Can early post-operative MRI describe a predictor model for the likelihood of early breast cancer recurrence after conservative surgery?

Abstract

Background Breast-conserving surgery is becoming more commonly used in breast cancer treatment. However, after surgery, the breast may undergo rapid changes that can sometimes hide signs of tumor recurrence. Breast MRI is highly sensitive and specific in detecting any residual or recurrent tumors after breast-conserving therapy, making it an effective tool in the management of breast cancer. We aimed to assess the detectability of DCE-MRI in breast cancer female patients following breast conservative surgery (after a minimum of 1–4 months post-operative) to confirm complete tumor removal and differentiate between post-procedural complications and metachronous cancer in the ipsilateral or contralateral breast. Methods This retrospective study was conducted from March 2017 to December 2023 on 269 patients. All cases had undergone breast conservative surgery and were suspected of either recurrence or post-operative complications by clinical examination and/or sono-mammography. DCE-MRI was performed at 1.5T. The findings were correlated with the histopathological results in all cases. Results Patients’ mean age was 50.7 years with 389 suspected breast lesions, post-surgical traumatic fat necrosis was the most common benign finding (75.8%), and most common histological type in malignant cases was invasive mammary carcinoma (15.2%). Sensitivity and specificity of MRI BI-RADS to differentiate benign from malignant lesions were 100%. The best ADC cutoff value to differentiate between benign and malignant lesions was 1.25 × 10−3 mm2/s. The model of predictors of likelihood of malignant lesion nature had sensitivity 77%, specificity 77.8%, PPV 90% and NPV 96.7%. Conclusions MRI proved crucial in assessing patients after BCS. DWI can be included in patients with negative sono-mammographic examination for initial lesions detection without the need of contrast media, yet DCE MRI is mandatory in case of lesion characterization to delineate its nature, thus it cannot be replaced by DWI alone.