Breast tumors: comparative accuracy of MR imaging relative to mammography and US for demonstrating extent.

Abstract

B r e a s t T u m o rs: C o m p a ra tiv e A c c u ra c y o f MR Im a g in g R elativ e to M a m m o g ra p h y a n d US fo r D e m o n s tra tin g E x te n t1 A PURPOSE; To evaluate the compara tive accuracy of magnetic resonance (MR) imaging relative to mammogra phy and ultrasonography (US) for assessing the extent of breast tumors. MATERIALS A N D METHODS:His tologic results and preoperative im aging findings (mammography, US, MR imaging) were analyzed regard ing tumor size and multifocality of 61 tumors in 60 women undergoing mastectomy for carcinoma. RESULTS:In 10% of cases, the index tumor was not seen at mammogra phy. With US, 15% of the index tu mors were not recognized, while MR imaging missed 2% of the index tu mors. On mammographic and US images, tumor size was underesti mated significantly (P < .005), by 14% and 18%, respectively, while MR im aging showed no significant differ ence in size compared with that found in a pathologic evaluation. Mammography showed 31% of the additional invasive lesions, w hile US showed 38% and MR imaging showed 100%. CONCLUSION: MR imaging was the most accurate of the three preopera tive imaging modalities in assessing the size and number of malignant lesions in the breast.

Using MRI to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer

“…Several studies have suggested that MRI is a more accurate method of delineating residual tumour following neoadjuvant chemotherapy than clinical, ultrasound or mammographic assessment (Boetes et al, 1995;Abraham et al, 1996;Drew et al, 1999Drew et al, , 2001Fischer et al, 1999;Balu-Maestro et al, 2002;Rieber et al, 2002;Cheung et al, 2003;Rosen et al, 2003;Martincich et al, 2004;Warren et al, 2004). Chemotherapy-induced fibrosis has been shown to impair the evaluation of tumour by conventional radiological methods and physical examination (Cocconi et al, 1984;Segel et al, 1988).…”

The impact of preoperative MRI on breast-conserving surgery of invasive cancer: a comparative cohort study

“…Level-II evidence is available showing that breast MRI visualizes disease extent more accurately than conventional breast imaging [8][9][10][11]. This evidence has created much confidence in favor of MRI in patients as well as in practitioners, making it difficult to implement prospective comparative level-I studies.…”

“…Conventional imaging by mammography and ultrasonography fails to accurately assess tumor extent in approximately one-third of patients eligible for BCT [7]. Several studies reported a higher sensitivity of contrastenhanced magnetic resonance imaging (CE MRI) to detect invasive breast cancer and to visualize disease extent compared to the standard workup using conventional imaging [8][9][10][11]. These observations have led to changes in the surgical management of patients [12][13][14][15][16][17].…”

Multicentre randomised controlled trial examining the cost-effectiveness of contrast-enhanced high field magnetic resonance imaging in women with primary breast cancer scheduled for wide local excision (COMICE)

“…In a comparative study of mammography, USS and MRI, Boetes et al 18 reported underestimation of tumour size by 14% and 18%, respectively, for mammography and USS, while MRI showed no significant difference in size compared with that found at pathological evaluation. MRI also detected all additional tumour foci found at subsequent histopathology compared with detection rates of 31% and 38% by mammography and USS, respectively.…”

“…Details of repeat MRI findings are displayed in Appendix 15 (Clinical significance of < 5-mm MRI-only-detected lesions: repeat MRI findings) for those patients who underwent a repeat scan. Median time from randomisation to repeat MR scan was 15 months (range [8][9][10][11][12][13][14][15][16][17][18][19]. Median time from starting adjuvant radiotherapy to repeat scan was 13 months (range 4-17) for the 12 patients who received radiotherapy.…”