Advertisement

La radiologia medica

, Volume 124, Issue 12, pp 1229–1237 | Cite as

Preoperative loco-regional staging of invasive lobular carcinoma with contrast-enhanced digital mammography (CEDM)

  • Francesco Amato
  • Giulia BicchieraiEmail author
  • Donatello Cirone
  • Catherine Depretto
  • Federica Di Naro
  • Ermanno Vanzi
  • Gianfranco Scaperrotta
  • Tommaso Vincenzo Bartolotta
  • Vittorio Miele
  • Jacopo Nori
BREAST RADIOLOGY
  • 24 Downloads

Abstract

The aim of our study was to assess the performance of contrast-enhanced digital mammography (CEDM) in the preoperative loco-regional staging of invasive lobular carcinoma (ILC) patients, about the valuation of the extension of disease and in measurement of lesions. Then, we selected retrospectively, among the 1500 patients underwent to CEDM at the Breast Diagnostics Department of the Careggi University Hospital of Florence and the National Cancer Institute of Milan from September 2016 to November 2018, 31 women (mean age 57.1 aa; range 41–78 aa) with a definitive histological diagnosis of ILC. CEDM has proved to be a promising imaging technique, being characterized by a sensitivity of 100% in the detection of the index lesion, and of 84.2% in identifying any adjunctive lesions: It was the presence of a non-mass enhancement (NME) to lower the sensitivity of the technique (25% vs. 100% for mass-like enhancements or a mass closely associated with a NME). Specificity in the characterization of additional lesions was 66.7%, and the diagnosis of the extension of disease was correct in 77.4% of cases: NME also led to a decrease in diagnostic accuracy in the evaluation of disease extension up to 40% versus 85% for masses and 80% for masses associated with NME (M/NME). Moreover, in 12/31 (38.7%), CEDM allowed to correctly identify lesions not shown by mammography + ultrasonography + tomosynthesis: In the half of these (6/12), there was a multicentricity, thus allowing an adequate surgical planning change. CEDM was also very accurate in analyzing the maximum diameter of the masses, while it was much less reliable in the case of the M/NME and pure NME. In conclusion, CEDM is a new promising imaging technique in the loco-regional preoperative staging and in the evaluation of disease extension for ILC, especially in case of mass enhancement lesions.

Keywords

Breast Contrast-enhanced digital mammography Contrast-enhanced spectral mammography Invasive lobular breast cancer Breast cancer staging 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee: “Regione Toscana, Comitato Etico Area Vasta Centro, reference number: SPE_16.251” and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Ethical standards

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Li CI, Anderson BO, Daling JR, Moe RE (2003) Trends in incidence rates of invasive lobular and ductal breast carcinoma. JAMA 289:1421–1424PubMedGoogle Scholar
  2. 2.
    Arpino G, Bardou VJ, Clark GM, Elledge RM (2004) Infiltrating lobular carcinoma of the breast: tumor characteristics and clinical outcome. Breast Cancer Res 6:R149–R156PubMedPubMedCentralGoogle Scholar
  3. 3.
    Macchini M, Ponziani M, Iamurri AP et al (2018) Role of DCE-MR in predicting breast cancer subtypes. Radiol Med 123(10):753–764PubMedGoogle Scholar
  4. 4.
    Berg WA, Gutierrez L, NessAiver MS et al (2004) Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology 233:830–849Google Scholar
  5. 5.
    Brem RF, Ioffe M, Rapelyea JA et al (2009) Invasive lobular carcinoma: detection with mammography, sonography, MRI, and breast- specific gamma. AJR Am J Roentgenol 192:379–383PubMedGoogle Scholar
  6. 6.
    Butler RS, Venta LA, Wiley EL, Ellis RL, Dempsey PJ, Rubin E (1999) Sonographic evaluation of infiltrating lobular carcinoma. AJR Am J Roentgenol 172:325–330PubMedGoogle Scholar
  7. 7.
    Montemezzi S, Cavedon C, Camera L et al (2017) 1H-MR spectroscopy of suspicious breast mass lesions at 3T: a clinical experience. Radiol Med 122(3):161–170PubMedGoogle Scholar
  8. 8.
    Weinstein SP, Orel SG, Heller R et al (2001) MR Imaging of the breast in patients with invasive lobular carcinoma. AJR Am J Roentgenol 176:399–406PubMedGoogle Scholar
  9. 9.
    Zanotel M, Bednarova I, Londero V et al (2018) Automated breast ultrasound: basic principles and emerging clinical applications. Radiol Med 123(1):1–12PubMedGoogle Scholar
  10. 10.
    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 107:1–14PubMedGoogle Scholar
  11. 11.
    Selvi V, Nori J, Meattini I, Francolini G, Morelli N, De Benedetto D, Bicchierai G, Di Naro F, Gill MK, Orzalesi L, Sanchez L, Susini T, Bianchi S, Livi L, Miele V (2018) Role of magnetic resonance imaging in the preoperative staging and work-up of patients affected by invasive lobular carcinoma or invasive ductolobular carcinoma. Biomed Res Int.  https://doi.org/10.1155/2018/1569060 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    ACR Guidelines and Standards Committee (2008) ACR practice guideline for the performance of contrast-enhanced magnetic resonance imaging (MRI) of the breastGoogle Scholar
  13. 13.
    Kalovidouri A, Firmenich N, Delattre BMA et al (2017) Fat suppression techniques for breast MRI: Dixon versus spectral fat saturation for 3D T1-weighted at 3 T. Radiol Med 122(10):731–742PubMedGoogle Scholar
  14. 14.
    Mann RM, Kuhl CK, Kinkel K, Boetes C (2008) Breast MRI: guidelines from the European Society of Breast Imaging. Eur Radiol 18:1307–1318PubMedPubMedCentralGoogle Scholar
  15. 15.
    Lee-Felker Stephanie A et al (2017) Newly diagnosed breast cancer: comparison of contrast-enhanced spectral mammography and breast mr imaging in the evaluation of extent of disease. Radiology 285(2):389–400PubMedGoogle Scholar
  16. 16.
    Jochelson MS, Dershaw DD, Sung JS et al (2013) Bilateral contrast-enhanced dual-energy digital mammography: feasibility and comparison with conventional digital mammography and MR imaging in women with known breast carcinoma. Radiology 266:743–751PubMedPubMedCentralGoogle Scholar
  17. 17.
    Hobbs MM, Taylor DB, Buzynski S, Peake RE (2015) Contrast-enhanced spectral mammography (CESM) and contrast enhanced MRI (CEMRI): patient preferences and tolerance. J Med Imaging Radiat Oncol 59:300–305PubMedGoogle Scholar
  18. 18.
    Bernardi D, Belli P, Benelli E et al (2017) Digital breast tomosynthesis (DBT): recommendations from the Italian College of BreastRadiologists (ICBR) by the Italian Society of Medical Radiology (SIRM) and the Italian Group for Mammography Screening (GISMa). Radiol Med 122(10):723–730PubMedPubMedCentralGoogle Scholar
  19. 19.
    Patel BK, Gray RJ, Pockaj BA (2017) Potential cost savings of contrast-enhanced digital mammography. AJR Am J Roentgenol 5:1–7.  https://doi.org/10.2214/AJR.16.17239 CrossRefGoogle Scholar
  20. 20.
    Luczynska E, Heinze-Paluchowska S, Hendrick E et al (2015) Comparison between breast MRI and contrast-enhanced spectral mammography. Med Sci Monit 21:1358–1367PubMedPubMedCentralGoogle Scholar
  21. 21.
    Francescone MA, Jochelson MS, Dershaw DD, Sung JS, Hughes MC, Zheng J, Moskowitz C, Morris EA (2014) Low energy mammogram obtained in contrast-enhanced digital mammography (CEDM) is comparable to routine full-field digital mammography (FFDM). Eur J Radiol 83(8):1350–1355PubMedGoogle Scholar
  22. 22.
    Bicchierai G, Nori J, De Benedetto D, Boeri C, Vanzi E, Bianchi S, Kaur Gill M, Cirone D, Miele V (2018) Role of contrast-enhanced spectral mammography in the post biopsy management of B3 lesions: preliminary results. Tumori J 17:300891618816212Google Scholar
  23. 23.
    Trimboli RM, Codari M, Khouri Chalouhi K et al (2018) Correlation between voxel-wise enhancement parameters on DCE-MRI and pathologicalprognostic factors in invasive breast cancers. Radiol Med 123(2):91–97PubMedGoogle Scholar
  24. 24.
    Bicchierai G, Di Naro F, Amato F (2018) CEDM lexicon and imaging interpretation tips. In: Nori J, Kaur M (eds) Contrast-enhanced digital mammography (CEDM), chapter. 9; pp 93–118. Springer, Berlin. ISBN 978-3-319- 94552-1. eBook ISBN 978-3-319-94553-8.  https://doi.org/10.1007/978-3-319-94553-8_9 Google Scholar
  25. 25.
    D’Orsi CJACR (2013) BI-RADS atlas: breast imaging reporting and data system. American College of Radiology, RestonGoogle Scholar
  26. 26.
    Morris EA, Comstock CE, Lee CH et al (2013) ACR BI-RADS® magnetic resonance imaging. In: ACR BI-RADS® Atlas, Breast imaging reporting and data system. American College of Radiology, RestonGoogle Scholar
  27. 27.
    Bartolotta TV, Orlando A, Cantisani V et al (2018) Focal breast lesion characterization according to the BI-RADS US lexicon: role of a computer-aided decision-making support. Radiol Med 123(7):498–506PubMedGoogle Scholar
  28. 28.
    Hilleren DJ, Andersson IT, Lindholm K, Linnell FS (1991) Invasive lobular carcinoma: mammographic findings in a 10-year experience. Radiology 178:149–154PubMedGoogle Scholar
  29. 29.
    Krecke KN, Gisvold JJ (1993) Invasive lobular carcinoma of the breast: mammographic findings and extent of disease at diagnosis in 184 patients. AJR Am J Roentgenol 161:957–960PubMedGoogle Scholar
  30. 30.
    Le Gal M, Ollivier L, Asselain B, Meunier M, Laurent M, Vielh P (1992) Mammographic features of 455 invasive lobular carcinomas. Radiology 185:705–708PubMedGoogle Scholar
  31. 31.
    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1(8476):307–310PubMedPubMedCentralGoogle Scholar
  32. 32.
    Koo Terry K, Li Mae Y (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15(2):155–163.  https://doi.org/10.1016/j.jcm.2016.02.012 CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Lee-Felker SA et al (2017) Newly diagnosed breast cancer: comparison of contrast-enhanced spectral mammography and breast MR imaging in the evaluation of extent of disease. Radiology 285(1):389–400PubMedGoogle Scholar
  34. 34.
    Boetes C et al (1995) Breast tumors: comparative accuracy of MR imaging relative to mammography and US for demonstrating extent. Radiology 197(3):743–747PubMedGoogle Scholar
  35. 35.
    Schelfout K et al (2004) Preoperative breast MRI in patients with invasive lobular breast cancer. Eur Radiol 14(7):1209–1216PubMedGoogle Scholar
  36. 36.
    Carin Anne-julie, Molière Sébastien, Gabriele Victor, Lodi Massimo, Thiébaut Nicolas, Neuberger Karl, Mathelin Carole (2017) Relevance of breast MRI in determining the size and focality of invasive breast cancer treated by mastectomy: a prospective study. World J Surg Oncol 15:128.  https://doi.org/10.1186/s12957-017-1197-1 CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Marino MA, Pennisi O, Donia A et al (2017) Organizational and welfare mode of breast centers network: a survey of Sicilian radiologists. Radiol Med 122(9):639–650PubMedGoogle Scholar
  38. 38.
    Gruber IV et al (2013) Measurement of tumour size with mammography, sonography and magnetic resonance imaging as compared to histological tumour size in primary breast cancer. BMC Cancer 13(1):328PubMedPubMedCentralGoogle Scholar
  39. 39.
    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):32–37PubMedGoogle Scholar
  40. 40.
    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
  41. 41.
    Patel BK, Davis J, Ferraro C, Kosiorek H, Hasselbach K, Ocal T, Pockaj B (2018) Value added of preoperative contrast enhanced digital mammography in patients with invasive lobular carcinoma of the breast. Clin Breast Cancer.  https://doi.org/10.1016/j.clbc.2018.07.012 CrossRefPubMedGoogle Scholar
  42. 42.
    Goldhirsch A, Winer EP, Coates AS, Gelber RD, Piccart-Gebhart M, Thürlimann B, Senn H-J (2013) Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013. Ann Oncol 24(9):2206–2223PubMedPubMedCentralGoogle Scholar
  43. 43.
    Jiang Yi-Zhou, Xia Chen, Peng Wen-Ting, Ke-Da Yu, Zhuang Zhi-Gang, Shao Zhi-Ming (2014) Preoperative measurement of breast cancer overestimates tumor size compared to pathological measurement. PLoS ONE 9(1):e86676.  https://doi.org/10.1371/journal.pone.0086676 CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Fallenberg EM, Dromain C, Diekmann F et al (2014) Contrast-enhanced spectral mammography versus MRI: initial results in the detection of breast cancer and assessment of tumour size. Eur Radiol 24:256–264PubMedGoogle Scholar
  45. 45.
    Zheng Y, Zhong M, Ni C et al (2017) Radiotherapy and nipple-areolar complex necrosis after nipple-sparing mastectomy: asystematic review and meta-analysis. Radiol Med 122(3):171–178PubMedGoogle Scholar
  46. 46.
    Kanyilmaz G, Aktan M, Koc M et al (2017) Unplanned irradiation of internal mammary lymph nodes in breast cancer. Radiol Med 122(6):405–411PubMedGoogle Scholar
  47. 47.
    Thomas M, Kelly ED, Abraham J et al (2019) Invasive lobular breast cancer: a review of pathogenesis, diagnosis, management, and future directions of early stage disease. Semin Oncol 46(2):121–132PubMedGoogle Scholar
  48. 48.
    Fiorentino A, Mazzola R, Naccarato S et al (2017) Synchronous bilateral breast cancer irradiation: clinical and dosimetrical issues using volumetricmodulated arc therapy and simultaneous integrated boost. Radiol Med 122(6):464–471PubMedGoogle Scholar
  49. 49.
    Iorfida Monica, Maiorano Eugenio, Orvieto Enrico, Maisonneuve Patrick, Bottiglieri Luca, Rotmensz Nicole, Montagna Emilia, Dellapasqua Silvia, Veronesi Paolo, Galimberti Viviana, Luini Alberto, Goldhirsch Aaron, Colleoni Marco, Viale Giuseppe (2012) Invasive lobular breast cancer: subtypes and outcome. Breast Cancer Res Treat 133:713–723.  https://doi.org/10.1007/s10549-012-2002-z CrossRefPubMedGoogle Scholar
  50. 50.
    Fallahpour S, Navaneelan T, De P, Borgo A (2017) Breast cancer survival by molecular subtype: a population-based analysis of cancer registry data. CMAJ Open 5:E734–E739PubMedPubMedCentralGoogle Scholar

Copyright information

© Italian Society of Medical Radiology 2019

Authors and Affiliations

  • Francesco Amato
    • 1
  • Giulia Bicchierai
    • 2
    Email author
  • Donatello Cirone
    • 3
  • Catherine Depretto
    • 4
  • Federica Di Naro
    • 2
  • Ermanno Vanzi
    • 2
  • Gianfranco Scaperrotta
    • 4
  • Tommaso Vincenzo Bartolotta
    • 1
  • Vittorio Miele
    • 5
  • Jacopo Nori
    • 2
  1. 1.Department of RadiologyUniversity of PalermoPalermoItaly
  2. 2.Diagnostic Senology UnitAzienda Ospedaliero-Universitaria CareggiFlorenceItaly
  3. 3.General Management StaffAzienda Ospedaliero-Universitaria CareggiFlorenceItaly
  4. 4.Breast Imaging UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
  5. 5.Department of RadiologyAzienda Ospedaliero-Universitaria CareggiFlorenceItaly

Personalised recommendations