Role of MRI (magnetic resonance imaging) versus conventional imaging for breast cancer presurgical staging in young women or with dense breast

Abstract

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. The role of magnetic resonance imaging (MRI) in the local staging of breast cancer is currently uncertain. The purpose of this prospective study is to evaluate the accuracy of preoperative MRI compared to conventional imaging in detecting breast cancer and the effect of pre-operative MRI on the surgical treatment in a subgroup of women with dense breasts, young age, invasive lobular cancer (ILC) or multiple lesions. Methods:Between January 2006 and October 2007, 91 patients with newly diagnosed breast cancer underwent preoperative clinical breast examination, mammography, bilateral breast ultrasonography and high-resolution breast MRI. All patients had histologically verified breast cancer. The imaging techniques were compared using the final pathological report as gold standard.Results: The sensitivity of MRI for the main lesion was 98.9%, while for multiple lesions sensitivity was 90.7% and specificity 85.4%. After preoperative MRI, 13 patients (14.3%) underwent additional fine needle/core biopsies, 9 of whom had specimen positive for cancer. Preoperative MRI changed the surgical plan in 26 patients: in 19.8% of the cases breast conservative surgery was converted to mastectomy and in 7.7% of the patients a wider excision was performed. At a mean follow-up of 48 months, 2 local recurrences occurred (local failure rate = 2.5%). Conclusions:Enhanced sensitivity of breast MRI may change the surgical approach, by increasing mastectomy rate or suggesting the need of wider local excision. MRI can play an important role in preoperative planning if used in selected patients with high risk of multifocal/multicentric lesions. However, the histologic confirmation of all suspicious findings detected by MRI is mandatory prior to definite surgery.

The use of sequential X-ray, CT and MRI in the preoperative evaluation of breast-conserving surgery

“…The high soft tissue resolution of an MRI and the advantages of enhancement scanning show the full appearance of ductal carcinoma in situ (DCIS) as well as the conditions of multicentricity and sub-lesions to determine the scope of tumors more accurately (16). MRI can detect breast cancer lesions as detected by ultrasound, and can detect multicentricity, invasive mammary carcinoma and contralateral breast cancers in order to guide the physicians on planning the therapeutic schedule (17). The present study showed that according to the inter-group comparisons age, tumor distribution and T-staging were not significantly different among the groups.…”

Microcalcifications in 1657 Patients with Pure Ductal Carcinoma in Situ of the Breast: Correlation with Clinical, Histopathologic, Biologic Features, and Local Recurrence

“…36 Recommending supplementary staging with an additional imaging tool such as MRI may be appropriate for patients with pure DCIS and dense breast tissue. 37–39 …”

A Multiparametric Serum Marker Panel as a Complementary Test to Mammography for the Diagnosis of Node-Negative Early-Stage Breast Cancer and DCIS in Young Women

“…MRI displays high sensitivity for invasive breast cancer (including mammographically occult invasive breast cancer; ref. [31][32][33]; however, its use is limited, by its relatively low sensitivity in the detection of DCIS and low specificity for both invasive carcinoma and DCIS (34)(35)(36)(37).…”