Abstract
The aim of this study was to determine whether pre-operative MR mammography could predict the extent of breast cancer in patients with dense breasts or whether dense parenchyma will lead to false-positive or inconclusive examinations. Sixty-seven patients with dense breasts with a malignant breast tumor planned for conservative surgery were reviewed. Detection rates of mammography, ultrasound, and MR mammography were studied, and the diameters of the lesions were measured and compared with pathological examination. Pathology revealed breast cancer in 65 patients. Sensitivity for detection of index lesions was 83% for mammography, 70.8% for ultrasound, and 98% for MR mammography. Mammography underestimated tumor extent in 37%, ultrasound in 40%, and MR in 12.5%. Of the 20 patients (31%) with multifocal or multicentric carcinoma, mammography detected the lesions in 35%, ultrasound in 30%, and MR in 100%, with a false-positive rate of 12.5, 14, and 23%. The MR mammography is more accurate in assessing tumor extent and multifocality in patients with dense breasts, but benign changes may lead to false-positive examinations.
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Winchester DP, Cox JD (1998) Standards for diagnosis and management of invasive breast carcinoma. American College of Radiology. American College of Surgeons. College of American pathologists. Society of Surgical Oncology. CA Cancer J Clin 48:83–107
Ghossein NA, Alpert S, Barba J, Pressman P, Stacey P, Lorenz E, Shulman M, Sadarangani GJ (1992) Breast cancer. Importance of adequate surgical excision prior to radiotherapy in the local control of breast cancer in patients treated conservatively. Arch Surg 127:411–415
Schmidt-Ulrich R, Wazer DE, Tercilla O, Safaii H, Marchant DJ, Smith TJ, Homer MA, Robert NJ (1989) Tumor margin assessment as a guide to optimal conservation surgery and irradiation in early stage breast carcinoma. Int J Radiat Oncol Biol Phys 17:733–738
Silverstein MJ, Gierson ED, Colburn WJ, Cope LM, Furmanski M, Senofsky GM et al. (1994) Can intraductal breast carcinoma be excised completely by local excision? Clinical and pathologic predictors. Cancer 73:2985–2989
Egan RL (1982) Multicentric breast carcinomas: clinical–radiographic–pathologic whole organ studies and 10-year survival. Cancer 49:1123–1130
Holland R, Connolly JL, Gelman R, Mravunac M, Hendriks JH, Verbeek AL, Schnitt SJ, Silver B, Boyages J, Harris JR (1990) The presence of an extensive intraductal component following a limited excision correlates with prominent residual disease in the remainder of the breast. J Clin Oncol 8:113–118
Mandelson MT, Oestreicher N, Porter PL, White D, Finder CA, Taplin SH, White E (2000) Breast density as a predictor of mammographic detection: comparison of interval- and screen-detected cancers. J Natl Cancer Inst 5:1081–1087
Fornage B, Toubas O, Morel M (1985) Clinical, mammographic and sonographic determination of preoperative breast cancer size. Cancer 56:979–990
Satake H, Shimamoto K, Sawaki A, Niimi R, Ando Y, Ishiguchi T, Ishigaki T, Yamakawa K, Nagasaka T, Funahashi H (2000) Role of ultrasonography in the detection of intraductal spread of breast cancer: correlation with pathologic findings, mammography and MR imaging. Eur Radiol 10:1726–1732
Heywang-Kobrunner S (1993) Brustkrebsdiagnostik mit MR/überblick nach 1250 patienten. Electromedica 61:43–52
Fischer U, Westerhof J, Brinck, Koabiowska M, Schauer A, Grabbe E (1996) Das duktale in-situ-karzinom in der dynamischen MR-mammographie bei 1,5T. Fortschr Röntgenstr 164:290–294
Gilles R, Zafrani B, Guinebretière JM, Meunier M, Lucidarme O, Tardivon A, Rochard F, Vanel D, Neuenschwander S, Arriagada R (1995) Ductal carcinoma in situ: MR imaging–histopathologic correlation. Radiology 196:415–419
Orel S, Mendonca MH, Reynolds C, Schnall M, Solin L, Sullivan D (1997) MR imaging of ductal carcinoma in situ. Radiology 202:413–420
Boetes C, Strijk S, Holland R, Barentsz J, Van Der Sluis, Ruijs J (1997) False-negative MR imaging of malignant breast tumors. Eur Radiol 7:1231–1234
Cross MJ, Harms SE, Cheek JH, Peters GN, Jones RC (1993) New horizons in the diagnosis and treatment of breast cancer using magnetic resonance imaging. Am J Surg 166:749–755
American College of Radiology (1998) Breast imaging reporting and data system (BI-RADS), 3rd edn. American College of Radiology, Reston, Virginia
Wolfe J (1983) Xeroradiography of the breast. Thomas, Springfield, Illinois
StatSoft, Inc. (2002) Electronic Statistics Textbook. Tulsa, Oklahoma: StatSoft. WEB: http://www.statsoft.com/textbook/stathome.html
Saarenma I, Salminen T, Geiger U et al. (2001) The effect of age and density of the breast on the sensitivity of breast cancer diagnostic by mammography and ultrasonography. Breast Cancer Res Treat 67:117–123
Kerlikowske K, Grady D, Barclay J, Sickles EA, Ernster V (1996) Effect of age, breast density,and family history on the sensitivity of first screening mammography. J Am Med Assoc 276:33–38
Fischer U, Kopka L, Grabbe E (1999) Breast carcinoma: effect of preoperative contrast-enhanced MR imaging on the therapeutic approach. Radiology 213:881–888
Boetes C, Mus R, Holland R, Barentsz J, Strijk S, Wobbes T, Hendriks J, Ruys S (1995) Breast tumors: comparitive accuracy of MR imaging relative to mammography and US for demonstrating extent. Radiology 197:743–747
Kolb TM, Lichy J, Newhouse JH (1998) Occult cancer in women with dense breasts: detection with screening US-diagnostic yield and tumor characteristics. Radiology 207:191–199
Kaplan SS (2001) Clinical utility of bilateral whole-breast US in the evaluation of women with dense breast tissue. Radiology 221:641–649
Harms S, Flamig D, Hesley K, Meiches M, Jensen R, Evans W, Savino D, Wells R (1993) MR imaging of the breast with rotating delivery of excitation off resonance: clinical experience with pathologic correlation. Radiology 187:493–501
Gatzemeier W, Liersch T, Stylianou A, Buttler A, Becker H, Fischer U (1999) Präoperative MR mammographie beim mammacarcinom. Chirurg 70:1460–1468
Orel S, Schnall M, Powell C, Hochman M, Solin L, Fowble B, Torosian M, Rosato E (1995) Staging of suspected breast cancer: effect of MR imaging and MR-guided biopsy. Radiology 196:16–18
Mumtaz H, Hall-Craggs M, Davidson T, Walmsley K, Thurell W, Kissin M, Taylor I (1997) Staging of symptomatic primary breast cancer with MR imaging. AJR 169:417–424
Berg W, Gilbreath P (2000) Multicentric and multifocal cancer: whole-breast US in preoperative evaluation. Radiology 214:59–66
Moon WK, Noh DY, Im JG (2002) Multifocal, multicentric and contralateral breast cancers: bilateral whole breast US in the preoperative evaluation of patients. Radiology 224:569–576
Kuhl C, Seibert C, Kreft B, Gieseke J, Schild H (1995) Focal and diffuse contrast enhancement in dynamic MR mammography of healthy volunteers. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 163:219–224
Kawashima H, Matsui O, Suzuki M, Kadoya M, Tawara M, Nonomura A, Noguchi M, Takashima T (2000) Breast cancer in dense breast: detection with contrast-enhanced dynamic MR imaging. J Magn Reson Imaging 11:233–243
Rieber A, Merkle E, Böhm W, Brambs H, Tomczak R (1997) MRI of histologically confirmed mammary carcinoma: clinical relevance of diagnostic procedures for detection of multifocal or contralateral secondary carcinoma. J Comput Assist Tomogr 21:773–779
Choi B, Kim H, Kim E, Kim B, Han J, Yoo S, Park S (2002) New subtraction algorithms for evaluation of lesions on dynamic contrast-enhanced MR mammography. Eur Radiol 12:3018–3022
Sardinelli F, Rescinito G, Giordano G, Calabrese M, Parodi R (2000) MR dynamic enhancement of breast lesions: high temporal resolution during the first-minute versus eight minute study. J Comput Assist Tomogr 24:724–731
Perlet C, Heinig A, Prat X, Casselman J, Baath L, Sittek H, Stets C, Lamarque J, Andersson I, Schneider P, Taourel P, Reiser M, Heywang-Kobrunner S (2002) Multicenter study for the evaluation of a dedicated biopsy device for MR-guided vacuum biopsy of the breast. Eur Radiol 12:1463–1470
Prat X, Sittek H, Grosse A, Baath L, Perlet C, Alberich T, Lamarque J, Andersson I, Reiser M, Taourel P, Fischer H, Heywang-Kobrunner S (2002) European quadricentric evaluation of a breast and localization device: technical improvements based on phase-I evaluation. Eur Radiol 12:1720–1727
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Van Goethem, M., Schelfout, K., Dijckmans, L. et al. MR mammography in the pre-operative staging of breast cancer in patients with dense breast tissue: comparison with mammography and ultrasound. Eur Radiol 14, 809–816 (2004). https://doi.org/10.1007/s00330-003-2146-7
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DOI: https://doi.org/10.1007/s00330-003-2146-7