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A practical approach to manage additional lesions at preoperative breast MRI in patients eligible for breast conserving therapy: results

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Abstract

The aim of this prospective study was to evaluate the efficacy of directives, established to handle additional lesions at preoperative contrast-enhanced magnetic resonance imaging (MRI). Six-hundred-and-ninety consecutive patients with pathology-proven breast cancer planned for BCT based on clinical examination and conventional imaging underwent preoperative breast MRI. The incidence of additional lesions detected at MRI and impact on management were evaluated. Additional findings were pathology-proven or considered benign by follow-up. Findings for which no pathology proof was available prior to surgery, were defined as Unidentified Breast Objects (UBOs). Patients with multicentric or contralateral UBOs underwent BCT as planned with annual follow-up. Multifocal UBOs in the vicinity of the index cancer were excised with wider local margins. Preoperative MRI detected 141 additional lesions in 121 patients (17.5%). Of these lesions, 44.0% were proven malignant. Additional findings classified as UBOs were found in 81 patients (11.7%). None of the UBOs outside the primary tumour region resulted in malignant disease at follow-up after BCT (mean follow-up time: 57.1 months). However, most multifocal UBOs (in the vicinity of the primary) were malignant (77.5%). The strategy to pursue BCT with larger wide-local excisions for multifocal UBOs and to follow-up multicentric and contralateral UBOs with conventional imaging is effective to exclude malignancy at follow-up. After second-look targeted ultrasound has been performed, MRI-guided biopsy of BIRADS-3 multicentric and contralateral additional findings may have limited complementary clinical value.

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Acknowledgments

This study was financially supported by The Dutch Cancer Foundation, grant number NKB 2004-3082. We thank Anita Paape and Angelique Schlief for the data management. Jelle Teertstra, Robert Kröger, Charlotte Lange, Warner Prevoo, Peter Besnard, Wim Koops, Frank Pameijer, Marie-Jeanne Vrancken Peeters, Hester Oldenburg, Saar Muller, Marc van de Vijver and Hans Peterse† are thanked for their dedicated input.

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Authors and Affiliations

  1. Department of Radiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Lotte E. Elshof, Eline E. Deurloo, Claudette E. Loo, Kenneth E. Pengel & Kenneth G.A. Gilhuijs

  2. Department of Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Emiel J. Th. Rutgers

  3. Department of Pathology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Jelle Wesseling

Authors
  1. Lotte E. Elshof
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  2. Emiel J. Th. Rutgers
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  3. Eline E. Deurloo
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  4. Claudette E. Loo
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  5. Jelle Wesseling
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  6. Kenneth E. Pengel
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  7. Kenneth G.A. Gilhuijs
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Correspondence to Kenneth G.A. Gilhuijs.

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Elshof, L.E., Rutgers, E.J.T., Deurloo, E.E. et al. A practical approach to manage additional lesions at preoperative breast MRI in patients eligible for breast conserving therapy: results. Breast Cancer Res Treat 124, 707–715 (2010). https://doi.org/10.1007/s10549-010-1064-z

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  • DOI: https://doi.org/10.1007/s10549-010-1064-z

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