Abstract
Purpose
Evaluation of the impact of preoperative magnetic resonance imaging (MRI) of the breast on the clinical management of patients with operable breast cancer (BC).
Methods
Retrospective analysis of 160 patients with operable breast cancer (stages Tis through T4), treated from 2002 through 2004. All patients underwent a full mammographic assessment, high frequency breast ultrasound, and breast MRI. The impact of preoperative MRI was evaluated for each patient with regard to changes in the therapeutic procedure. Patient and tumor characteristics were analyzed to identify possible patient subgroups that predominantly would benefit from preoperative MRI.
Results
Preoperative MRI affected the clinical management in 44 of 160 patients (27.5%). In 30 cases (18.75%) additional in situ or invasive cancers or a more widespread tumor extent were diagnosed correctly which went undetected by clinical palpation, mammography, and breast ultrasound. In 14 cases (8.75%) additional surgical procedures were performed based on suspicious MRI findings that turned out to be benign in final pathology. Age, menopausal status, breast density, tumor characteristics (type, tumor size, grading), ER-, PR- and HER2-receptor features did not significantly differ between patients in which breast MRI affected the clinical management and patients that experienced no additional information from MRI.
Conclusions
Preoperative breast MRI changes surgical management of patients with operable breast cancer. MRI detects additional invasive carcinoma and proves to be a powerful supplement to the conventional work-up in the clinical management of breast cancer. This advantage is independent from patients- and tumor-specific characteristics.
Similar content being viewed by others
References
Holland R et al (1985) Histologic multifocality of Tis, T1-2 breast carcinomas. Implications for clinical trials of breast-conserving surgery. Cancer 56(5):979–990
Wapnir IL et al (2006) Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five National Surgical Adjuvant Breast and Bowel Project node-positive adjuvant breast cancer trials. J Clin Oncol 24(13):2028–2037
Vicini FA et al (2003) Does local recurrence affect the rate of distant metastases and survival in patients with early-stage breast carcinoma treated with breast-conserving therapy? Cancer 97(4):910–919
Slanetz PJ et al (2002) Occult contralateral breast carcinoma incidentally detected by breast magnetic resonance imaging. Breast J 8(3):145–148
Liberman L et al (2003) MR imaging of the ipsilateral breast in women with percutaneously proven breast cancer. Am J Roentgenol 180(4):901–910
Orel SG et al (1995) Staging of suspected breast cancer: effect of MR imaging and MR-guided biopsy. Radiology 196(1):115–122
Fischer U, Kopka L, Grabbe E (1999) Breast carcinoma: effect of preoperative contrast-enhanced MR imaging on the therapeutic approach. Radiology 213(3):881–888
Bedrosian I et al (2003) Changes in the surgical management of patients with breast carcinoma based on preoperative magnetic resonance imaging. Cancer 98(3):468–473
Tillman GF et al (2002) Effect of breast magnetic resonance imaging on the clinical management of women with early-stage breast carcinoma. J Clin Oncol 20(16):3413–3423
Hata T et al (2004) Magnetic resonance imaging for preoperative evaluation of breast cancer: a comparative study with mammography and ultrasonography. J Am Coll Surg 198(2):190–197
Morakkabati-Spitz N et al (2005) Diagnostic usefulness of segmental and linear enhancement in dynamic breast MRI. Eur Radiol 15(9):2010–2017
Menell JH et al (2005) Determination of the presence and extent of pure ductal carcinoma in situ by mammography and magnetic resonance imaging. Breast J 11(6):382–390
Esserman L et al (1999) Contrast-enhanced magnetic resonance imaging to assess tumor histopathology and angiogenesis in breast carcinoma. Breast J 5(1):13–21
Liberman L et al (2003) MR imaging findings in the contralateral breast of women with recently diagnosed breast cancer. Am J Roentgenol 180(2):333–341
Bluemke DA et al (2004) Magnetic resonance imaging of the breast prior to biopsy. JAMA 292(22):2735–2742
Fabre Demard N et al (2005) Breast MRI in invasive lobular carcinoma: diagnosis and staging. J Radiol 86(9 Pt 1):1027–1034
Weinstein SP et al (2001) MR imaging of the breast in patients with invasive lobular carcinoma. Am J Roentgenol 176(2):399–406
Schelling M et al (1997) Optimized differential diagnosis of breast lesions by combined B-mode and color Doppler sonography. Ultrasound Obstet Gynecol 10(1):48–53
Eberl MM et al (2006) BI-RADS classification for management of abnormal mammograms. J Am Board Fam Med 19(2):161–164
Kuhl CK et al (1997) Interventional breast MR imaging: clinical use of a stereotactic localization and biopsy device. Radiology 204(3):667–675
Kuhl CK et al (2001) MR imaging-guided large-core (14-gauge) needle biopsy of small lesions visible at breast MR imaging alone. Radiology 220(1):31–39
Remmele W, Stegner HE (1987) Recommendation for uniform definition of an immunoreactive score (IRS) for immunohistochemical estrogen receptor detection (ER-ICA) in breast cancer tissue. Pathologe 8(3):138–140
Schelfout K et al (2004) Contrast-enhanced MR imaging of breast lesions and effect on treatment. Eur J Surg Oncol 30(5):501–507
Harms SE et al (1993) MR imaging of the breast with rotating delivery of excitation off resonance: clinical experience with pathologic correlation. Radiology 187(2):493–501
Morrow M (2004) Magnetic resonance imaging in the preoperative evaluation of breast cancer: primum non nocere. J Am Coll Surg 198(2):240–241
Fisher B et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347(16):1233–1241
Bartelink H et al (2001) Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Engl J Med 345(19):1378–1387
Veronesi U et al (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347(16):1227–1232
Saphner T, Tormey DC, Gray R (1996) Annual hazard rates of recurrence for breast cancer after primary therapy. J Clin Oncol 14(10):2738–2746
Lehman CD et al (2005) Added cancer yield of MRI in screening the contralateral breast of women recently diagnosed with breast cancer: results from the International Breast Magnetic Resonance Consortium (IBMC) trial. J Surg Oncol 92(1):9–15; discussion 15–16
Touboul E et al (1999) Local recurrences and distant metastases after breast-conserving surgery and radiation therapy for early breast cancer. Int J Radiat Oncol Biol Phys 43(1):25–38
Haffty BG et al (1996) Ipsilateral breast tumor recurrence as a predictor of distant disease: implications for systemic therapy at the time of local relapse. J Clin Oncol 14(1):52–57
Freedman GM, Fowble BL (2000) Local recurrence after mastectomy or breast-conserving surgery and radiation. Oncology (Williston Park) 14(11):1561–1581; discussion 1581–1582, 1582–1584
Clarke M et al (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366(9503):2087–2106
Fredriksson I et al (2003) Risk factors for local recurrence after breast-conserving surgery. Br J Surg 90(9):1093–1102
Ghossein NA et al (1992) Breast cancer. Importance of adequate surgical excision prior to radiotherapy in the local control of breast cancer in patients treated conservatively. Arch Surg 127(4):411–415
Coombs NJ, Boyages J (2005) Multifocal and multicentric breast cancer: does each focus matter? J Clin Oncol 23(30):7497–7502
Blair S et al (2006) The efficacy of breast MRI in predicting breast conservation therapy. J Surg Oncol 94(3):220–225
Kristoffersen Wiberg M et al (2002) Value of MR imaging in clinical evaluation of breast lesions. Acta Radiol 43(3):275–281
Bone B et al (1996) Sensitivity and specificity of MR mammography with histopathological correlation in 250 breasts. Acta Radiol 37(2):208–213
Stomper PC et al (1995) Suspect breast lesions: findings at dynamic gadolinium-enhanced MR imaging correlated with mammographic and pathologic features. Radiology 197(2):387–395
Morris EA (2001) Cancer staging with breast MR imaging. Magn Reson Imaging Clin N Am 9(2):333–344, vi–vii
Monostori Z et al (1991) Limitations in distinguishing malignant from benign lesions of the breast by systematic review of mammograms. Surg Gynecol Obstet 173(6):438–442
Hadjiiski L et al (2004) Improvement in radiologists’ characterization of malignant and benign breast masses on serial mammograms with computer-aided diagnosis: an ROC study. Radiology 233(1):255–265
Roubidoux MA et al (2004) Invasive cancers detected after breast cancer screening yielded a negative result: relationship of mammographic density to tumor prognostic factors. Radiology 230(1):42–48
Echevarria JJ et al (2006) Overall breast density in MR mammography: diagnostic and therapeutic implications in breast cancer. J Comput Assist Tomogr 30(1):140–147
Author information
Authors and Affiliations
Corresponding author
Additional information
Michael Braun and Martin Pölcher have contributed equally to this work.
Rights and permissions
About this article
Cite this article
Braun, M., Pölcher, M., Schrading, S. et al. Influence of preoperative MRI on the surgical management of patients with operable breast cancer. Breast Cancer Res Treat 111, 179–187 (2008). https://doi.org/10.1007/s10549-007-9767-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10549-007-9767-5