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Which factors influence MRI-pathology concordance of tumour size measurements in breast cancer?

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To assess MRI-pathology concordance and factors influencing tumour size measurement in breast cancer.

Materials and methods

MRI tumour size (greatest diameter in anatomical planes (MRI-In-Plane) and greatest diameter along main tumour axis (MRI-MPR)) of 115 consecutive breast lesions (59 invasive lobular carcinoma, 46 invasive ductal carcinoma, and 10 ductal carcinoma in situ) was retrospectively compared to size measured at histopathology (pT size (Path-TNM) and greatest tumour diameter as relevant for excision (Path-Diameter; reference standard)). Histopathological tumour types, preoperative palpability, surgical management, additional high-risk lesions, and BI-RADS lesion type (mass versus non-mass enhancements) were assessed as possible influencing factors.


Systematic errors were most pronounced between MRI-MPR and Path-TNM (7.1 mm, limits of agreement (LoA) [-21.7; 35.9]), and were lowest between MRI-In-Plane and Path-Diameter (0.2 mm, LoA [-19.7; 20.1]). Concordance rate of MRI-In-Plane with Path-Diameter was 86 % (97/113), overestimation 9 % (10/113) and underestimation 5 % (6/113); BI-RADS mass lesions were overestimated in 7 % (6/81) versus 41 % (13/32) for non-mass enhancements. On multivariate analysis only BI-RADS lesion type significantly influenced MRI-pathology concordance (p < 0.001). 2/59 (3 %) ILC did not enhance.


Concordance rate varies according to the execution of MRI and histopathological measurements. Beyond this only non-mass enhancement significantly predicted discordance.

Key Points

Execution and scope of MRI and histopathological size measurements influence concordance rate.

Non-mass like enhancement predicts discordance.

Additional high-risk lesions in proximity of tumour do not cause measurement discordance.

Low percentage of ILC do not enhance at all.

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Invasive ductal carcinoma


Invasive lobular carcinoma


Ductal carcinoma in situ


Limits of agreement


Maximum intensity projection


Greatest diameter in anatomical planes on MRI


Greatest diameter along main tumour axis on MRI


Multiplanar reconstruction


pT-stage size according to TNM at histopathology


Greatest tumour diameter as relevant for excision at histopathology


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The scientific guarantor of this publication is Prof. Dr. Marga Rominger. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding.

One of the authors has significant statistical expertise. Institutional Review Board approval: waived requirement for IRB approval and informed consent because retrospective study and anonymity was ensured. Written informed consent was waived by the Institutional Review Board. The manuscript contains parts of the thesis work of cand. med. Daniela Berg (second author)

Methodology: retrospective, case-control study, performed at one institution.

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Correspondence to M. Rominger.

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Rominger, M., Berg, D., Frauenfelder, T. et al. Which factors influence MRI-pathology concordance of tumour size measurements in breast cancer?. Eur Radiol 26, 1457–1465 (2016).

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