Does Preoperative Magnetic Resonance Imaging Modify Breast Cancer Surgery ?

Buxant, Frédéric; Scuotto, F.; Hottat, Nathalie; Noël, Jean Christophe; Simon, Philippe

doi:10.1080/00015458.2007.11680058

Cited by 8 publications

(3 citation statements)

References 12 publications

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“…This study confirms our original hypothesis that preoperative bilateral breast MRI in young women with breast cancer alters surgical management in a significant proportion of patients. This finding is in agreement with several other retrospective and prospective studies evaluating the use of preoperative breast MRI in patients with newly diagnosed breast cancer; [13][14][15][16][17][18][19] however, this is one of the first studies to specifically evaluate a younger patient population.…”

Section: Discussionsupporting

confidence: 92%

A Retrospective Study Evaluating the Impact of Preoperative Breast MRI on Surgical Decision-Making in Young Patients (≤50 Years) with Invasive Breast Cancer

Mukherjee

Hodgson

Lovrics

et al. 2016

Breast Cancer�(Auckl)

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INTRODUCTIONBreast 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.METHODSA 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.RESULTSOf 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.CONCLUSIONSPreoperative brea...

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Section: Discussionsupporting

confidence: 92%

A Retrospective Study Evaluating the Impact of Preoperative Breast MRI on Surgical Decision-Making in Young Patients (≤50 Years) with Invasive Breast Cancer

Mukherjee

Hodgson

Lovrics

et al. 2016

Breast Cancer�(Auckl)

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“…A spectrum of positive biopsy rates have previously been described for suspicious contralateral breast MRI findings in this patient population. Ours is within the range of 18.8–61.5% for positive biopsy rates that have been reported in the largest prior studies [6, 8, 12, 14–17, 20, 53–62]. Although we found that sampling by excisional biopsy had a higher positive biopsy rate than that by needle biopsy (42.9% vs 20.5%), the majority of surgical biopsy results, including excisional biopsy, were benign.…”

Section: Discussionsupporting

confidence: 77%

Evaluation of Tissue Sampling Methods Used for MRI-Detected Contralateral Breast Lesions in the American College of Radiology Imaging Network 6667 Trial

DeMartini

Hanna

Gatsonis

et al. 2012

American Journal of Roentgenology

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OBJECTIVE The purpose of our study was to evaluate tissue sampling methods used for MRI-detected suspicious contralateral breast lesions in the American College of Radiology Imaging Network (ACRIN) 6667 trial. MATERIALS AND METHODS Breast MRI was performed at 25 institutions in 969 women who had a recent diagnosis of unilateral breast cancer and negative contralateral mammography and clinical breast examinations. Biopsy was recommended for MRI findings in 135 women, and 121 underwent sampling. Frequencies and positive biopsy rates of sampling methods used for initial diagnosis and imaging guidance techniques were calculated and compared. RESULTS Sampling yielded 30 malignant and 91 benign results. Initial sampling used needle biopsy in 88 of 121 (72.7%) and surgical biopsy in 30 of 121 (24.8%) women. Surgical biopsy was excisional biopsy in 28 of 30 (93.3%) and mastectomy in two of 30 (6.7%). The remaining three of 121 (2.5%) women underwent mastectomy, but it was not documented whether this represented initial tissue sampling. Of imaging-guided procedures, 56 of 106 (52.8%) used MRI; 49 of 106 (46.2%), ultrasound; and one of 106 (1.0%), stereotaxis. MRI-guided sampling was with needle biopsy rather than wire-localized surgical biopsy in 33 of 56 (58.9%) women, whereas ultrasound used needle biopsy in 47 of 49 (95.9%). Positive biopsy rates of sampling methods were 20.5% for needle biopsy, 46.2% for excisional biopsy, and 0% for mastectomy. CONCLUSION The majority of initial biopsies for MRI-detected contralateral breast lesions used needle biopsy rather than surgical biopsy. Contralateral surgery could have been avoided in most cases had needle biopsy been performed because most excisional biopsy and all mastectomy results were benign. MRI-guided biopsy was significantly more likely than ultrasound-guided sampling to use wire-localized surgical biopsy rather than needle biopsy.

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“…There is little doubt that the use of MR data to influence surgical planning has important implications in the surgical management of patients [5,6]. We believe that better image-to-physical data alignment strategies can be used more directly for better surgical management.…”

Section: Introductionmentioning

confidence: 99%

Realization of a biomechanical model-assisted image guidance system for breast cancer surgery using supine MRI

et al. 2015

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Purpose Unfortunately, the current re-excision rates for breast conserving surgeries due to positive margins average 20–40%. The high re-excision rates arise from difficulty in localizing tumor boundaries intraoperatively and lack of real-time information on the presence of residual disease. The work presented here introduces the use of supine magnetic resonance (MR) images, digitization technology, and bio-mechanical models to investigate the capability of using an image guidance system to localize tumors intraoperatively. Methods Preoperative supine MR images were used to create patient-specific biomechanical models of the breast tissue, chest wall, and tumor. In a mock intraoperative setup, a laser range scanner was used to digitize the breast surface and tracked ultrasound was used to digitize the chest wall and tumor. Rigid registration combined with a novel non-rigid registration routine was used to align the preoperative and intraoperative patient breast and tumor. The registra tion framework is driven by breast surface data (laser range scan of visible surface), ultrasound chest wall surface, and MR-visible fiducials. Tumor localizations by tracked ultra-sound were only used to evaluate the fidelity of aligning preoperative MR tumor contours to physical patient space. The use of tracked ultrasound to digitize subsurface features to constrain our nonrigid registration approach and to assess the fidelity of our framework makes this work unique. Two patient subjects were analyzed as a preliminary investigation toward the realization of this supine image-guided approach. Results An initial rigid registration was performed using adhesive MR-visible fiducial markers for two patients scheduled for a lumpectomy. For patient 1, the rigid registration resulted in a root-mean-square fiducial registration error (FRE) of 7.5 mm and the difference between the intraoperative tumor centroid as visualized with tracked ultrasound imaging and the registered preoperative MR counterpart was 6.5 mm. Nonrigid correction resulted in a decrease in FRE to 2.9 mm and tumor centroid difference to 5.5 mm. For patient 2, rigid registration resulted in a FRE of 8.8 mm and a 3D tumor centroid difference of 12.5 mm. Following nonrigid correction for patient 2, the FRE was reduced to 7.4 mm and the 3D tumor centroid difference was reduced to 5.3 mm. Conclusion Using our prototype image-guided surgery platform, we were able to align intraoperative data with preoperative patient-specific models with clinically relevant accuracy; i.e., tumor centroid localizations of approximately 5.3–5.5 mm.

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Does Preoperative Magnetic Resonance Imaging Modify Breast Cancer Surgery ?

Abstract: Breast MRI could be recommended as a pre-surgical diagnostic procedure in patients allocated to breast conservation surgery. Nevertheless, further studies are needed to determine if preoperative breast MRI leads to a decrease in tumor recurrence and in overall survival.

Cited by 8 publications

References 12 publications

A Retrospective Study Evaluating the Impact of Preoperative Breast MRI on Surgical Decision-Making in Young Patients (≤50 Years) with Invasive Breast Cancer

A Retrospective Study Evaluating the Impact of Preoperative Breast MRI on Surgical Decision-Making in Young Patients (≤50 Years) with Invasive Breast Cancer

Evaluation of Tissue Sampling Methods Used for MRI-Detected Contralateral Breast Lesions in the American College of Radiology Imaging Network 6667 Trial

Realization of a biomechanical model-assisted image guidance system for breast cancer surgery using supine MRI

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