Abstract
Purpose
This study was done to verify the usefulness of preoperative breast magnetic resonance (MR) imaging in patients with newly diagnosed breast cancer.
Materials and methods
A retrospective analysis of 291 patients with invasive breast cancer newly diagnosed with conventional breast imaging (mammography and ultrasound) was performed. All patients underwent MR imaging prior to surgery. The MR imaging detection rate of additional malignant cancers occult to mammography and ultrasound was calculated. Data were analysed with Fisher’s exact test (p<0.05) according to the following parameters: histopathological features of the index tumour (histological type and size) and mammographic density [according to the Breast Imaging Reporting and Data System (BI-RADS) classification from 1 fatty to 4 dense). The gold standard was the histological examination on the surgical specimen.
Results
MR imaging identified 40 mammographically and sonographically occult malignant lesions other than the index cancer in 27/291 patients (9%). These additional cancers were located in the same quadrant as the index cancer in 13 women (4%), in a different quadrant in 12 (4%) and in the contralateral breast in the remaining two (1%). The cancer detection rate in the subgroup of index cancers with lobular histological type was 25%, significantly higher (p=0.03) than the detection rate of 11% recorded in the subgroup of ductal cancers. The cancer detection rate in the subgroup of index cancers >2 cm was 27%, significantly higher (p=0.001) than the rate of 8% found in the subgroup of index cancers <2 cm. Mammographic density was not correlated (p=0.48) with MR detection of additional cancer, with 14% of additional malignancies being detected in both dense and fatty breasts.
Conclusions
In patients with newly diagnosed invasive breast cancer, preoperative MR imaging is useful for detecting additional synchronous malignancies that are not detected on conventional breast imaging. The cancer detection rate is 9%. The use of preoperative MR imaging as an adjunct to conventional breast imaging in women with an infiltrating lobular index cancer and an index cancer >2 cm is especially beneficial.
Riassunto
Obiettivo
Verificare l’utilità dell’esecuzione della risonanza magnetica (RM) mammaria preoperatoria in pazienti con carcinoma invasivo della mammella.
Materiali e metodi
Sono state analizzate retrospettivamente 291 pazienti con carcinoma invasivo della mammella sottoposte a mammografia, ecografia e RM prima di intervento chirurgico. È stato calcolato il tasso diagnostico aggiuntivo di lesioni maligne sincrone rispetto al tumore principale identificate dalla sola RM, occulte alla mammografia e all’ecografia. I dati sono stati analizzati con il test esatto di Fisher (p<0,05) secondo i seguenti parametri: caratteri istologici della lesione principale (istotipo tumorale e dimensione), densità mammografica (classificazione Breast Imaging Reporting and Data System [BI-RADS] in categorie da 1=adiposa a 4=densa). Il gold standard è stato l’esame istologico del pezzo operatorio.
Risultati
L’indagine RM ha diagnosticato 40 lesioni maligne sincrone in 27/291 Pazienti (tasso diagnostico: 9%). Le lesioni maligne identificate dalla RM erano nello stesso quadrante rispetto alla lesione principale in 13 pazienti (4%), interessavano un altro quadrante in 12 pazienti (4%) e la mammella controlaterale nei rimanenti 2 pazienti (1%). Una correlazione significativa positiva (p=0,03) è emersa tra il tasso di identificazione RM di lesione maligna e istotipo lobulare del carcinoma principale (lesioni maligne sincrone sono state rilevate nel 25% dei tumori lobulari vs 11% dei tumori duttali). Una correlazione significativa (p=0,001) è stata osservata tra identificazione RM di lesione maligne e dimensione della lesione principale superiore a 2 cm (lesioni maligne sincrone sono state diagnosticate dalla RM nel 27% dei tumori superiori a 2 cm vs 8% dei tumori inferiori a 2 cm). L’aspetto radiologico della densità mammaria non è risultato correlato (p=0,48) con l’incidenza di malignità, in quanto lesioni maligne sincrone sono state trovate nel 14% dei casi sia con seno denso che adiposo.
Conclusioni
In pazienti con neoplasia mammaria infiltrante, l’indagine RM preoperatoria è utile nella ricerca di lesioni occulte e identifica foci multipli sincroni alla lesione principale nel 9% delle Pazienti. Il tasso diagnostico è superiore quando la neoplasia principale ha istotipo lobulare e dimensioni >2 cm.
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Girardi, V., Carbognin, G., Camera, L. et al. Multifocal, multicentric and contralateral breast cancers: breast MR imaging in the preoperative evaluation of patients with newly diagnosed breast cancer. Radiol med 116, 1226–1238 (2011). https://doi.org/10.1007/s11547-011-0704-7
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DOI: https://doi.org/10.1007/s11547-011-0704-7