Imaging in Locoregional Management of Breast Cancer

Kuhl, Christiane K.; Lehman, Constance D.; Bedrosian, Isabelle

doi:10.1200/jco.19.03257

Cited by 18 publications

(17 citation statements)

References 92 publications

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“…In tumors with a significant component of DCIS, the tumor extent may be underestimated on ultrasound as the typical microcalcifications are less readily visible or measurable. Non- calcified DCIS may lead to tumor underestimation on mammography (24)(25)(26). We found no difference in the degree of size underestimation between mammography and ultrasonography in this study, although we did find that underestimation of tumor size was commoner in patients with DCIS and also with larger tumors, findings echoed in other studies (25,27).…”

Section: Discussionsupporting

confidence: 53%

Radiological Underestimation of Tumor Size Influences the Success Rate of Re-Excision after Breast-conserving Surgery

Simpson¹,

Allan²,

McFall³

2021

EJBH

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Objective: Failure to achieve adequate margins after breast-conserving surgery often leads to re-excision, either by repeat breast-conserving surgery (BCS) or by mastectomy. Despite the high frequency of this problem, the success rate of achieving adequate margins by repeat BCS is not well documented. The objective of this study was to determine the success rate of repeat BCS and identify the factors influencing that rate. Materials and Methods:A retrospective review was performed of all women undergoing repeat BCS for inadequate margins after initial BCS in our breast unit between 2013 and 2019. Univariate and multivariate analyses were carried out to identify the factors influencing how often adequate margins were achieved after repeat BCS.Results: One hundred fifty-four patients underwent repeat BCS after initially inadequate margins, of which adequate margins were achieved in 82%. Patients with successful repeat BCS had smaller tumors, had less underestimation of tumor size on imaging, and were less likely to have had cavity shaves taken at their initial BCS. A tumor size more than 50% larger than predicted by imaging was independently associated with failure of repeat BCS in multivariate analysis (odds ratio: 3.6, 95% CI: 1.41-9.20, p = 0.007). Underestimation of tumor size by imaging was commoner and more extensive in patients with larger tumors and those with ductal carcinoma in situ. Conclusion:Re-excision by cavity shaves has a high success rate and should be offered to all patients who are deemed suitable for the procedure. Patients whose tumors are more than 50% larger than predicted by imaging should be counseled about the higher risk of failure.

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Section: Discussionsupporting

confidence: 53%

Radiological Underestimation of Tumor Size Influences the Success Rate of Re-Excision after Breast-conserving Surgery

Simpson¹,

Allan²,

McFall³

2021

EJBH

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“…Magnetic resonance imaging (MRI) is an established imaging modality for the detection of breast cancer 1 and has improved accuracy in the assessment of locoregional disease extent by identifying additional cancers in the ipsilateral and contralateral breast. 2,3 Preoperative breast MRI has been shown to improve size assessment of index tumour, identify occult foci of cancer in the ipsilateral breast in 15% of patients and occult synchronous cancers in the contralateral breast up to 3-5%. 3,4,[5][6][7][8][9][10][11][12] Its utility can influence the choice of surgical and neoadjuvant treatment options, with reportedly improved surgical outcome.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 Preoperative breast MRI has been shown to improve size assessment of index tumour, identify occult foci of cancer in the ipsilateral breast in 15% of patients and occult synchronous cancers in the contralateral breast up to 3-5%. 3,4,[5][6][7][8][9][10][11][12] Its utility can influence the choice of surgical and neoadjuvant treatment options, with reportedly improved surgical outcome. 3,12,14 However, there are opposing views that preoperative breast MRI may result in overdiagnosis, over-treatment with more extensive surgery or mastectomy 3,[15][16][17][18][19][20] and potentially treatment delay.…”

Section: Introductionmentioning

confidence: 99%

The selective use of preoperative MRI in the staging of breast cancer: a single‐institution experience

Gillies

Kwok

2021

J Med Imag Rad Onc

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Introduction: Routine use of preoperative breast magnetic resonance imaging (MRI) for loco-regional staging of breast cancer remains controversial. At Counties Manukau District Health Board (CMDHB), preoperative breast MRI is used selectively within a multidisciplinary setting. The purpose of this study is to determine the accuracy of selective use of preoperative MRI in staging loco-regional disease and how it has impacted our clinical practice. Methods: Patients who received preoperative MRI at CMDHB between October 2015 and October 2018 were identified on a prospective database. The decision to offer MRI was made by multidisciplinary consensus. Patient data were collected retrospectively from clinical, imaging and histology records. The accuracy of MRI was determined by comparing it against histology as gold standard, and its potential contribution to treatment decisions and treatment delay was determined by clinical record review. Results: Ninety-two patients received preoperative MRI. Additional foci of cancer were identified in ten patients (11%). Sixteen patients (17%) required additional biopsies. In fourteen patients (15%), MRI identified more extensive disease than conventional imaging prompting a change of surgical management. This 'upstaging' was confirmed histologically in twelve (13%). In one (1%) patient, MRI incorrectly 'downstaged' disease, but it did not alter the management. No patients experienced a delay in treatment due to MRI. Conclusion: A selective, considered use of preoperative MRI within a multidisciplinary setting at our local institution results in more biopsies but with an acceptable risk-benefit ratio. It provides accurate staging to aid treatment decisions without resulting in a delay in treatment.

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“…Currently, the basic evaluation for locoregional staging of breast cancer patients includes clinical examination, mammography, and ultrasound [ 2 ]. Breast magnetic resonance imaging (MRI) has been increasingly used, as it has proven to be superior to conventional imaging methods in assessing tumor extent and identifying additional lesions [ 3 , 4 ]. MRI is able to identify additional tumor foci in 20% of patients on the same breast and 5.5% on the contralateral breast, modifying treatment in up to one third of patients with breast cancer [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, the widespread implementation of this method is limited by its high cost, long exam time, low availability in some regions, and perceived low specificity [ 6 ]. Despite more accurate staging with MRI, guidelines differ widely in their recommendations for the performance of pretreatment breast MRI for all newly diagnosed breast cancer patients [ 3 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Multidetector Computed Tomography with Dedicated Protocol for Breast Cancer Locoregional Staging: Feasibility Study

et al. 2020

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Background: The aim of this study was to demonstrate the feasibility of performing multidetector computed tomography (MDCT) with a dedicated protocol for locoregional staging in breast cancer patients. Methods: This prospective single-center study included newly diagnosed breast cancer patients submitted to contrast-enhanced chest MDCT and breast magnetic resonance imaging (MRI). MDCT was performed in prone position and using subtraction techniques. Fleiss’ Kappa coefficient (K) and intraclass correlation coefficient (ICC) were used to assess agreement between MRI, MDCT, and pathology, when available. Results: Thirty-three patients were included (mean age: 47 years). Breast MRI and MDCT showed at least substantial agreement for evaluation of tumor extension (k = 0.674), presence of multifocality (k = 0.669), multicentricity (k = 0.857), nipple invasion (k = 1.000), skin invasion (k = 0.872), and suspicious level I axillary lymph nodes (k = 0.613). MDCT showed higher number of suspicious axillary lymph nodes than MRI, especially on levels II and III. Both methods had similar correlation with tumor size (MRI ICC: 0.807; p = 0.008 vs. MDCT ICC: 0.750; p = 0.020) and T staging (k = 0.699) on pathology. Conclusions: MDCT with dedicated breast protocol is feasible and showed substantial agreement with MRI features in stage II or III breast cancer patients. This method could potentially allow one-step locoregional and systemic staging, reducing costs and improving logistics for these patients.

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Imaging in Locoregional Management of Breast Cancer

Abstract: Author affiliations and support information (if applicable) appear at the end of this article.

Cited by 18 publications

References 92 publications

Radiological Underestimation of Tumor Size Influences the Success Rate of Re-Excision after Breast-conserving Surgery

Radiological Underestimation of Tumor Size Influences the Success Rate of Re-Excision after Breast-conserving Surgery

The selective use of preoperative MRI in the staging of breast cancer: a single‐institution experience

Multidetector Computed Tomography with Dedicated Protocol for Breast Cancer Locoregional Staging: Feasibility Study

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