Role of magnetic resonance imaging in the diagnosis and single-stage surgical resection of invasive lobular carcinoma of the breast

Abstract

MRI can provide considerable additional information in the detection and characterization of ILC.

The impact of preoperative breast MRI on the re-excision rate in invasive lobular carcinoma of the breast

“…Many studies have shown that preoperative MRI changes the surgical approach in 22-44% of patients [11][12][13][14][15][16][17][18], and as mentioned before, in 12-33% of patients this change is a conversion from BCS to mastectomy [11,13,16,[19][20][21][22]. Based on few reported findings, this rate of therapy change is balanced by a conversion rate in the opposite direction of approximately 5% [11].…”

“…With a stable sensitivity of approximately 93%, an accuracy in lesion size estimation of 80% (with an accompanying 10% underestimation of lesion size and 10% overestimation of lesion size) and a good correlation with tumor size at pathology, breast MRI aids in lesion appreciation [11,14,20,23]. Consequently, MRI has been shown to change the therapeutic approach in approximately one-third of patients with ILC [11,16,19,[21][22][23].…”

“…Conversely, many studies have shown that preoperative breast MRI changes therapy in 12-33% of patients from BCS to mastectomy [11,13,16,[19][20][21][22]. Although the changes may be appropriate in 88% of cases according to pathology [23], this percentage is still relatively high compared to local recurrence rates [24].…”

Selecting patients for breast‐conserving therapy

“…[3][4][5] Several recent studies have indicated that preoperative magnetic resonance imaging (MRI) in women with ILC identifies more extensive disease than anticipated based on the results of mammography and physical examination and detects unsuspected multifocal cancer in 25% to 50% of cases. 6,7 These observations are difficult to reconcile with the low rates of local failure observed after BCT, and may be a reflection of biased selection of patients for MRI evaluation rather than characteristic of the entire spectrum of patients with lobular carcinoma. Given the possibility that the extent of ILC is less reliably assessed by physical examination and conventional imaging than the extent of invasive ductal carcinoma (IDC), we hypothesized that the rate of reexcision for positive surgical margins and the conversion rate from BCT to mastectomy would be higher in women with ILC than in those with IDC.…”

“…Weinstein et al 6 32 60 Kneeshaw et al 22 21 24 Schelfout et al 21 26 50 Quan et al 20 59 61 (22 biopsy proven) Munot et al 7 14 50…”