Ultrasound for Accurate Measurement of Invasive Breast Cancer Tumor Size

Abstract

Accurate presurgical assessment of tumor size is important for choosing appropriate treatment, especially with the increasing use of neoadjuvant and minimally invasive therapy. Breast sonography is increasingly used by breast surgeons as a part of their basic clinical evaluation. We undertook this study to compare clinical evaluation, mammography, and breast sonography for evaluating breast tumor size. A prospective analysis of 124 consecutive patients with palpable breast cancer was performed. Tumor masses belonging to T1 and small T2 were selectively selected. All women had clinical, mammographic, and sonographic assessment of tumor size. Measurements were compared to the pathologic tumor size of the surgical specimen. Both mammographic and sonographic measurements tend to underestimate tumor size, while clinical assessment tends to overestimate it. Ultrasound was significantly more accurate in determining tumor size. The maximal tumor diameter measured was within 2 mm of the pathologic tumor size in 45.2% of cases measured by breast ultrasound, 28.2% of cases measured by mammography, and 14.5% of cases measured clinically. These data suggest that ultrasound is more accurate than clinical breast examination and mammography in assessing breast cancer size. Ultrasound assessment should be used by surgeons as an accurate adjunct to clinical examination in outpatient breast clinics.

Clinical Assessment of Axillary Lymph Nodes and Tumor Size in Breast Cancer Compared with Histopathological Examination: A Population‐Based Analysis of 2,537 Women

“…There are different ways to estimate tumour size, physical examination, mammography and ultra sonography are common methods, and many studies have indicated that measurement by ultrasonography is the most accurate way (9,19,20,21), e.g. Hieken TJ et.al.…”

“…Moreover, Shoma A et.al showed in a study involving 162 patients that it was common to overestimate the tumour size during clinical examination (19).…”

Needle core biopsy characteristics identify patients at risk of compromised margins in breast conservation surgery

“…Selecting patients for breast conservation is primarily based on the perceived size of the tumour on preoperative radiology, which has frequently been shown to be unreliable in determining extent of disease. [4][5][6][7] The results of this study on a cohort of patients who had invasive ductal carcinoma demonstrate that reporting the relative quantity of accompanying DCIS in core biopsy specimens is of considerable value in identifying patients most at risk of compromised margins. Patients with invasive ductal carcinoma and minimal DCIS in their core biopsy had a 23% risk of compromised margins compared to a 39% risk if a DCIS component of at least 5% was present in the core biopsy.…”

“…Attempting to gauge size of lesion preoperatively has been shown to be prone to error, with under-and overestimates of disease extent. [4][5][6][7] Additional means of identifying those at high risk of compromised margins would be valuable in aiding the precision of patient selection for breast conservation or may identify patients who would benefit from wider margins at the time of initial operation.…”

Intraoperative micro-computed tomography (micro-CT): a novel method for determination of primary tumour dimensions in breast cancer specimens

“…This finding is consistent with prior studies (Table 1). 1,3,6,[12][13][14][15][16][17][18][19][20][21] Tumour size measured by micro-CT correlated better with histopathological invasive tumour size than any of the three pre-operative imaging modalities. This is likely because micro-CT generates higher resolution images, making fine structures, anatomic features and tumour boundaries more clearly visible.…”