Pre-operative estimation of primary breast cancer size: a comparison of clinical assessment, mammography and ultrasound

Allen, Scott; Cunliffe, W. J.; Gray, Joanne; Liston, J; Lunt, L.G.; Webb, L.A.; Young, J. R.

doi:10.1054/brst.2000.0255

Cited by 24 publications

(19 citation statements)

References 19 publications

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“…Previous studies have focused on the ability to predict clinical tumour shrinkage, despite the fact that local response is a crude measure dependent on several variables including primary tumour size, oedema, necrosis and subjective variation in tumour measurements. Clinical assessment frequently overestimates tumour size (Fornage et al, 1987;Pain et al, 1992;Forouhi et al, 1994;Meden et al, 1995;Allen et al, 2001). Radiological assessment of maximum tumour dimensions by ultrasound or mammography is often performed to assess response and correlates better with histological tumour size than clinical measurements (Allen et al, 2001;Fiorentino et al, 2001).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of ER, PgR, HER-2 and Ki-67 as predictors of response to neoadjuvant anthracycline chemotherapy for operable breast cancer

et al. 2004

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Primary systemic therapy (PST) for operable breast cancer enables the identification of in vivo biological markers that predict response to treatment. A total of 118 patients with T2 -4 N0 -1 M0 primary breast cancer received six cycles of anthracycline-based PST. Clinical and radiological response was assessed before and after treatment using UICC criteria. A grading system to score pathological response was devised. Diagnostic biopsies and postchemotherapy surgical specimens were stained for oestrogen (ER) and progesterone (PgR) receptor, HER-2 and cell proliferation (Ki-67). Clinical, radiological and pathological response rates were 78, 72 and 38%, respectively. There was a strong correlation between ER and PgR staining (Po0.0001). Higher Ki-67 proliferation indices were associated with PgRÀ tumours (median 28.3%, PgR þ 22.9%; P ¼ 0.042). There was no relationship between HER-2 and other biological markers. No single pretreatment or postchemotherapy biological parameter predicted response by any modality of assessment. In all, 10 tumours changed hormone receptor classification after chemotherapy (three ER, seven PgR); HER-2 staining changed in nine cases. Median Ki-67 index was 24.9% before and 18.1% after treatment (P ¼ 0.02); the median reduction in Ki-67 index after treatment was 21.2%. Tumours displaying 475% reduction in Ki-67 after chemotherapy were more likely to achieve a pathological response (77.8 vs 26.7%, P ¼ 0.004).

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Section: Discussionmentioning

confidence: 99%

Evaluation of ER, PgR, HER-2 and Ki-67 as predictors of response to neoadjuvant anthracycline chemotherapy for operable breast cancer

et al. 2004

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“…Using BlandAltman and Wilcoxon Signed Rank test, it was clear that ultrasound and clinical measurements tended to under and overestimate the lesions respectively which was statistically significant. Other studies have also shown the proneness of ultrasound to underestimate [4][5][6]8,[15][16][17]. In all the modalities, it can be deduced that as the size of the lesion increases, error in size measurement magnifies.…”

Section: Discussionmentioning

confidence: 98%

“…Bland-Altman analysis was additionally applied to the measurements of imaging modalities against histopathology measurements as were also performed by Allen et al and Dummin et al [5,8]. Bland and Altman argued that correlation coefficients were often incorrectly applied to studies when comparing methods of measuring the same variable.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical staging aided by imaging drives the decision for mastectomy or breast conserving surgery, both of which are significant life-changing procedures for the patient. Since the 1990s research has been addressing the issue of which imaging modality correlates best with pathological size (Table 1) [4][5][6][7][8][9][10][11][12][13][14][15][16][17]. These studies variably assessed size via clinical, ultrasound, mammogram and pathological examination.…”

Section: Introductionmentioning

confidence: 99%

“…The literature predominantly demonstrated superior accuracy of ultrasound compared to other modalities [6,10,11,14,16]. However, ultrasound tended to underestimate [5,6,15,16], whereas clinical palpation tended to overestimate size [5,6,16] and mammography was equivocal [5].…”

Section: Introductionmentioning

confidence: 99%

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Multimodal assessment of mammogram, ultrasound and clinical palpation in relation to pathological size of breast carcinoma

Fadzli¹,

Rahmat²,

MN³

et al. 2018

Integr Cancer Sci Therap

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Objectives: Ultrasonography, mammography and clinical examination (conventional triple assessment modalities) are compared to the gold standard of pathological size to assess their accuracy in measuring size of palpable breast cancer lesions. This knowledge has an important role in the patient's further management: for staging, choice of surgical technique and prognostication.Patients and methods: 71 tumours were studied in 70 patients who were prospectively collected over a 2 year period. Pearson's correlation test and Bland-Altman's plot were used to analyse tumour size by clinical palpation, ultrasound and mammogram.Results: Histopathological examination revealed 60 invasive carcinomas (58 ductal type, 2 lobular type), 4 ductal carcinoma in situ, 2 mixed and 5 special types. The pathological size varied from 0.5cm to 9.5cm. Ultrasound had the best correlation with pathological size, with r= 0.845 (p< 0.001), but with a tendency to underestimate. Size correlation for mammogram and clinical palpation were similar and statistically significant. However, the standard deviation of mammographic size was more compared to size on clinical examination (1.3 (mammogram) vs. 2.2 (clinical)). Clinical palpation was inclined to overestimate, whereas mammogram neither over-nor under-estimated size. Measurements using ultrasonography produced the lowest standard deviation, thus a lower variability from the mean. Conclusion:This study demonstrated that ultrasound is the more accurate modality compared to mammogram and clinical palpation size for the measurement of palpable breast cancer lesions. However, ultrasound may downstage tumours due to its tendency to underestimate size.

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Dynamic Magnetic Resonance Imaging in Breast Cancer

Ah-See

Padhani

Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Oncology

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Pre-operative estimation of primary breast cancer size: a comparison of clinical assessment, mammography and ultrasound

Cited by 24 publications

References 19 publications

Evaluation of ER, PgR, HER-2 and Ki-67 as predictors of response to neoadjuvant anthracycline chemotherapy for operable breast cancer

Evaluation of ER, PgR, HER-2 and Ki-67 as predictors of response to neoadjuvant anthracycline chemotherapy for operable breast cancer

Multimodal assessment of mammogram, ultrasound and clinical palpation in relation to pathological size of breast carcinoma

Dynamic Magnetic Resonance Imaging in Breast Cancer

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