Identification of Preoperative Magnetic Resonance Imaging Features Associated with Positive Resection Margins in Breast Cancer: A Retrospective Study

Abstract

ObjectiveTo determine which preoperative breast magnetic resonance imaging (MRI) findings and clinicopathologic features are associated with positive resection margins at the time of breast-conserving surgery (BCS) in patients with breast cancer.Materials and MethodsWe reviewed preoperative breast MRI and clinicopathologic features of 120 patients (mean age, 53.3 years; age range, 27–79 years) with breast cancer who had undergone BCS in 2015. Tumor size on MRI, multifocality, patterns of enhancing lesions (mass without non-mass enhancement [NME] vs. NME with or without mass), mass characteristics (shape, margin, internal enhancement characteristics), NME (distribution, internal enhancement patterns), and breast parenchymal enhancement (BPE; weak, strong) were analyzed. We also evaluated age, tumor size, histology, lymphovascular invasion, T stage, N stage, and hormonal receptors. Univariate and multivariate logistic regression analyses were used to determine the correlation between clinicopathological features, MRI findings, and positive resection margins.ResultsIn univariate analysis, tumor size on MRI, multifocality, NME with or without mass, and segmental distribution of NME were correlated with positive resection margins. Among the clinicopathological factors, tumor size of the invasive breast cancer and in situ components were significantly correlated with a positive resection margin. Multivariate analysis revealed that NME with or without mass was an independent predictor of positive resection margins (odds ratio [OR] = 7.00; p < 0.001). Strong BPE was a weak predictor of positive resection margins (OR = 2.59; p = 0.076).ConclusionNon-mass enhancement with or without mass is significantly associated with a positive resection margin in patients with breast cancer. In patients with NME, segmental distribution was significantly correlated with positive resection margins.

Preoperative Magnetic Resonance Imaging Features Associated with Positive Resection Margins in Patients with Invasive Lobular Carcinoma

“…In past studies with study populations composed mostly of patients with IDC, NME on preoperative MRI, tumor size exceeding 5 cm, and multifocal lesions were factors associated with positive resection margins after BCS ( 9 27 28 ). As DCIS lesions commonly appear as NME on MRI ( 29 30 ), previous studies suggested an association between DCIS components and positive resection margins ( 12 ).…”

“…However, these results were based on study populations composed mostly of patients with invasive ductal carcinoma (IDC) ( 9 10 ). Furthermore, the majority of malignant NME lesions depicted by MRI in previous studies were confirmed as DCIS, so the sensitivity advantage of MRI over conventional imaging in depicting local tumor extent was reported to increase as DCIS component size increased, which would be less frequently detected in invasive lobular carcinoma (ILC) ( 11 12 ).…”

Raman spectroscopy and artificial intelligence to predict the Bayesian probability of breast cancer

“…As a result, the accurate determination of tumor margins in real time during surgical intervention has received significant attention 4 , 5 . Advanced technologies proposed to solve what has become known as “the margins problem” have included hyperspectral optical imaging 6 , magnetic resonance imaging 7 , and ultrasound 8 .…”

Ultrafast Dynamic Contrast-Enhanced Breast MRI: Lesion Conspicuity and Size Assessment according to Background Parenchymal Enhancement

“…Although background parenchymal enhancement (BPE) on breast MRI results from physiological enhancement in fibroglandular tissue, strong BPE may yield abnormal interpretation and false-positive biopsy results (14,15). Moderate to marked BPE is also associated with an inaccurate estimation of tumor size at preoperative staging MRI and has been associated with higher rates of positive resection margins (16)(17)(18)(19)(20). In general, BPE increases after a contrast agent is administered and is more prominent during the late phase than the early phase in DCE-MRI (19).…”