The additive role of dynamic contrast-enhanced and diffusion-weighted MR imaging in preoperative staging of breast cancer

Abstract

Background In women with diagnosed breast cancer, accurate loco-regional staging and preoperative examination are of utmost importance for optimal patient management decisions. MRI may be warranted for correct preoperative staging as recommended from international guidelines. DWI-MRI can be combined with CE-MRI to assess more functional data. So we aimed to evaluate the performance of CE-MRI and qualitative DWI-MRI in preoperative loco-regional staging of malignant breast lesions as regards the local extension of the disease and axillary lymph node status, beyond standard assessment with mammography and ultrasound. This prospective study included 50 female patients with pathologically proven malignant breast lesions (BIRADS VI) coming for preoperative staging. Full-field digital mammography (FFDM) and ultrasound, CE-MRI, and DWI-MRI findings were compared for all patients, and the findings were evaluated independently. Results were then correlated to postoperative histopathology. Results Fifty women with pathologically proven malignant breast lesions (BIRADS VI) were enrolled in this study; the mean age of this study population was 43.25 years. The 50 patients were divided into 2 groups: 37/50 (74%) underwent upfront surgery and 13/50 (26%) received neoadjuvant therapy before surgery. All patients performed DCE and DWI-MRI breast. Among patients who underwent upfront surgery, DCE-MRI showed the highest correlation with the postoperative pathology size and the overall sensitivity regarding multiplicity. Regarding patients who received neoadjuvant therapy, DCE-MRI was found to have the highest correlation with the postoperative pathology concerning lesion size and multiplicity after completion of the neoadjuvant chemotherapy cycles. Conclusion CE-MRI can accurately map lesion extension and detect multifocality/multicentricity, thus tailor surgical management options (either conservative surgery or mastectomy). Qualitative DWI can be combined with ultrasonography for better evaluation of the axillary nodal status.

Contrast-enhanced mammography versus breast MRI in the assessment of multifocal and multicentric breast cancer: a retrospective study

“…The present study revealed that CEM was more accurate regarding multiple lesion detection compared to MRI, while Anwar et al (20) reported that the diagnostic accuracy of MRI was higher than that of CEM, and Hashem et al (16) found the accuracy of MRI was 83.78%.…”

“…The choice between total mastectomy and breast-conserving surgery depends on multiple factors, including the extent of cancer and its multifocality or multicentricity. Tumour extent overestimation can lead to avoidable mastectomies, while underestimation can lead to re-operations or recurrence (11,16). Accurate breast imaging and identification of additional malignant foci may, in the future, reduce the quantity of postoperative breast radiotherapy after conserving surgery and correspondingly decrease the number of complications in those patients, which will consequently lower treatment costs (12).…”

Advanced Magnetic Resonance Imaging Modalities for Breast Cancer Diagnosis: An Overview of Recent Findings and Perspectives

“…Moreover, they stated that qualitative DWI could be accompanied by ultrasonography to better assess the axillary nodal status. Both combinations enable the preoperative loco-regional staging of malignant breast disease to be effective and precise [ 69 ].…”