Nonmammographic Evaluation of the Extent of Breast Carcinoma

Smith, Michael; Allison, Kelley; Paredes, Ellen Shaw de

doi:10.1053/j.sult.2006.05.005

Cited by 5 publications

(6 citation statements)

References 37 publications

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“…Some studies (26,27,31) also evaluated the accuracy of mammography in predicting DCIS histological extent. The impact of breast MRI in preoperative DCIS assessment has also been investigated with widely varying results (20,32,33).…”

Section: Discussionmentioning

confidence: 99%

“…Inadequate surgical margin is a key problem in surgical treatment of patients with DCIS, since its involvement is associated with increased local recurrence rate (17) and warrants additional surgery (18,19). Surgical planning depends on precise preoperative assessment of the radiological extent of DCIS (microcalcifications) and non-mammographic imaging modalities (ultrasound [US], magnetic resonance imaging [MRI]) have also been used (20,21). Despite it, reoperation rates for DCIS due to involved margins are high, on average in the range of 30-50% (21)(22)(23).…”

Section: Introductionmentioning

confidence: 99%

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Reoperation rate of ductal carcinoma in situ: impact of tomosynthesis (3D) and spot magnification

2022

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Background Surgical planning depends on precise preoperative assessment of the radiological extent of ductal carcinoma in situ (DCIS). Despite different modalities used, reoperation rates for DCIS due to involved margins are high. Purpose To evaluate the impact of additional imaging views (spot magnification, tomosynthesis) on surgical reoperation rate of DCIS. Material and Methods The retrospective single institute study includes 157 patients with biopsy-proven pure DCIS seen on mammogram as microcalcifications and treated with breast-conserving surgery. Patients have been divided into three groups according to additional imaging performed: spot magnification, tomosynthesis, and none. All breast images (mammograms, spot magnification, tomosynthesis) were reviewed and the maximum extent of pathological microcalcifications was recorded. Radiological size was compared to final histopathological size. Reoperation rate due to inadequate margins was recorded. Results Reoperation rates (25%) due to inadequate margins were as follows: spot (18%), tomosynthesis (27%), none (31%); P = 0.488. Spot magnification, tomosynthesis, and digital zoom of full-field digital mammography predicted similarly the final histopathological size. Reoperation group had a significantly greater preoperative radiological median size (26 mm vs. 20 mm; P = 0.014) as well as median size of disease on final histopathological report (29 mm vs. 14 mm; P < 0.001). Discrepancy between radiological and final histopathological size became greater with increasing DCIS extent. Conclusion The main factors for reoperations are DCIS size and discordance between radiological and histopathological sizes. The use of additional imaging views (spot magnification, tomosynthesis) did not reduce reoperation rate.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reoperation rate of ductal carcinoma in situ: impact of tomosynthesis (3D) and spot magnification

2022

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“…Low grade DCIS had often quite nontypical form of enhancement pattern and initial rise was usually lower and is of course difficult to diff erentiate it from benign proliferative processes that often enhance on MRI (ref. 20,21 10 . Regarding the kinetic curve assessment of DCIS, the rapid initial peak of enhancement was found in almost 77 % and washout pattern of enhancement in nearly 54 % of women 13 .…”

Section: Discussionmentioning

confidence: 99%

“…MRI is not an absolutely reliable method and overestimation and underestimation of the size of the lesion is found 13,14 . It was found that quite a high percentage of re-operations in cases of DCIS was diagnosed only by MG. MRI is understood to be an invaluable adjunct in the evaluation of DCIS or invasive carcinoma especially in those women who consider breast conserving therapy 5,6,9,10 . Very typical morphological feature for high but also for low DCIS is ductal pattern of enhancement 7,15,16 .Usually it is clumped, and the heterogeneous or homogeneous enhancement sometimes can be of branching appearance and follows the course of the duct 8 .…”

Section: Discussionmentioning

confidence: 99%

“…The sensitivity, specifi city and accuracy of breast MR imaging in detecting DCIS with microinvasion were found high in some studies, 71 %, 85 % and 76 %, respectively 8 . Particularly in dense type of breast during MRI, the extent of microcalcifi cation lesion can be bigger in comparison with that of MG and it is possible to detect another mammographically and ultrasonographically occult foci of DCIS and observe more accurately the tumour size 5,[9][10][11] . Microcalcifi cations as other lesions of the breast are categorized according to BI-RADS.…”

Section: Discussionmentioning

confidence: 99%

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The Value of Dynamic Contrast Enhanced Breast Mri in Mammographically Detected Bi-Rads 5 Microcalcifications

Houserková¹,

Prasad²,

Svach³

et al. 2008

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aims:To evaluate the role of dynamic contrast-enhanced magnetic resonance imaging (MRI) in the diagnosis of BI-RADS-5 type of microcalcifi cations of the breast, to compare the size of the microcalcifi cation lesions using mammography (MG) and MRI, and to determine the value of MRI in surgery for microcalcifi cations. The study also determines the morphology of microcalcifi cation lesions, assesses kinetic curves and compare MRI features of ductal carcinoma in situ (DCIS) for diff erent histopathological grades.Methods: Our group consisted of 32 patients with mammographically detected BI-RADS 5 microcalcifi cations. The MRI was done in this group of women which was later followed by stereotactic vaccum-assisted biopsy (SVAB). Surgery was performed on all patients with a biopsy that resulted in a diagnosis of breast cancer or atypical ductal hyperplasia (ADH).Results: Of our group of 32 patients, there were 35 mammograhically detected microcalcifi cation lesions, 32 DCIS, one ADH and two benign fi ndings according to the fi nal histology.The microcalcifi cation lesions were larger using MRI than in MG in 10 women. We diagnosed DCIS multifocality in 6 women and bilateral carcinoma in one woman. As with kinetic curve assessment, we found in 67 % of DCIS a rapid rise, 27 % a moderate and in 6 % a slow initial rise. With the pattern of enhancement in the delayed phase, we found in 30 % of DCIS a washout pattern, 67 % a plateau and in 3 % a persistent pattern. Noted diff erence between high and low grade DCIS was confi rmed.Conclusions: MRI sensitivity in the detection of DCIS was 94 % in our group of patients and was the sole evidence for detection of multifocality and bilateral incidence of carcinoma. In 26 % of women the outcome of MRI was the most important for converting breast conserving surgery to mastectomy.

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Place de l’imagerie dans le bilan d’extension et l’évaluation de la réponse thérapeutique des cancers du sein

Stines

Troufléau

2007

Cancer Du Sein Avancé

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Place dans le bilan d'extensionLe bilan d'extension d'un cancer du sein a pour but de définir son extension locale, régionale et générale apparente basée sur la clinique (et l'imagerie) ou sur des constatations anatomo-pathologiques. Il permet de préciser les facteurs pronostiques.Pour les cancers du sein sans métastases viscérales ou osseuses, l'existence de métastases ganglionnaires est le facteur pronostique principal (1). Elle est prédictive d'une maladie métastatique. La taille tumorale est le facteur qui vient en second. C'est pour ces deux facteurs que l'imagerie peut avoir un impact. Les autres facteurs sont histologiques et biologiques.Les anatomo-pathologistes nous ont appris de longue date que les cancers du sein étaient, au moment de leur découverte, souvent multifocaux ou multicentriques voire bilatéraux. Les protocoles thérapeutiques tiennent compte très largement de la possibilité de ces lésions multiples. La radiothérapie permet d'éradiquer des microfoyers tumoraux mais est moins efficace sur des lésions de plus grande taille. Il importe donc de détecter celles-ci avant la décision thérapeutique. La tumeurLa mammographie est considérée comme la référence pour déterminer la taille tumorale (2). Une étude de Coombs de 2005 a porté sur 800 patientes et a Auteur

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Nonmammographic Evaluation of the Extent of Breast Carcinoma

Cited by 5 publications

References 37 publications

Reoperation rate of ductal carcinoma in situ: impact of tomosynthesis (3D) and spot magnification

Reoperation rate of ductal carcinoma in situ: impact of tomosynthesis (3D) and spot magnification

The Value of Dynamic Contrast Enhanced Breast Mri in Mammographically Detected Bi-Rads 5 Microcalcifications

Place de l’imagerie dans le bilan d’extension et l’évaluation de la réponse thérapeutique des cancers du sein

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