MR-mammography – impact on disease extent determination and surgical treatment of invasive ductal and lobular breast cancers

Abstract

The aim of this study is to assess the impact of multiparametric MR imaging to an exact determination of the extent of invasive ductal and lobular breast cancers in routine clinical practice.180 women aged 27-74 years (median 52.4 years) with newly diagnosed invasive ductal and lobular breast cancers confirmed by core-cut or vacuum-assisted biopsy were examined by all three imaging modalities, i.e. digital X-ray mammography, ultrasonography and 3T MR-mammography. In case of MR-mammography an extended protocol, i.e. combination of morphological breast MRI + DCE + DWI was used. For overall detection and determination of the extent of invasive breast cancers (IDC + ILC) MRmammography alone reached the diagnostic accuracy of 72.48%, while X-ray mammography 69.12% and ultrasonography 59.87%. In cases of ILC combination of X-ray mammography and MR-mammography with sensitivity of 96.15% was the most effective. In comparison with X-ray mammography and ultrasonography MR-mammography had higher sensitivity (96.15%, versus 90.28%) in the diagnosis of multifocal/ multicentric invasive lobular carcinoma and invasive ductal carcinoma with extensive intraductal component, as well. 3T MR-mammography is an effective complementary consulting modality to digital X-ray mammography and ultrasonography, and it is particularly beneficial in the detection of additional mammographically and ultrasonografically occult breast lesions, as well as in the determination of the real extent of pathological changes in the ipsilateral and contralateral breast. Key words: MR-mammography, occult breast cancer, invasive ductal cancer, invasive lobular cancer, multifocality, multicentricityDetection and diagnosis of breast lesions are primarily based on the X-ray mammography, both in group of asymptomatic women in screening program as well as in women with palpation findings. The main goal is to find any changes, try to determine their extent and to assess local spread. The sensitivity of X-ray mammography varies according to technical parameters, physician competence and measurement criteria, and is reported between 69% and 90% [1]. Furthermore, X-ray mammography (MG) and ultrasonography (US) is limited by soft tissue contrast and the ability to measure tumor vascularity. Women with suspicious X-ray mammography are referred for additional targeted mammography examinations and breast ultrasound, followed by percutaneous biopsy. Approximately in 10-20 % of patients with benign changes in preoperative histology are found one or more occult malignant lesions in the definitive histology of surgically retrieved tissue [2, 3, 4]. Those lesions cause morphological and functional changes in the MR image, but do not correlate with mammographical and ultrasonographical images. The potential of MR -mammography currently lies in the high sensitivity of dynamic contrast-enhanced images (DCE) for the detection of malignant breast tumors (92-99 %) [5,6]. Since only a few studies correlate histopathological findings with the extent and nature of changes in the MR im...

Preoperative axillary nodal staging of invasive lobular breast cancer with ultrasound guided fine needle aspiration in patients with suspicious ultrasound findings versus aspiration in all patients – A retrospective single institutional analysis

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Pre-surgical Multiparametric Assessment of Breast Lesions Using 3-Tesla Magnetic Resonance

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The Role of Multidirectional Diffusion Weighted Imaging in the diagnosis of breast carcinoma in Magnetic Resonance Imaging.

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