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Use of Preoperative Magnetic Resonance Imaging for Invasive Lobular Cancer: Good, Better, but Maybe not the Best?

  • American Society of Breast Surgeons
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Invasive lobular cancer (ILC) of the breast is difficult to diagnose clinically and radiologically. It is hoped that preoperative magnetic resonance imaging (MRI) can improve evaluation of extent of disease.

Methods

Patients diagnosed with ILC at a single institution from 2001 to 2008 who underwent clinical breast examination (CBE), mammography, ultrasound, and MRI were studied retrospectively. Concordance between tumor size on imaging/CBE and pathologic size was defined as size within ±0.5 cm. Pearson correlation coefficients (R) were calculated for each modality. Local recurrence and reexcision rates were compared with those patients with ILC who did not undergo preoperative MRI.

Results

Seventy patients with ILC had all imaging modalities, including CBE, performed preoperatively. The sensitivity for detection of ILC by MRI was 99%. MRI-based tumor size was concordant with pathologic tumor size in 56% of tumors. MRI overestimated tumor size by >0.5 cm in 31% of tumors. Correlation of tumor size on imaging with final pathology was better for MRI (R = 0.75) than for mammography (R = 0.65), CBE (R = 0.63), or ultrasound (R = 0.45, all P < 0.01). Preoperative MRI was associated with lower reoperation rates for close/positive margins (P > 0.05).

Conclusions

For ILC, MRI has better sensitivity of detection and correlation with tumor size at pathology than CBE, mammography, or ultrasound. However, 31% of cases are overestimated by MRI, and correlation remains only at 0.75. The select use of MRI for preoperative estimation of tumor size in ILC is supported by our data, but the need for improvement and refinement of imaging remains.

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Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA

    Lee J. McGhan MB. BCh, Nabil Wasif MD, Richard J. Gray MD, Chee-Chee H. Stucky MD & Barbara A. Pockaj MD

  2. Department of Radiology, Mayo Clinic Arizona, Scottsdale, AZ, USA

    Marina E. Giurescu MD, Victor J. Pizzitola MD & Roxanne Lorans MD

  3. Department of Pathology, Mayo Clinic Arizona, Scottsdale, AZ, USA

    Idris T. Ocal MD

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  1. Lee J. McGhan MB. BCh
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  2. Nabil Wasif MD
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  3. Richard J. Gray MD
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Correspondence to Barbara A. Pockaj MD.

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McGhan, L.J., Wasif, N., Gray, R.J. et al. Use of Preoperative Magnetic Resonance Imaging for Invasive Lobular Cancer: Good, Better, but Maybe not the Best?. Ann Surg Oncol 17 (Suppl 3), 255–262 (2010). https://doi.org/10.1245/s10434-010-1266-y

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  • DOI: https://doi.org/10.1245/s10434-010-1266-y

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