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

  • R. M. Mann
  • C. E. Loo
  • T. Wobbes
  • P. Bult
  • J. O. Barentsz
  • K. G. A. Gilhuijs
  • C. Boetes
Clinical trial

Abstract

Re-excision rates after breast conserving surgery (BCS) of invasive lobular carcinoma (ILC) are high. Preoperative breast MRI has the potential to reduce re-excision rates, but may lead to an increased rate of mastectomies. Hence, we assessed the influence of preoperative breast MRI on the re-excision rate and the rate of mastectomies. We performed a retrospective cohort study of a consecutive series of patients with ILC who presented in one of two dedicated tertiary cancer centers between 1993 and 2005. We assessed the initial type of surgery (BCS or mastectomy), the re-excision rate and the final type of surgery. Patients were stratified into two groups: those who received preoperative MRI (MR+ group) and those who did not (MR− group). In the MR− group, 27% of the patients underwent a re-excision after initial BCS. In the MR+ group, this rate was significantly lower at 9%. The odds ratio was 3.64 (95% CI: 1.30–10.20, P = 0.010). There was a trend towards a lower final mastectomy rate in the MR+ group compared to the MR− group (48 vs. 59%, P = 0.098). In conclusion, preoperative MRI in patients with ILC can reduce re-excision rates without increasing the rate of mastectomies.

Keywords

Breast cancer Breast MRI Breast conserving surgery Mastectomy Invasive lobular carcinoma Re-excision rate 

References

  1. 1.
    Keskek M, Kothari M, Ardehali B, Betambeau N, Nasiri N, Gui GP (2004) Factors predisposing to cavity margin positivity following conservation surgery for breast cancer. Eur J Surg Oncol 30(10):1058–1064CrossRefPubMedGoogle Scholar
  2. 2.
    O’Sullivan MJ, Li T, Freedman G, Morrow M (2007) The effect of multiple reexcisions on the risk of local recurrence after breast conserving surgery. Ann Surg Oncol 14(11):3133–3140CrossRefPubMedGoogle Scholar
  3. 3.
    Smitt MC, Horst K (2007) Association of clinical and pathologic variables with lumpectomy surgical margin status after preoperative diagnosis or excisional biopsy of invasive breast cancer. Ann Surg Oncol 14(3):1040–1044CrossRefPubMedGoogle Scholar
  4. 4.
    van den Broek N, van der Sangen MJ, van de Poll-Franse LV, van Beek MW, Nieuwenhuijzen GA, Voogd AC (2007) Margin status and the risk of local recurrence after breast-conserving treatment of lobular breast cancer. Breast Cancer Res Treat 105(1):63–68CrossRefPubMedGoogle Scholar
  5. 5.
    Waljee JF, Hu ES, Newman LA, Alderman AK (2008) Predictors of re-excision among women undergoing breast-conserving surgery for cancer. Ann Surg Oncol 15(5):1297–1303CrossRefPubMedGoogle Scholar
  6. 6.
    Dillon MF, Hill AD, Fleming FJ, O’Doherty A, Quinn CM, McDermott EW, O’Higgins N (2006) Identifying patients at risk of compromised margins following breast conservation for lobular carcinoma. Am J Surg 191(2):201–205CrossRefPubMedGoogle Scholar
  7. 7.
    Hussien M, Lioe TF, Finnegan J, Spence RA (2003) Surgical treatment for invasive lobular carcinoma of the breast. Breast 12(1):23–35CrossRefPubMedGoogle Scholar
  8. 8.
    Molland JG, Donnellan M, Janu NC, Carmalt HL, Kennedy CW, Gillett DJ (2004) Infiltrating lobular carcinoma—a comparison of diagnosis, management and outcome with infiltrating duct carcinoma. Breast 13(5):389–396CrossRefPubMedGoogle Scholar
  9. 9.
    Morrow M, Keeney K, Scholtens D, Wei J, Steel J, Khan SA (2006) Selecting patients for breast-conserving therapy: the importance of lobular histology. Cancer 106(12):2563–2568CrossRefPubMedGoogle Scholar
  10. 10.
    Yeatman TJ, Cantor AB, Smith TJ, Smith SK, Reintgen DS, Miller MS, Ku NN, Baekey PA, Cox CE (1995) Tumor biology of infiltrating lobular carcinoma. Implications for management. Ann Surg 222(4):549–559PubMedGoogle Scholar
  11. 11.
    Caramella T, Chapellier C, Ettore F, Raoust I, Chamorey E, Balu-Maestro C (2007) Value of MRI in the surgical planning of invasive lobular breast carcinoma: a prospective and a retrospective study of 57 cases: comparison with physical examination, conventional imaging, and histology. Clin Imaging 31(3):155–161CrossRefPubMedGoogle Scholar
  12. 12.
    Kepple J, Layeeque R, Klimberg VS, Harms S, Siegel E, Korourian S, Gusmano F, Henry-Tillman RS (2005) Correlation of magnetic resonance imaging and pathologic size of infiltrating lobular carcinoma of the breast. Am J Surg 190(4):623–627CrossRefPubMedGoogle Scholar
  13. 13.
    Kneeshaw PJ, Turnbull LW, Smith A, Drew PJ (2003) Dynamic contrast enhanced magnetic resonance imaging aids the surgical management of invasive lobular breast cancer. Eur J Surg Oncol 29(1):32–37CrossRefPubMedGoogle Scholar
  14. 14.
    Mann RM, Veltman J, Barentsz JO, Wobbes T, Blickman JG, Boetes C (2008) The value of MRI compared to mammography in the assessment of tumour extent in invasive lobular carcinoma of the breast. Eur J Surg Oncol 34(2):135–142PubMedGoogle Scholar
  15. 15.
    Qayyum A, Birdwell RL, Daniel BL, Nowels KW, Jeffrey SS, Agoston TA, Herfkens RJ (2002) MR imaging features of infiltrating lobular carcinoma of the breast: histopathologic correlation. AJR Am J Roentgenol 178(5):1227–1232PubMedGoogle Scholar
  16. 16.
    Rodenko GN, Harms SE, Pruneda JM, Farrell RS Jr, Evans WP, Copit DS, Krakos PA, Flamig DP (1996) MR imaging in the management before surgery of lobular carcinoma of the breast: correlation with pathology. AJR Am J Roentgenol 167(6):1415–1419PubMedGoogle Scholar
  17. 17.
    Schelfout K, Van Goethem M, Kersschot E, Verslegers I, Biltjes I, Leyman P, Colpaert C, Thienpont L, Van Den HJ, Gillardin JP, Tjalma W, Buytaert P, De SA (2004) Preoperative breast MRI in patients with invasive lobular breast cancer. Eur Radiol 14(7):1209–1216CrossRefPubMedGoogle Scholar
  18. 18.
    Weinstein SP, Orel SG, Heller R, Reynolds C, Czerniecki B, Solin LJ, Schnall M (2001) MR imaging of the breast in patients with invasive lobular carcinoma. AJR Am J Roentgenol 176(2):399–406PubMedGoogle Scholar
  19. 19.
    Bedrosian I, Mick R, Orel SG, Schnall M, Reynolds C, Spitz FR, Callans LS, Buzby GP, Rosato EF, Fraker DL, Czerniecki BJ (2003) Changes in the surgical management of patients with breast carcinoma based on preoperative magnetic resonance imaging. Cancer 98(3):468–473CrossRefPubMedGoogle Scholar
  20. 20.
    Fabre DN, Boulet P, Prat X, Charra L, Lesnik A, Taourel P (2005) Breast MRI in invasive lobular carcinoma: diagnosis and staging. J Radiol 86(9 Pt 1):1027–1034Google Scholar
  21. 21.
    Munot K, Dall B, Achuthan R, Parkin G, Lane S, Horgan K (2002) Role of magnetic resonance imaging in the diagnosis and single-stage surgical resection of invasive lobular carcinoma of the breast. Br J Surg 89(10):1296–1301CrossRefPubMedGoogle Scholar
  22. 22.
    Quan ML, Sclafani L, Heerdt AS, Fey JV, Morris EA, Borgen PI (2003) Magnetic resonance imaging detects unsuspected disease in patients with invasive lobular cancer. Ann Surg Oncol 10(9):1048–1053CrossRefPubMedGoogle Scholar
  23. 23.
    Mann RM, Hoogeveen YL, Blickman JG, Boetes C (2008) MRI compared to conventional diagnostic work-up in the detection and evaluation of invasive lobular carcinoma of the breast: a review of existing literature. Breast Cancer Res Treat 107(1):1–14CrossRefPubMedGoogle Scholar
  24. 24.
    Jobsen JJ, Riemersma S, van der Palen J, Ong F, Jonkman A, Struikmans H (2009) The impact of margin status in breast-conserving therapy for lobular carcinoma is age related. Eur J Surg Oncol. doi:10.1016/j.ejso.2009.06.003
  25. 25.
    Luini A, Rososchansky J, Gatti G, Zurrida S, Caldarella P, Viale G, Rosali dos SG, Frasson A (2009) The surgical margin status after breast-conserving surgery: discussion of an open issue. Breast Cancer Res Treat 113(2):397–402CrossRefPubMedGoogle Scholar
  26. 26.
    Kuhl C, Kuhn W, Braun M, Schild H (2007) Pre-operative staging of breast cancer with breast MRI: one step forward, two steps back? Breast 16(Suppl 2):S34–S44CrossRefPubMedGoogle Scholar
  27. 27.
    Morrow M, Freedman G (2006) A clinical oncology perspective on the use of breast MR. Magn Reson Imaging Clin N Am 14(3):363–378 viCrossRefPubMedGoogle Scholar
  28. 28.
    Morrow M (2004) Magnetic resonance imaging in breast cancer: one step forward, two steps back? JAMA 292(22):2779–2780CrossRefPubMedGoogle Scholar
  29. 29.
    National Breast Cancer Organization Netherlands (2008) Guideline for treatment of patients with breast cancer. Kwaliteitsinstituut voor de gezondheidszorg CBO. Available via http://www.oncoline.nl
  30. 30.
    Morris EA (2006) Breast MR imaging lexicon updated. Magn Reson Imaging Clin N Am 14(3):293–303CrossRefPubMedGoogle Scholar
  31. 31.
    Veltman J, Boetes C, Wobbes T, Blickman JG, Barentsz JO (2005) Magnetic resonance-guided biopsies and localizations of the breast: initial experiences using an open breast coil and compatible intervention device. Invest Radiol 40(6):379–384CrossRefPubMedGoogle Scholar
  32. 32.
    Tresserra F, Feu J, Grases PJ, Navarro B, Alegret X, Fernandez-Cid A (1999) Assessment of breast cancer size: sonographic and pathologic correlation. J Clin Ultrasound 27(9):485–491CrossRefPubMedGoogle Scholar
  33. 33.
    Veltman J, Boetes C, van Die L, Bult P, Blickman JG, Barentsz JO (2006) Mammographic detection and staging of invasive lobular carcinoma. Clin Imaging 30(2):94–98CrossRefPubMedGoogle Scholar
  34. 34.
    Watermann DO, Tempfer C, Hefler LA, Parat C, Stickeler E (2005) Ultrasound morphology of invasive lobular breast cancer is different compared with other types of breast cancer. Ultrasound Med Biol 31(2):167–174CrossRefPubMedGoogle Scholar
  35. 35.
    Arpino G, Bardou VJ, Clark GM, Elledge RM (2004) Infiltrating lobular carcinoma of the breast: tumor characteristics and clinical outcome. Breast Cancer Res 6(3):R149–R156CrossRefPubMedGoogle Scholar
  36. 36.
    Al-Ghazal SK, Blamey RW, Stewart J, Morgan AA (1999) The cosmetic outcome in early breast cancer treated with breast conservation. Eur J Surg Oncol 25(6):566–570CrossRefPubMedGoogle Scholar
  37. 37.
    Wazer DE, Dipetrillo T, Schmidt-Ullrich R, Weld L, Smith TJ, Marchant DJ, Robert NJ (1992) Factors influencing cosmetic outcome and complication risk after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol 10(3):356–363PubMedGoogle Scholar
  38. 38.
    Pengel KE, Loo CE, Teertstra HJ, Muller SH, Wesseling J, Peterse JL, Bartelink H, Rutgers EJ, Gilhuijs KG (2009) The impact of preoperative MRI on breast-conserving surgery of invasive cancer: a comparative cohort study. Breast Cancer Res Treat 116(1):161–169CrossRefPubMedGoogle Scholar
  39. 39.
    Aziz D, Rawlinson E, Narod SA, Sun P, Lickley HL, McCready DR, Holloway CM (2006) The role of reexcision for positive margins in optimizing local disease control after breast-conserving surgery for cancer. Breast J 12(4):331–337CrossRefPubMedGoogle Scholar
  40. 40.
    Menes TS, Tartter PI, Bleiweiss I, Godbold JH, Estabrook A, Smith SR (2005) The consequence of multiple re-excisions to obtain clear lumpectomy margins in breast cancer patients. Ann Surg Oncol 12(11):881–885CrossRefPubMedGoogle Scholar
  41. 41.
    Fischer U, Zachariae O, Baum F, von Heyden D, Funke M, Liersch T (2004) The influence of preoperative MRI of the breasts on recurrence rate in patients with breast cancer. Eur Radiol 14(10):1725–1731CrossRefPubMedGoogle Scholar
  42. 42.
    Solin LJ, Orel SG, Hwang WT, Harris EE, Schnall MD (2008) Relationship of breast magnetic resonance imaging to outcome after breast-conservation treatment with radiation for women with early-stage invasive breast carcinoma or ductal carcinoma in situ. J Clin Oncol 26(3):386–391CrossRefPubMedGoogle Scholar
  43. 43.
    Poortmans PM, Collette L, Bartelink H, Struikmans H, Van den Bogaert WF, Fourquet A, Jager JJ, Hoogenraad W, Muller RP, Dubois JB, Bolla M, Van Der HM, Warlam-Rodenhuis CC, Pierart M, Horiot JC (2008) The addition of a boost dose on the primary tumour bed after lumpectomy in breast conserving treatment for breast cancer. A summary of the results of EORTC 22881–10882 “boost versus no boost” trial. Cancer Radiother 12(6–7):565–570PubMedGoogle Scholar
  44. 44.
    ACR Guidelines and Standards Committee, Basset LW, Berg WA, Birdwell RL, et al (2008) ACR practice guideline for the performance of contrast-enhanced magnetic resonance imaging (MRI) of the breast. Available via http://www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/breast/mri_breast.aspx
  45. 45.
    Mann RM, Kuhl CK, Kinkel K, Boetes C (2008) Breast MRI: guidelines from the European Society of Breast Imaging. Eur Radiol 18(7):1307–1318CrossRefPubMedGoogle Scholar
  46. 46.
    Kuhl C (2007) The current status of breast MR imaging. Part I. Choice of technique, image interpretation, diagnostic accuracy, and transfer to clinical practice. Radiology 244(2):356–378CrossRefPubMedGoogle Scholar
  47. 47.
    Turnbull LW (2009) Dynamic contrast-enhanced MRI in the diagnosis and management of breast cancer. NMR Biomed 22(1):28–39CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2009

Authors and Affiliations

  • R. M. Mann
    • 1
  • C. E. Loo
    • 2
  • T. Wobbes
    • 3
  • P. Bult
    • 4
  • J. O. Barentsz
    • 1
  • K. G. A. Gilhuijs
    • 2
  • C. Boetes
    • 1
    • 5
    • 6
  1. 1.Department of RadiologyRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
  2. 2.Department of RadiologyThe Netherlands Cancer Institute/Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  3. 3.Department of SurgeryRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
  4. 4.Department of PathologyRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
  5. 5.Department of RadiologyMaastricht University Medical CenterMaastrichtThe Netherlands
  6. 6.GROW, School for Oncology and Developmental BiologyMaastricht University Medical CenterMaastrichtThe Netherlands

Personalised recommendations