Preoperative breast MRI in patients with invasive lobular breast cancer

Abstract

To investigate the use of MRI in preoperative characterization of invasive lobular breast cancer (ILC) and in detection of multifocal/multicentric disease. We retrospectively reviewed T1-weighted FLASH 3D precontrast and postcontrast MR images together with subtraction images of 26 women with histopathologically proven invasive lobular cancer. Two experienced radiologists described tumor patterns of ILC independently. MR findings of unifocal, multifocal, single quadrant and multiquadrant disease were correlated with results of other imaging techniques and compared with histopathological findings as gold standard. Most ILC presented on MRI as a single spiculated/irregular, inhomogeneous mass (pattern 1, n=12) or as a dominant lesion surrounded by multiple small enhancing foci (pattern 2, n=8). Multiple small enhancing foci with interconnecting enhancing strands (pattern 3) and an architectural distortion (pattern 4) were both described in three cases. There was one case of a focal area of inhomogeneous enhancement (pattern 5) and one normal MR examination (pattern 6). Unifocal and multifocal lesions were identified on MRI in four patients with normal conventional imaging. In nine women, multiple additional lesions or more extensive multiquadrant disease were correctly identified only on MRI. MRI may play an important role in the evaluation of patients with ILC, which is often difficult to diagnose on clinical examination and conventional imaging and more likely occur in multiple sites and in both breasts. However, false-negative MR findings do occur in a small percentage of ILC.

The impact of preoperative breast MRI on the re-excision rate in invasive lobular carcinoma of the breast

“…Many studies have shown that preoperative MRI changes the surgical approach in 22-44% of patients [11][12][13][14][15][16][17][18], and as mentioned before, in 12-33% of patients this change is a conversion from BCS to mastectomy [11,13,16,[19][20][21][22]. Based on few reported findings, this rate of therapy change is balanced by a conversion rate in the opposite direction of approximately 5% [11].…”

“…The technique is superior to conventional imaging methods in staging ILC [11][12][13][14][15][16][17][18], which is mainly achieved by improving tumor delineation and detection of additional tumor foci.…”

Current Status and New Developments in Breast MRI

“…Recent studies show that MRI can even depict ductal carcinoma in situ (DCIS) ( fig. 1) and invasive lobular carcinoma with high sensitivity [17][18][19][20]. To avoid false-positive enhancing lesions and subsequent unnecessary breast biopsies, breast MRI should be only used for certain indications.…”

Increased incidence of lobular breast cancer in women treated with hormone replacement therapy: implications for diagnosis, surgical and medical treatment

“…The reported false negative rate in fine needle aspiration (FNA) of ILC ranges from 15% to w60% with a sensitivity of 60.5-76%, considerably lower than that of IDCs (Schelfout et al 2004). A false negative core biopsy is also more likely because of the difficult in the localization of the lesions and the sparse cellularity of the tumour (Pointon & Cunningham 1999).…”