Magnetic resonance imaging of the breast: Recommendations from the EUSOMA working group

Sardanelli, Francesco; Boetes, C.; Borisch, Bettina; Decker, Thomas; Federico, Massimo; Gilbert, Fiona J.; Helbich, Thomas H.; Heywang‐Köbrunner, Sylvia H.; Kaiser, Werner A.; Kerin, Michael J.; Mansel, Robert Edward; Marotti, Lorenza; Martincich, Laura; Mauriac, L.; Meijers-Heijboer, Hanne; Orecchia, Roberto; Panizza, Pietro; Ponti, Antonio; Purushotham, Arnie; Regitnig, Peter; Turco, Marco Rosselli Del; Thibault, Fabienne; Wilson, Robin

doi:10.1016/j.ejca.2010.02.015

Cited by 829 publications

(627 citation statements)

References 195 publications

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“…The rates of tumour NAC involvement in the literature are inconsistent [14][15][16][17][18][19][20][21] likely due to different pathological protocols for NAC evaluation and variable accuracy of clinical and pathological data collection. For example, a recent systematic review of the literature showed that only 6.4% of the nipple cores of 2477 NAC sparing mastectomies were involved with tumour [13].…”

Section: Discussionmentioning

confidence: 99%

“…MRI examinations were acquired with a 1.5T equipment and dedicated phased-array 8-channel coil (HDx Signa Excite, GE HealthCare Milwaukee, WI, USA), following the recommended technical requirements [20]. In particular, the dynamic study was performed by a 3D Vibrant sequence (slice thickness 2.6 mm; matrix 416x416; temporal resolution 90 s) acquired before and five times after intravenous contrast agent administration (0.1 mmol/kg of Gadobenate Dimeglumine, Bracco Imaging, Milan, Italy) at a flow rate of 2 ml/s.…”

Section: Mri Examinationmentioning

confidence: 99%

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MRI and intraoperative pathology to predict nipple–areola complex (NAC) involvement in patients undergoing NAC-sparing mastectomy

Ponzone

Carabalona

Rivolin

et al. 2015

European Journal of Cancer

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Background: Nipple-areola sparing mastectomy (NSM) with immediate implant reconstruction is an option for patients with non-locally advanced breast cancer. The prediction of occult tumour involvement of the nipple-areola complex (NAC) may help select candidates to NSM. Patients and methods: We prospectively recorded clinical and pathological data, magnetic resonance imaging (MRI) results and intraoperative pathological assessments of the subareolar (SD) and proximal nipple ducts (ND) of 112 consecutive breast cancer patients scheduled for NSM. All parameters were correlated with final pathological NAC assessment by univariate and multivariate analysis. Results: Thirty-one patients (27.7%) had tumour involvement of the NAC. At univariate analysis, age (p = 0.001), post-menopausal status (0.003), tumour central location (p = 0.03), tumour-NAC distance measured by MRI (p = 0.000) and intraoperative pathologic assessment (SD + ND) (p = 0.000) were significantly correlated with NAC involvement. At multivariate analysis, only MRI tumour-NAC distance (p = 0.008) and menopausal status (p = 0.039) among all preoperative variables retained statistical significance. The sensitivity and specificity of MRI tumour-NAC distance were 32.2% and 88.6% and those of E-mail address: riccardo.ponzone@ircc.it (R. Ponzone).European Journal of Cancer (2015) 51, 1882-1889 A v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m ScienceDirectj o u r n a l h o m e p a g e : ww w . e j c a n c e r . c o m intraoperative pathologic assessment were 46.7% and 100%, respectively. Sensitivity, specificity and accuracy of the double assessment (MRI plus intraoperative pathology) were 50.0%, 96.2% and 84.1%, respectively. Conclusion: Intraoperative pathologic assessment and tumour-NAC distance measured by MRI are the most important predictors of occult NAC involvement in breast cancer patients. A negative pathological assessment and a tumour-NAC distance P 5 mm allow optimal discrimination between NAC positive and NAC negative cases and may serve as a guide for the optimal planning of oncological and reconstructive surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Mri Examinationmentioning

confidence: 99%

MRI and intraoperative pathology to predict nipple–areola complex (NAC) involvement in patients undergoing NAC-sparing mastectomy

Ponzone

Carabalona

Rivolin

et al. 2015

European Journal of Cancer

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“…This apparent doubling in incidence of MIBC over the 10 years between 1990 and 2000 may be due in part to improved breast imaging (digital mammography, ultrasonography and MRI) and increased screening24. Standard imaging of MIBC may include digital mammography, ultrasound examination and MRI, with biopsy confirmation of any additional suspected cancers on MRI to minimize their misdiagnosis, which occurs in 30 per cent of ‘lesions’24 25. Studies6 10, 11 19, 20, 21 23, 26 are conflicting on the prognostic implications of MIBC, with suggestions of increased axillary lymph node involvement latterly using sentinel lymph node biopsy (SLNB), and with worse overall outcomes than those for unifocal cancers19 22, 23.…”

Section: Introductionmentioning

confidence: 99%

Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Winters¹,

Horsnell

Elvers

et al. 2018

BJS Open

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BackgroundThe clinical effectiveness of treating ipsilateral multifocal (MF) and multicentric (MC) breast cancers using breast‐conserving surgery (BCS) compared with the standard of mastectomy is uncertain. Inconsistencies relate to definitions, incidence, staging and intertumoral heterogeneity. The primary aim of this systematic review was to compare clinical outcomes after BCS versus mastectomy for MF and MC cancers, collectively defined as multiple ipsilateral breast cancers (MIBC).MethodsComprehensive electronic searches were undertaken to identify complete papers published in English between May 1988 and July 2015, primarily comparing clinical outcomes of BCS and mastectomy for MIBC. All study designs were included, and studies were appraised critically using the Newcastle–Ottawa Scale. The characteristics and results of identified studies were summarized.ResultsTwenty‐four retrospective studies were included in the review: 17 comparative studies and seven case series. They included 3537 women with MIBC undergoing BCS; breast cancers were defined as MF in 2677 women, MC in 292, and reported as MIBC in 568. Six studies evaluated MIBC treated by BCS or mastectomy, with locoregional recurrence (LRR) rates of 2–23 per cent after BCS at median follow‐up of 59·5 (i.q.r. 56–81) months. BCS and mastectomy showed apparently equivalent rates of LRR (risk ratio 0·94, 95 per cent c.i. 0·65 to 1·36). Thirteen studies compared BCS in women with MIBC versus those with unifocal cancers, reporting LRR rates of 2–40 per cent after BCS at a median follow‐up of 64 (i.q.r. 57–73) months. One high‐quality study reported 10‐year actuarial LRR rates of 5·5 per cent for BCS in 300 women versus 6·5 per cent for mastectomy among 887 women.ConclusionThe available studies were mainly of moderate quality, historical and underpowered, with limited follow‐up and biased case selection favouring BCS rather than mastectomy for low‐risk patients. The evidence was inconclusive, weakening support for the St Gallen consensus and supporting a future randomized trial.

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“…Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a noninvasive imaging technique increasingly used in breast cancer diagnosis as an adjunct to conventional imaging techniques (3,4). DCE-MRI shows promise in detecting both invasive and ductal carcinoma in situ cancers, gives information on the biological aggressiveness of tumors and may be used to evaluate response to neoadjuvant chemotherapy (5)(6)(7)(8).…”

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confidence: 99%

Performance of a fully automatic lesion detection system for breast DCE‐MRI

Vignati

Giannini

Luca

et al. 2011

Magnetic Resonance Imaging

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Purpose: To describe and test a new fully automatic lesion detection system for breast DCE-MRI.Materials and Methods: Studies were collected from two institutions adopting different DCE-MRI sequences, one with and the other one without fat-saturation. The detection pipeline consists of (i) breast segmentation, to identify breast size and location; (ii) registration, to correct for patient movements; (iii) lesion detection, to extract contrast-enhanced regions using a new normalization technique based on the contrast-uptake of mammary vessels; (iv) false positive (FP) reduction, to exclude contrastenhanced regions other than lesions. Detection rate (number of system-detected malignant and benign lesions over the total number of lesions) and sensitivity (systemdetected malignant lesions over the total number of malignant lesions) were assessed. The number of FPs was also assessed.Results: Forty-eight studies with 12 benign and 53 malignant lesions were evaluated. Median lesion diameter was 6 mm (range, 5-15 mm) for benign and 26 mm (range, 5-75 mm) for malignant lesions. Detection rate was 58/65 (89%; 95% confidence interval [CI] 79%-95%) and sensitivity was 52/53 (98%; 95% CI 90%-99%). Mammary median FPs per breast was 4 (1st-3rd quartiles 3-7.25). Conclusion:The system showed promising results on MR datasets obtained from different scanners producing fatsat or non-fat-sat images with variable temporal and spatial resolution and could potentially be used for early diagnosis and staging of breast cancer to reduce reading time and to improve lesion detection. Further evaluation is needed before it may be used in clinical practice.

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Magnetic resonance imaging of the breast: Recommendations from the EUSOMA working group

Cited by 829 publications

References 195 publications

MRI and intraoperative pathology to predict nipple–areola complex (NAC) involvement in patients undergoing NAC-sparing mastectomy

MRI and intraoperative pathology to predict nipple–areola complex (NAC) involvement in patients undergoing NAC-sparing mastectomy

Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Performance of a fully automatic lesion detection system for breast DCE‐MRI

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