Breast Cancer Preoperative Staging: Does Contrast-Enhanced Magnetic Resonance Mammography Modify Surgery?

Abstract

Women with newly diagnosed breast cancer may have lesions undetected by conventional imaging. Recently contrast-enhanced magnetic resonance mammography (CE-MRM) showed higher sensitivity in breast lesions detection. The present analysis was aimed at evaluating the benefit of preoperative CE-MRM in the surgical planning. From 2005 to 2009, 525 consecutive women (25–75 years) with breast cancer, newly diagnosed by mammography, ultrasound, and needle-biopsy, underwent CE-MRM. The median invasive tumour size was 19 mm. In 144 patients, CE-MRM identified additional lesions. After secondlook, 119 patients underwent additional biopsy. CE-MRM altered surgery in 118 patients: 57 received double lumpectomy or wider excision (41 beneficial), 41 required mastectomy (40 beneficial), and 20 underwent contra lateral surgery (18 beneficial). The overall false-positive rate was 27.1% (39/144). CE-MRM contributed significantly to the management of breast cancer, suggesting more extensive disease in 144/525 (27.4%) patients and changing the surgical plan in 118/525 (22.5%) patients (99/525, 18.8% beneficial).

The Usefulness of Spectral Mammography in Surgical Planning of Breast Cancer Treatment—Analysis of 999 Patients with Primary Operable Breast Cancer

“…Research shows that even 14–16% of tumors visible in MRI may remain invisible in MG, and multifocal tumors visualized in MRI and not diagnosed in mammography are often invasive cancers smaller than 10 mm [ 40 , 41 ]. Using MRI in the preoperative diagnostics of breast cancer patients results in modification of the treatment method in every fifth patient [ 41 , 42 , 43 ]. The decision change rate concerning the planned treatment in our study after CESM amounted to 20%.…”

The additive role of dynamic contrast-enhanced and diffusion-weighted MR imaging in preoperative staging of breast cancer

“…In women with diagnosed breast cancer, accurate locoregional staging and preoperative examination of the whole breast and both axillae are of utmost importance for optimal patient management decisions and correct choice of therapy [1].…”

“…The choice between mastectomy and breastconserving surgery with or without axillary evacuation and with or without neoadjuvant chemotherapy depends on numerous factors. These factors include tumor location, grade and size in relation to breast volume, multifocality or multicentricity, and axillary lymph node status [1]. Overestimation can lead to unnecessary mastectomies and unnecessary axillary evacuation.…”