Clinical Significance of Multidetector-Row Computed Tomography in Breast Surgery

Abstract

Several reports support the association of higher ipsilateral breast tumor recurrence rates with positive or intermediate margins compared with negative pathologic margins. Precise evaluation of tumor extension and adequate surgical margin are important factors affecting tumor recurrence after breast-conserving surgery (BCS). Many studies have reported the utility of magnetic resonance imaging (MRI) for diagnosing the tumor extension of breast cancer, but few have evaluated the utility of multidetector-row computed tomography (MDCT). The results of this study show the clinical significance of MDCT for detecting cancer extension and demonstrate the clinical role of MDCT in BCS. Subjects comprised 136 patients grouped into two categories based on whether or not tumor extension was evaluated with MDCT preoperatively. The positive surgical margin rate and breast conservation rate were analyzed in each group and the clinical role of MDCT in BCS was evaluated. Moreover, evaluation of intraductal extension was done both with MDCT and histologically, and computed tomography (CT)-pathologic correlations were examined retrospectively. Finally, the margin-positive cases were analyzed in relation to their clinical characteristics. Sensitivity, specificity, positive predictive value, and negative predictive value for detection of the intraductal component were 71.8%, 85.7%, 82.1%, and 76.9%, respectively. The positive surgical margin rate and conservation rate are 7.46% and 81.9%, respectively, for those who were diagnosed with MDCT preoperatively; their corresponding rates without MDCT were 16.67% and 67.9%. Most margin-positive patients have remarkable lymphatic space invasion. Positive surgical margins were often recognized toward the nipple. For diagnosing the intraductal extension, MDCT shows sufficient diagnosability. Moreover, MDCT can provide appropriate information for the determination of adequate surgical margins and contribute to increases in breast conservation rates.

Iodinated Contrast Enhancement of Breast Cancer on Prone Multidetector Computed Tomography—Preliminary Findings

“…Microcalcifications are usually not seen on MDCT because of the method's spatial resolution. However, some authors have shown that intraductal component of breast cancer may present as NME on MDCT, similar to MRI 15,17–19,21 …”

Multidetector Computed Tomography with Dedicated Protocol for Breast Cancer Locoregional Staging: Feasibility Study

“…Prior studies have also demonstrated that tumor size accessed on MDCT images has a good correlation with pathological tumor size, providing appropriate information for the determination of adequate surgical margins [ 11 , 13 ]. However, there are concerns about the capability of MDCT to identify the intraductal component of a breast cancer.…”

“…Moreover, the use of iodinated contrast media on contrast-enhanced mammography (CEM), which are the same media used on CT, has proven to be as effective as the paramagnetic contrast used on MRI to characterize tumor vascularity. However, few studies have evaluated the performance of conventional MDCT devices in the evaluation of breast lesions [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. Compared to MRI, the advantages of CT include lower cost and shorter exam time, in addition to the ability to identify distant metastases in the same exam.…”

Intramammary Findings on CT of the Chest – a Review of Normal Anatomy and Possible Findings

“…The main limitation is the applied radiation, which hinders its use in younger or high-risk populations on a broader scale. The preoperative use of CT in addition to mammography and ultrasound increased breast conservation rates because of the better delineation of tumor extent [5]. Interestingly, dedicated breast CT and contrast-enhanced mammography have been recently introduced into clinical practice and showed promising results [6,7].…”