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Impact of pre-operative MRI on surgical management of screening digital breast tomosynthesis-detected invasive lobular carcinoma

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Abstract

Purpose

The purpose of this study is to determine the impact of pre-operative MRI on surgical management of screening digital breast tomosynthesis (DBT)-detected invasive lobular carcinoma (ILC).

Methods

A retrospective medical record analysis was conducted of women with screening DBT-detected ILC and subsequent surgery from 2017–2021. Clinical, imaging, and pathological features were compared between women who did and did not undergo MRI, and between women with and without additional disease detected on MRI, using the Pearson’s chi-squared test and Wilcoxon signed-rank test. Concordance between imaging and surgical pathology sizes was also evaluated.

Results

Of 125 women (mean age 67 years, range 44–90) with screening-detected ILC, MRI was obtained in 62 women (49.6%) with a mean age of 63 years (range 45–80). Compared to women without MRI, women who had MRI examinations were younger, more likely to have dense breast tissue, and more likely to undergo mastectomy initially rather than lumpectomy (p < 0.001–0.01). Eighteen biopsies were performed based on MRI findings, of which 55.6% (10/18) were malignant. Conventional imaging more frequently underestimated ILC span at the biopsy site than MRI, using a 25% threshold difference (17.5% [7/40] versus 58.5% [24/41], p < 0.001). MRI detected more extensive disease at the biopsy site in six patients (9.7%, 6/62), additional ipsilateral disease in six patients (9.7%, 6/62), and contralateral disease in one patient (1.6%, 1/62). MRI therefore impacted surgical management in 21.0% (13/62) of patients.

Conclusion

MRI led to the detection of additional disease, thus impacting surgical management, in one-fifth of patients with ILC.

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Data availability

The datasets generated during and/or analyzed during the study are not publicly available due to possible compromise of individual privacy; however, the datasets are available from the corresponding author on reasonable request.

References

  1. Thomas M, Kelly ED, Abraham J, Kruse M (2019) Invasive lobular breast cancer: a review of pathogenesis, diagnosis, management, and future directions of early stage disease. Semin Oncol 46:121–132. https://doi.org/10.1053/j.seminoncol.2019.03.002

    Article  PubMed  Google Scholar 

  2. Mann RM (2010) The effectiveness of MR imaging in the assessment of invasive lobular carcinoma of the breast. Magn Reson Imaging Clin N Am 18:259–276, ix. https://doi.org/10.1016/j.mric.2010.02.005

    Article  PubMed  Google Scholar 

  3. American Society of Breast Surgeons (2018) Consensus guideline on diagnostic and screening magnetic resonance imaging of the breast. https://www.breastsurgeons.org/docs/statements/Consensus-Guideline-on-Diagnostic-and-Screening-Magnetic-Resonance-Imaging-of-the-Breast.pdf. Accessed 15 July 2023

  4. National Comprehensive Cancer Network (NCCN) (2023) NCCN clinical practice guidelines in oncology version 4.2023. https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 15 July 2023

  5. 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 34:135–142. https://doi.org/10.1016/j.ejso.2007.04.020

    Article  CAS  PubMed  Google Scholar 

  6. Sinclair K, Sakellariou S, Dawson N, Litherland J (2016) Does preoperative breast MRI significantly impact on initial surgical procedure and re-operation rates in patients with screen-detected invasive lobular carcinoma? Clin Radiol 71:543–550. https://doi.org/10.1016/j.crad.2016.03.011

    Article  CAS  PubMed  Google Scholar 

  7. Friedewald SM, Rafferty EA, Rose SL et al (2014) Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA 311:2499–2507. https://doi.org/10.1001/jama.2014.6095

    Article  CAS  PubMed  Google Scholar 

  8. Bahl M, Lamb LR, Lehman CD (2017) Pathologic outcomes of architectural distortion on digital 2D versus tomosynthesis mammography. AJR Am J Roentgenol 209:1162–1167. https://doi.org/10.2214/AJR.17.17979

    Article  PubMed  Google Scholar 

  9. 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. Reston, VA. American College of Radiology

  10. Lamb LR, Oseni TO, Lehman CD, Bahl M (2020) Pre-operative MRI in patients with ductal carcinoma in situ: is MRI useful for identifying additional disease? Eur J Radiol 129:109130. https://doi.org/10.1016/j.ejrad.2020.109130

    Article  PubMed  Google Scholar 

  11. American College of Radiology (2022) Complete accreditation information: MRI. https://accreditationsupport.acr.org/support/solutions/articles/11000063276-complete-accreditation-information-mri. Accessed 15 July 2023

  12. Lai HW, Chen DR, Wu YC et al (2015) Comparison of the diagnostic accuracy of magnetic resonance imaging with sonography in the prediction of breast cancer tumor size: a concordance analysis with histopathologically determined tumor size. Ann Surg Oncol 22:3816–3823. https://doi.org/10.1245/s10434-015-4424-4

    Article  PubMed  Google Scholar 

  13. Seely JM, Lamb L, Malik N, Lau J (2016) The yield of pre-operative breast MRI in patients according to breast tissue density. Eur Radiol 26:3280–3289. https://doi.org/10.1007/s00330-015-4118-0

    Article  PubMed  Google Scholar 

  14. 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 107:1–14. https://doi.org/10.1007/s10549-007-9528-5

    Article  PubMed  Google Scholar 

  15. Amin AL, Sack S, Larson KE et al (2021) Does the addition of breast MRI add value to the diagnostic workup of invasive lobular carcinoma? J Surg Res 257:144–152. https://doi.org/10.1016/j.jss.2020.07.035

    Article  PubMed  Google Scholar 

  16. Mann RM, Loo CE, Wobbes T et al (2010) The impact of preoperative breast MRI on the re-excision rate in invasive lobular carcinoma of the breast. Breast Cancer Res Treat 119:415–422. https://doi.org/10.1007/s10549-009-0616-6

    Article  CAS  PubMed  Google Scholar 

  17. Ha SM, Chae EY, Cha JH, Kim HH, Shin HJ, Choi WJ (2018) Breast MR imaging before surgery: outcomes in patients with invasive lobular carcinoma by using propensity score matching. Radiology 287:771–777. https://doi.org/10.1148/radiol.2018171472

    Article  PubMed  Google Scholar 

  18. Moloney BM, McAnena PF, Ryan EJ et al (2020) The impact of preoperative breast magnetic resonance imaging on surgical management in symptomatic patients with invasive lobular carcinoma. Breast Cancer (Auckl) 14:1178223420948477. https://doi.org/10.1177/1178223420948477

    Article  PubMed  Google Scholar 

  19. Hovis KK, Lee JM, Hippe DS et al (2021) Accuracy of preoperative breast MRI versus conventional imaging in measuring pathologic extent of invasive lobular carcinoma. J Breast Imaging 3:288–298. https://doi.org/10.1093/jbi/wbab015

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, WAC 240, Boston, MA, 02114, USA

    M. Bahl

  2. Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, 149 13th Street, Suite 2282, Charlestown, MA, 02129, USA

    B. Deng

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Contributions

Dr. Bahl and Dr. Deng contributed to the study conception, design, and material preparation. Dr. Bahl performed the data collection and analysis. The first draft of the manuscript was written by Dr. Bahl, and both Dr. Bahl and Dr. Deng read and approved the final manuscript.

Corresponding author

Correspondence to M. Bahl.

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Conflict of interest

Financial interests: Dr. Bahl is a consultant for Hologic and an expert panelist for 2nd.MD. She previously served as a consultant for Lunit. These relationships are not directly relevant to the submitted work. Dr. Deng has no financial interests. Non-financial interests: The authors have no relevant non-financial interest to disclosure.

Ethical approval

This retrospective study was approved by the Massachusetts General Hospital Institutional Review Board and compliant with the Health Insurance Portability and Accountability Act.

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This retrospective study was exempted from the written informed consent requirement.

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Presentations: Poster Presentation at the National Consortium of Breast Centers 32nd Annual Interdisciplinary Breast Center Conference in March 2023.

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Bahl, M., Deng, B. Impact of pre-operative MRI on surgical management of screening digital breast tomosynthesis-detected invasive lobular carcinoma. Breast Cancer Res Treat 204, 397–405 (2024). https://doi.org/10.1007/s10549-023-07175-9

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  • DOI: https://doi.org/10.1007/s10549-023-07175-9

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