Staging of suspected breast cancer: effect of MR imaging and MR-guided biopsy.

Orel, Susan G.; Schnall, Mitchell D.; Powell, Colleen M.; Hochman, Mary G.; Solin, Lawrence J.; Fowble, Barbara; Torosian, Michael H.; Rosato, Ernest F.

doi:10.1148/radiology.196.1.7784554

Cited by 380 publications

(217 citation statements)

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“…However, breast lesions remain difficult to diagnose and characterize, especially in dense fibroglandular breasts. The main advantage of dynamic studies with MRI in the breast is that they can improve the detection and characterization of multiple and/or small lesions (29,30). However, the low specificity of MRI (1-4) remains a problem.…”

Section: Discussionmentioning

confidence: 99%

Quantitative diffusion imaging in breast cancer: A clinical prospective study

Rubesova

Grell

Maertelaer

et al. 2006

Magnetic Resonance Imaging

230

199

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Purpose: To study the correlation between apparent diffusion coefficient (ADC) and pathology in patients with undefined breast lesion, to validate how accurately ADC is related to histology, and to define a threshold value of ADC to distinguish malignant from benign lesions. Materials and Methods:Seventy-eight patients (110 lesions) were referred for positive or dubious findings. Threedimensional fast low-angle shot (3D-FLASH) with contrast injection was applied. EPI diffusion-weighted imaging (DWI) with fat saturation was performed, and ROIs were selected on subtraction 3D-FLASH images before and after contrast injection, and copied on an ADC map. Inter-and intraobserver analyses were performed.Results: At pathology 22 lesions were benign, 65 were malignant, and 23 were excluded. The ADCs of malignant and benign lesions were statistically different. In malignant tumors the ADC was (mean Ϯ SEM) 0.95 Ϯ 0.027 ϫ 10 -3mm 2 /second, and in benign tumors it was 1.51 Ϯ 0.068 ϫ 10 -3 mm 2 /second. According to receiver operating characteristic (ROC) curves, we found a threshold between malignant and benign lesions for highest sensitivity and specificity (both 86%) around 1.13 Ϯ 0.10 ϫ 10 -3 mm 2 /second. For a threshold of 0.95 Ϯ 0.10 ϫ 10 -3 mm 2 /second, specificity was 100% but sensitivity was very low. Inter-and intraobserver studies showed good reproducibility. Conclusion:The ADC may help to differentiate benign and malignant lesions with good specificity, and may increase the overall specificity of breast MRI.

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Section: Discussionmentioning

confidence: 99%

Quantitative diffusion imaging in breast cancer: A clinical prospective study

Rubesova

Grell

Maertelaer

et al. 2006

Magnetic Resonance Imaging

230

199

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“…Breast MRI has been found to be very sensitive for the detection of primary invasive breast cancer but less is known about the accuracy of MRI for detecting residual disease after chemotherapy as cytotoxic agents may affect the dynamics of contrast uptake (Gilles et al, 1994;Orel et al, 1995;Hunt et al, 1996;Fisher et al, 1998;Partridge et al, 2002;Bedrosian et al, 2003).…”

Section: Discussionmentioning

confidence: 99%

Using MRI to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer

et al. 2008

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Contrast-enhanced magnetic resonance imaging (MRI) was used to monitor the response of patients undergoing neoadjuvant chemotherapy for breast cancer with the aim of undergoing breast-conserving surgery (BCS). Patients were prospectively recruited to undergo MRI as well as conventional methods of clinical examination, mammography (MM) and ultrasonography (USS) and response was assessed by each of these methods. Thirty-two patients with primary breast cancer were recruited. Magnetic resonance imaging correlation with histopathological size (r ¼ 0.71) was superior to USS (r ¼ 0.65) and to MM where tumour size was not measurable following chemotherapy in 71% of patients. Magnetic resonance imaging had 87.5% sensitivity (95% CI ¼ 68 -97%) and 50% specificity (95% CI ¼ 16 -84%) for a PPV (positive predictive value) of 99.8% and NPV (negative predictive value) of 80% for the detection of residual invasive cancer. Magnetic resonance imaging displayed 80% sensitivity (95% CI ¼ 28.4 -99.5%) and 89% specificity (95% CI ¼ 71 -98%) to detect pathological pCR in the breast. Eighty-four per cent of recruited patients were identified as potentially suitable candidates for BCS following chemotherapy and of those choosing to accept BCS, breast conservation was achieved in 90.5%, or 65.6% of all patients. Of those who proceeded to BCS, 9.5% required a re-do mastectomy because of positive margins; however, no residual tumour was found on histological examination of mastectomy specimens. Magnetic resonance imaging appears to be superior to conventional methods for assessing pathological response and the low rate of re-operation for positive margins indicates a valuable role in aiding the decision to undergo BCS or mastectomy.

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“…CEDM is of interest in the non-screening setting and has the potential to increase the cancer detection rate, to improve staging and to improve the selection of patients for biopsy. At present, breast MRI is considered to be the most sensitive imaging technique for breast cancer detection and assessment of the extent of disease [19][20][21][22]. However breast MRI is expensive and not widely available.…”

Section: Breast Tumoursmentioning

confidence: 99%

Dual-energy contrast-enhanced digital mammography: initial clinical results

Dromain

Thibault

Muller³

et al. 2010

Eur Radiol

242

158

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Objective To assess the diagnostic accuracy of Dual-Energy Contrast-Enhanced Digital Mammography (CEDM) as an adjunct to mammography (MX) versus MX alone and versus mammography plus ultrasound (US). Materials and methods 120 women with 142 suspect findings on MX and/or US underwent CEDM. A pair of low-and high-energy images was acquired using a modified full-field digital mammography system. Exposures were taken in MLO at 2 min and in CC at 4 min after the injection of 1.5 ml/kg of an iodinated contrast agent. One reader evaluated MX, US and CEDM images during 2 sessions 1 month apart. Sensitivity, specificity, and area under the ROC curve were estimated. Results The results from pathology and follow-up identified 62 benign and 80 malignant lesions. Areas under the ROC curves were significantly superior for MX+CEDM than it was for MX alone and for MX+US using BI-RADS. Sensitivity was higher for MX+CEDM than it was for MX (93% vs. 78%; p<0.001) with no loss in specificity. The lesion size was closer to the histological size for CEDM. All 23 multifocal lesions were correctly detected by MX+CEDM vs. 16 and 15 lesions by MX and US respectively. Conclusion Initial clinical results show that CEDM has better diagnostic accuracy than mammography alone and mammography+ultrasound.

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Staging of suspected breast cancer: effect of MR imaging and MR-guided biopsy.

Abstract: MR imaging allows detection of mammographically and clinically occult foci of carcinoma in patients with suspected breast cancer.

Cited by 380 publications

References 0 publications

Quantitative diffusion imaging in breast cancer: A clinical prospective study

Quantitative diffusion imaging in breast cancer: A clinical prospective study

Using MRI to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer

Dual-energy contrast-enhanced digital mammography: initial clinical results

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