MR Imaging of the Ipsilateral Breast in Women with Percutaneously Proven  Breast Cancer

Liberman, Laura; Morris, Elizabeth A.; Dershaw, D. David; Abramson, A F; Tan, Lee K.

doi:10.2214/ajr.180.4.1800901

Cited by 348 publications

(165 citation statements)

References 38 publications

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“…[4][5][6][7][8][9][10][11][12][13][14][15] Of the 22 malignant lesions identified only on DCE MRI, 13 (59%) lesions were invasive carcinoma and 5 (56%) lesions of the 9 DCE MRIdetected ductal carcinomas in situ were grade 3, with 1 lesion being 8 cm in size. These clinically significant lesions would have been missed if pre-operative DCE MRI had not been performed, lending some support for breast MRI in staging newly diagnosed breast cancer.…”

Section: Discussionmentioning

confidence: 99%

“…3 Numerous studies have also shown that MRI improves the detection of occult tumour foci in the ipsilateral and contralateral breasts in patients with newly diagnosed breast cancer, leading to changes in surgical planning. [4][5][6][7][8][9][10][11][12][13][14][15] Systematic reviews of the literature found that pre-operative MRI detected additional ipsilateral disease in 16-20% of patients and occult synchronous contralateral cancer in 4-5% of patients. [16][17][18] Despite the widespread use of breast MRI for pre-operative staging in recent years, this use remains controversial.…”

Section: Introductionmentioning

confidence: 99%

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Incremental cancer detection using breast ultrasonographyversusbreast magnetic resonance imaging in the evaluation of newly diagnosed breast cancer patients

He¹,

Plaxco²,

Wei³

et al. 2016

BJR

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Objective: To compare the incremental cancer detection rate (ICDR) using bilateral whole-breast ultrasonography (BWBUS) vs dynamic contrast-enhanced MRI in patients with primary breast cancer. Methods: A retrospective database search in a single institution identified 259 patients with breast cancer diagnosed from January 2011 to August 2014 who underwent mammography, BWBUS and MRI before surgery. Patient characteristics, tumour characteristics and lesions seen on each imaging modality were recorded. The sensitivity, specificity and accuracy for each modality were calculated. ICDRs according to index tumour histology and receptor status were also evaluated. The effect of additional cancer detection on surgical planning was obtained from the medical records. Results: A total of 266 additional lesions beyond 273 index malignancies were seen on at least 1 modality, of which 121 (45%) lesions were malignant and 145 (55%) lesions were benign. MRI was significantly more sensitive than BWBUS (p 5 0.01), while BWBUS was significantly more accurate and specific than MRI (p , 0.0001). Compared with mammography, the ICDRs using BWBUS and MRI were significantly higher for oestrogen receptorpositive and triple-negative cancers, but not for human epidermal growth factor receptor 2-positive cancers. 22 additional malignant lesions in 18 patients were seen on MRI only. Surgical planning remained unchanged in 8 (44%) of those 18 patients. Conclusion: MRI was more sensitive than BWBUS, while BWBUS was more accurate and specific than MRI. MRIdetected additional malignant lesions did not change surgical planning in almost half of these patients. Advances in knowledge: BWBUS may be a cost-effective and practical tool in breast cancer staging.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incremental cancer detection using breast ultrasonographyversusbreast magnetic resonance imaging in the evaluation of newly diagnosed breast cancer patients

He¹,

Plaxco²,

Wei³

et al. 2016

BJR

View full text Add to dashboard Cite

show abstract

“…Indications for an MRI examination included preoperative evaluation before planned breast conserving operation to exclude multicentricity and bilaterality, assessment of axillary lymph node status, and evaluation of residual tumor after excisional biopsy at other hospitals. We defined additional lesions on MRI according to the definition of Liberman et al (12). MRI lesions were considered as a separate entity if they were located in a different breast quadrant than the index cancer, if they were in the same quadrant but separated from the index cancer by at least 1.0 cm of intervening normal-appearing tissue on MRI, or if they were in the same quadrant and contiguous with the index cancer but extended at least 4.0 cm beyond the site of the index cancer.…”

Section: Patient Selection and Data Collectionmentioning

confidence: 99%

Follow-up design of unexpected enhancing lesions on preoperative MRI of breast cancer patients

Cheung¹,

Moon²

2015

Diagn Interv Radiol

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second-look ultrasound (SLUS) was recommended for 84 of 312 breast cancer patients having unexpected enhancing lesions on MRI. SLUS was performed for 85 unexpected enhancing lesions in 72 patients. We performed a retrospective review to determine the size, lesion type, enhancement kinetic curve, and location in relation to the index cancer. We obtained the pathologic outcome of the detected lesions and in case of a negative finding on SLUS, we performed follow-up examinations for at least two years. RESULTSOf 85 unexpected lesions, 72 (85%) were detected on SLUS. In total, 41 lesions (56.9%) were confirmed as malignant and 31 lesions (43.6%) as benign. Cancer rate was statistically higher in lesions having type III enhancement pattern, located at the same quadrant as the index cancer. However, no significant association was observed between the cancer rate and the lesion size and type. None of the 13 negative cases on SLUS developed cancer on follow-up. CONCLUSIONIn case of unexpected enhancing lesions on preoperative MRI of breast cancer patients, SLUS can be useful to find out the matched lesion. Lesions with type III enhancement pattern or those located at the same quadrant as the index cancer should be considered as a separate cancer. In the absence of any suspicious findings on SLUS, patient may be followed up with confidence. Dynamic contrast-enhanced magnetic resonance imaging (MRI) has been the most accurate technique for the detection and delineation of invasive and some in situ breast cancers (1-6). Despite the high sensitivity of MRI (83%-100%), the reported specificity of this modality is relatively low and ranges from 40% to 80% (7,8). MRI identifies additional lesions much more frequently than other imaging modalities do (9). On preoperative MRI of breast cancer patients, other enhancing lesions are frequently detected in addition to the index cancer. Since the probability of malignancy is high for additionally detected lesions on MRI of breast cancer patients, MRI-guided percutaneous biopsy is a reasonable next step, but it is an expensive and time-consuming procedure, and it is not yet widely available all over the world. Alternatively, ultrasonography (US)-guided biopsy is preferable, because it is less expensive and more convenient for the patients.Second-look ultrasound (SLUS) is a reevaluation method for MRI-detected lesions with the information provided by MRI. Sometimes, SLUS is used even when there is no antecedent US examination. This technique has become increasingly important for detecting unexpected enhancing lesions on MRI, especially for breast cancer patients.Several reports demonstrated the usefulness of SLUS (5, 10, 11). If a lesion can be detected on SLUS, a new malignant lesion can be differentiated from a false-positive enhancing lesion on MRI to conclude the diagnostic workup. Also US guidance can be used for biopsy instead of MRI guidance. Nevertheless, few studies have reported the characterization and meaning of additionally detected lesions on preoperative MRI and SLUS of ...

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“…However, MRI has higher sensitivity than X-ray mammography in identifying occult breast lesions, particularly dense lesions (11). MRI can provide a more reliable basis for accurate staging and the development of a clinical treatment strategy for breast cancer.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the diagnostic efficacy between ultrasound elastography and magnetic resonance imaging for breast masses

Cheng¹,

Li²,

Ji³

et al. 2017

Exp Ther Med

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Abstract. The present study compared the efficacy of ultrasound elastography (UE), magnetic resonance imaging (MRI) and the combination of the two methods (UE+MRI) in the differential diagnosis of benign and malignant breast tumors. In total, 86 patients with breast masses were recruited and evaluated by UE, MRI and UE+MRI. Strain ratios of UE were calculated for the breast mass and adjacent normal tissues. In addition, the receiver operating characteristic (ROC) curve was obtained, while the sensitivity and specificity were calculated to determine the optimal cut-off point for the differential diagnosis. The area under the ROC curve (AUC) was also calculated to evaluate the diagnostic performance of these methods. The results indicated that the diagnostic accuracy of UE+MRI was significantly higher compared with the UE or MRI methods in the differential diagnosis of invasive ductal, invasive lobular, intraductal papillary, medullary and mucinous carcinomas (all P<0.05). The optimal cut-off points of ROC curve of the Strain Ratio in the diagnosis of breast lesions were 2.81, 3.76 and 3.42 for UE, MRI and UE+MRI, respectively. Furthermore, the AUC values were 86.7, 79.2 and 91.4%, while the diagnostic accuracy rates were 82.5, 75.5 and 95.3%, for UE, MRI and UE+MRI, respectively. Accuracy rate differences between UE and MRI or between UE and UE+MRI were statistically significant (P<0.05), whereas no significant difference existed between MRI and UE+MRI (P>0.05). Finally, the diagnostic consistency of the UE+MRI method with the pathological diagnosis was higher compared with UE or MRI alone. In conclusion, the combination of UE and MRI is superior to the use of UE or MRI alone in the differential diagnosis of benign and malignant breast masses.

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MR Imaging of the Ipsilateral Breast in Women with Percutaneously Proven Breast Cancer

Cited by 348 publications

References 38 publications

Incremental cancer detection using breast ultrasonographyversusbreast magnetic resonance imaging in the evaluation of newly diagnosed breast cancer patients

Incremental cancer detection using breast ultrasonographyversusbreast magnetic resonance imaging in the evaluation of newly diagnosed breast cancer patients

Follow-up design of unexpected enhancing lesions on preoperative MRI of breast cancer patients

Comparison of the diagnostic efficacy between ultrasound elastography and magnetic resonance imaging for breast masses

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