
García-Lallana A, Antón I, Saiz-Mendiguren R, Elizalde A, Martínez-Regueira F, Rodríguez-Spiteri N, Pina L. Using magnetic resonance imaging for staging can change the therapeutic management in patients with breast cancer. RADIOLOGIA 2012. [DOI: 10.1016/j.rxeng.2011.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
33
|
García-Lallana A, Antón I, Saiz-Mendiguren R, Elizalde A, Martínez-Regueira F, Rodríguez-Spiteri N, Pina L. [Using magnetic resonance imaging for staging can change the therapeutic management in patients with breast cancer]. RADIOLOGIA 2012; 54:350-6. [PMID: 22534560 DOI: 10.1016/j.rx.2011.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 12/28/2011] [Accepted: 12/31/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To compare two series of patients with breast cancer, one staged using preoperative MRI and the other staged using conventional techniques, analyzing the changes to treatment, the number of mastectomies, and the number of reinterventions due to involvement of the margins. MATERIAL AND METHODS We reviewed 600 patients divided into 300 patients with preoperative MRI (series 1) and 300 without preoperative MRI (series 2). We recorded the following variables: age, menopausal status, tumor size on pathological examination, multiplicity and bilaterality, surgical treatment and type of treatment, the administration of neoadjuvant chemotherapy, and reintervention for involved margins. We used Student's t-test and the chi-square test to compare the variables between the two series. RESULTS The mean age of patients in the two series was similar (51.5 and 51.8 years, P=0.71). The mean size of the tumor was smaller in series 1 (16.9 mm vs 22.3 mm) (P<.001). More multiple tumors were detected in series 1 (28.7 vs 15.7%) (P<.001). The rate of mastectomies was lower in series 1 (25 vs 48%) (P<.001). Oncoplastic and bilateral surgeries were performed only in series 1. Neoadjuvant chemotherapy was administered more often in series 1 (30.7 vs 9.3%) (P<.001). The difference in the number of reinterventions for involved margins did not reach significance (7.2% in series 1 vs 3.2% in series 2) (P=.095). CONCLUSION When MRI was used for staging, neoadjuvant chemotherapy and oncoplastic surgery were used more often and the mastectomy rate decreased. Despite the increase in conservative surgery in patients staged with MRI, the number of reinterventions for involved margins did not increase, although there was a trend towards significance.
Collapse
Affiliation(s)
- A García-Lallana
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, España.
| | | | | | | | | | | | | |
Collapse
|
34
|
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: 2.3] [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.
Collapse
Affiliation(s)
| | - Max Scholle
- Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland
| | | | | | | |
Collapse
|
35
|
Plana MN, Carreira C, Muriel A, Chiva M, Abraira V, Emparanza JI, Bonfill X, Zamora J. Magnetic resonance imaging in the preoperative assessment of patients with primary breast cancer: systematic review of diagnostic accuracy and meta-analysis. Eur Radiol 2011; 22:26-38. [PMID: 21847541 DOI: 10.1007/s00330-011-2238-8] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 07/11/2011] [Accepted: 07/28/2011] [Indexed: 12/12/2022]
Affiliation(s)
- María Nieves Plana
- Clinical Biostatistics Unit. Hospital Universitario Ramón y Cajal, CIBER en Epidemiología y Salud Pública (CIBERESP) and Instituto de Investigación Sanitaria (IRYCIS), Ctra. Colmenar km 9, 100 28034 Madrid, Spain
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
Breast magnetic resonance (MR) is highly sensitive in the detection of invasive breast malignancies. As technology improves, as interpretations and reporting by radiologists become standardized through the development of guidelines by expert consortiums, and as scientific investigation continues, the indications and uses of breast MR as an adjunct to mammography continue to evolve. This article discusses the current clinical indications for breast MR including screening for breast cancer, diagnostic indications for breast MR, and MR guidance for interventional procedures.
Collapse
Affiliation(s)
- Eren D Yeh
- Division of Breast Imaging, Department of Radiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA.
| |
Collapse
|
37
|
Boisserie-Lacroix M, Adenet C, Trillaud H. [Evaluation of suspicious nipple discharge with MRI: review of 50 cases]. ACTA ACUST UNITED AC 2011; 92:412-20. [PMID: 21621107 DOI: 10.1016/j.jradio.2011.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 12/06/2010] [Accepted: 03/17/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine the role of MRI in the evaluation and management of patients with suspicious nipple discharge and normal mammographic and US evaluation. PATIENTS AND METHODS A total of 50 patients with suspicious nipple discharge and normal mammographic and US evaluation prospectively underwent MRI. The first 16 patients underwent routine breast MRI, while MR-ductography with image fusion at the console was added for the last 34 patients. RESULTS In 22 of 25 high-risk and malignant lesions, MRI showed enhancement whereas it was normal in three cases. In 25 benign cases (resolution of discharge/benign non-proliferative breast disease), MRI was negative in 22 cases and falsely positive in three cases. CONCLUSION In this clinical setting, MRI shows excellent sensitivity, PPV and NPV. A negative result on MRI would support clinical follow-up as opposed to surgery.
Collapse
|
38
|
Dorrius MD, Jansen-van der Weide MC, van Ooijen PMA, Pijnappel RM, Oudkerk M. Computer-aided detection in breast MRI: a systematic review and meta-analysis. Eur Radiol 2011; 21:1600-8. [PMID: 21404134 PMCID: PMC3128262 DOI: 10.1007/s00330-011-2091-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Revised: 12/01/2010] [Accepted: 01/12/2011] [Indexed: 01/31/2023]
Abstract
Objectives To evaluate the additional value of computer-aided detection (CAD) in breast MRI by assessing radiologists’ accuracy in discriminating benign from malignant breast lesions. Methods A literature search was performed with inclusion of relevant studies using a commercially available CAD system with automatic colour mapping. Two independent researchers assessed the quality of the studies. The accuracy of the radiologists’ performance with and without CAD was presented as pooled sensitivity and specificity. Results Of 587 articles, 10 met the inclusion criteria, all of good methodological quality. Experienced radiologists reached comparable pooled sensitivity and specificity before and after using CAD (sensitivity: without CAD: 89%; 95% CI: 78–94%, with CAD: 89%; 95%CI: 81–94%) (specificity: without CAD: 86%; 95% CI: 79–91%, with CAD: 82%; 95% CI: 76–87%). For residents the pooled sensitivity increased from 72% (95% CI: 62–81%) without CAD to 89% (95% CI: 80–94%) with CAD, however, not significantly. Concerning specificity, the results were similar (without CAD: 79%; 95% CI: 69–86%, with CAD: 78%; 95% CI: 69–84%). Conclusions CAD in breast MRI has little influence on the sensitivity and specificity of experienced radiologists and therefore their interpretation remains essential. However, residents or inexperienced radiologists seem to benefit from CAD concerning breast MRI evaluation.
Collapse
Affiliation(s)
- Monique D Dorrius
- Department of Radiology, Center for Medical Imaging, University Medical Center Groningen, Hanzeplein 1, PO box 30.001, 9700 RB Groningen, the Netherlands.
| | | | | | | | | |
Collapse
|
39
|
Guarneri V, Pecchi A, Piacentini F, Barbieri E, Dieci MV, Ficarra G, Tazzioli G, Frassoldati A, Battista R, Canossi B, Mauri C, D'Amico R, Conte P, Torricelli P. Magnetic resonance imaging and ultrasonography in predicting infiltrating residual disease after preoperative chemotherapy in stage II-III breast cancer. Ann Surg Oncol 2011; 18:2150-7. [PMID: 21301969 DOI: 10.1245/s10434-011-1590-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study was designed to evaluate the accuracy of breast magnetic resonance imaging (MRI) and ultrasonography (US) in predicting the extent of breast residual disease after preoperative chemotherapy. METHODS Patients with stage II-III invasive breast tumors who received preoperative chemotherapy and were imaged with post-treatment MRI were included. Histopathological verification was available for all patients. The longest diameter of residual tumor measured with MRI and US has been compared with the infiltrating residual tumor size at pathologic evaluation. RESULTS A total of 108 patients were enrolled: 59 were imaged with both MRI and US (MRI group), and 49 were imaged with US only (non-MRI group). The non-MRI group was enrolled as an external control to avoid possible bias in the selection of patients. In the MRI group, the means of the deltas between MRI residual tumor size and pathologic size and between US and pathologic size were 0.16 cm and -0.06 cm respectively (P = not significant). Overall, a discrepancy limited in the interval from -0.5 cm to +0.5 cm compared with the pathologic size was observed in 54% and 51% of the patients with MRI and US, respectively (P = not significant). The linear correlation between the radiological measurement and pathologic tumor size was r = 0.53 for MRI and r = 0.66 for breast US. In the non-MRI group, the mean of the deltas between US residual tumor size and pathologic size was 0.06 cm, and the linear correlation was r = 0.79. CONCLUSIONS In this series of patients, MRI and US do not show significant differences in predicting the breast residual infiltrating tumor after preoperative chemotherapy.
Collapse
Affiliation(s)
- Valentina Guarneri
- Department of Oncology, Hematology and Respiratory Diseases, Modena University Hospital, Modena, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Park JS, Moon WK, Lyou CY, Cho N, Kang KW, Chung JK. The assessment of breast cancer response to neoadjuvant chemotherapy: comparison of magnetic resonance imaging and 18F-fluorodeoxyglucose positron emission tomography. Acta Radiol 2011; 52:21-8. [PMID: 21498321 DOI: 10.1258/ar.2010.100142] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Neoadjuvant chemotherapy for locally advanced breast cancer is a widely accepted treatment. For assessment of the tumor response after chemotherapy, both magnetic resonance imaging (MRI) and (18)F-fluorodeoxyglucose positron emission tomography (PET) are promising methods. PURPOSE To retrospectively compare MRI and PET in the assessment of tumor response to neoadjuvant chemotherapy for primary breast cancer with the pathologic response as the reference standard. MATERIAL AND METHODS Between August 2006 and May 2008, 32 women with breast cancer underwent concurrent MRI and PET before and after neoadjuvant chemotherapy. For response assessment, we calculated the changes in the maximum diameters of the tumor (ΔD(max)) on MRI, and the changes in the standard uptake values (ΔSUV) on PET. The correlation between the ΔD(max) and ΔSUV was analyzed using Pearson's correlation coefficient. The correspondence rates between each imaging modality and pathologic assessment were calculated. For prediction of the pathologic complete response (pCR), the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were analyzed using the McNemar test. RESULTS The pathologic assessment of tumor response to neoadjuvant chemotherapy identified eight complete responses (25.0%), 10 partial responses (31.2%), and 14 non-responses (43.8%). The change in size on MRI was moderately correlated with the change in SUV on PET (r=0.574, p=0.001). The correspondence rate of response assessment was 75.0% (24/32) between MRI and pathologic response and 53.1% (17/32) between PET and pathologic response. For the pCR, specificity (95.8% vs. 62.5%) and PPV (83.3% vs. 47.1%) were statistically higher on MRI than PET (p < 0.05), while sensitivity (100.0% vs. 62.5%) and NPV (100.0% vs. 88.5%) on PET tended to be higher than MRI. CONCLUSION Before and after neoadjuvant chemotherapy for breast cancer, the ΔD(max) of MRI correlated moderately with the ΔSUV on PET. For prediction of the pCR, MRI proved to be a more specific modality than PET.
Collapse
Affiliation(s)
- Jeong Seon Park
- Department of Radiology, College of Medicine Seoul National University and the Institute of Radiation Medicine, Seoul National University Medical Research Center
- Department of Radiology, Hanyang University College of Medicine
| | - Woo Kyung Moon
- Department of Radiology, College of Medicine Seoul National University and the Institute of Radiation Medicine, Seoul National University Medical Research Center
| | - Chae Yeon Lyou
- Department of Radiology, College of Medicine Seoul National University and the Institute of Radiation Medicine, Seoul National University Medical Research Center
| | - Nariya Cho
- Department of Radiology, College of Medicine Seoul National University and the Institute of Radiation Medicine, Seoul National University Medical Research Center
| | - Keon Wook Kang
- Department of Nuclear Medicine, College of Medicine Seoul National University and the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - June-Key Chung
- Department of Nuclear Medicine, College of Medicine Seoul National University and the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| |
Collapse
|
41
|
Landercasper J, Linebarger JH. Contemporary breast imaging and concordance assessment: a surgical perspective. Surg Clin North Am 2011; 91:33-58. [PMID: 21184900 DOI: 10.1016/j.suc.2010.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Disease conditions of the breast are very common. Patients with such conditions often present to surgeons for both diagnostic evaluation and treatment. Nearly all of them will require breast imaging. This article summarizes the use, applicability, and concordance assessment of mammography, ultrasonography, and magnetic resonance imaging in patients who have breast complaints or abnormalities on clinical examination or imaging.
Collapse
Affiliation(s)
- Jeffrey Landercasper
- Norma J. Vinger Center for Breast Care, Department of Surgery, Gundersen Lutheran Health System, 1900 South Avenue, Mailstop: EB1-002, La Crosse, WI 54601, USA
| | | |
Collapse
|
42
|
Dorrius MD, Pijnappel RM, Jansen-van der Weide MC, Oudkerk M. Breast magnetic resonance imaging as a problem-solving modality in mammographic BI-RADS 3 lesions. Cancer Imaging 2010; 10 Spec no A:S54-8. [PMID: 20880790 PMCID: PMC2967149 DOI: 10.1102/1470-7330.2010.9020] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The probability of a mammographic Breast Imaging Reporting and Data System (BI-RADS) 3 lesion being cancer is considered to be less than 2%. Therefore, the work-up of a mammographic BI-RADS 3 lesion should be biopsy or follow-up mammography after 6 months. However, most patients referred for biopsy have benign disease. Although the negative predictive value (NPV) of magnetic resonance imaging (MRI) is highest of all imaging techniques, it is not yet common practice to use breast MRI as a problem-solving modality to exclude patients for further diagnostic work-up. Therefore, in this meta-analysis the usefulness of breast MRI as a problem-solving modality in mammographic BI-RADS 3 lesions is investigated. After a systematic search only 5 out of 61 studies met the inclusion criteria. The NPV in 2 of those studies was reported to be 100%. It was concluded that MRI can be used as an adjunctive tool to mammographic BI-RADS 3 findings to exclude patients for further diagnostic work-up. The other 3 studies assessed the accuracy of MRI in mammographic BI-RADS 3 microcalcifications. These studies reported an NPV of MRI between 76% and 97%. Therefore, MRI cannot be implemented as a diagnostic tool to evaluate mammographic microcalcifications at this time. The first solid data indicate that breast MRI might be useful as a problem-solving modality to exclude patients with non-calcified mammographic BI-RADS 3 lesions for further diagnostic work-up. However, further research is needed to verify these results.
Collapse
Affiliation(s)
- M D Dorrius
- Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | | |
Collapse
|
43
|
A practical approach to manage additional lesions at preoperative breast MRI in patients eligible for breast conserving therapy: results. Breast Cancer Res Treat 2010; 124:707-15. [DOI: 10.1007/s10549-010-1064-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 07/10/2010] [Indexed: 02/03/2023]
|
44
|
Tafreshi NK, Kumar V, Morse DL, Gatenby RA. Molecular and Functional Imaging of Breast Cancer. Cancer Control 2010; 17:143-55. [DOI: 10.1177/107327481001700302] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Significant efforts have been directed toward developing and enhancing imaging methods for the early detection, diagnosis, and characterization of small breast tumors. Molecular and functional imaging sets the stage for enhancement of current methodology. Methods Current imaging modalities are described based on the molecular characteristics of normal and malignant tissue. New molecular imaging methods that have the potential for clinical use are also discussed. Results: Dynamic contrast-enhanced magnetic resonance imaging is more sensitive than mammography in BRCA1 carriers. It is used in screening and in the early evaluation of neoadjuvant therapy. Positron emission mammography is 91% sensitive and 93% specific in detecting primary breast cancers. Sentinel node scintigraphy is a key component of axillary lymph node evaluation. Other imaging modalities being studied include Tc99m sestamibi, radiolabeled thymidine or uridine, estrogen receptor imaging, magnetic resonance spectroscopy, and diffusion magnetic resonance imaging. Conclusions Molecular and functional imaging of the breast will likely alter clinical practice in diagnosing and staging primary breast cancer and assessing response to therapy since it will provide earlier information regarding the underlying biology of individual breast cancers, tumor stage, potential treatment strategies, and biomarkers for early evaluation of treatment effects.
Collapse
Affiliation(s)
| | - Virendra Kumar
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - David L. Morse
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | | |
Collapse
|
45
|
Duhem C, Janssens D. Chimiothérapie néoadjuvante : un paradigme de pluridisciplinarité. IMAGERIE DE LA FEMME 2010. [DOI: 10.1016/j.femme.2010.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
46
|
Yeh ED. Breast Magnetic Resonance Imaging: Current Clinical Indications. Magn Reson Imaging Clin N Am 2010; 18:155-69, vii. [DOI: 10.1016/j.mric.2010.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
47
|
|
48
|
Horvath E. Revisión de la literatura para el uso del ultrasonido (US) en cáncer de mama - indicaciones y requerimientos mínimos para asegurar la calidad del examen. Medwave 2010. [DOI: 10.5867/medwave.2010.01.4318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
49
|
Moon HG, Han W, Lee JW, Ko E, Kim EK, Yu JH, Jung SY, Lyou CY, Moon WK, Hwang KT, Noh DY. Limitations of Conventional Contrast-enhanced MRI in Selecting Sentinel Node Biopsy Candidates among DCIS Patients. J Breast Cancer 2010. [DOI: 10.4048/jbc.2010.13.2.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hyeong-Gon Moon
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Wonshik Han
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Won Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eunyoung Ko
- Department of Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Eun-Kyu Kim
- Department of Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Jong-Han Yu
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So-Youn Jung
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Chae Yeon Lyou
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Woo Kyung Moon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ki-Tae Hwang
- Department of Surgery, Seoul National University Boramae Hospital, Seoul, Korea
| | - Dong-Young Noh
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
50
|
Ferreira R. Revisión de la literatura para biopsias percutáneas mamarias. Medwave 2010. [DOI: 10.5867/medwave.2010.01.4329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|