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Aroney S, Lloyd T, Birch S, Godwin B, Walters K, Khoo J, Geere S, Shen L, Vujovic P, Bennett I, Santamaría G. Preoperative breast MR imaging influences surgical management in patients with invasive lobular carcinoma. J Med Imaging Radiat Oncol 2024. [PMID: 39250690 DOI: 10.1111/1754-9485.13754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 08/18/2024] [Indexed: 09/11/2024]
Abstract
INTRODUCTION The purpose of the study is to assess the role of preoperative magnetic resonance (MR) imaging on the surgical management of invasive lobular carcinoma (ILC) and to evaluate whether breast density and background parenchymal enhancement (BPE) influence surgical treatment. METHODS This retrospective study was conducted on 56 patients who were diagnosed with ILC between 2014 and 2020. All patients had mammogram and ultrasound. Preoperative MRI was available in 34 patients. Age, menopausal status, breast density, BPE, multifocality/multicentricity and surgical treatment were collected. RESULTS Mean pathological tumour size was 36.4 mm (range 5-140 mm). Dense breasts had larger tumours compared to non-dense breasts (P = 0.072). Of the 34 patients with MRI, 6 opted for mastectomy. Of the remaining 28 cases, MRI findings upgraded surgery to mastectomy in 54% (15/28) because mammogram/ultrasound underestimated tumour extent in 25% (7/28), or multifocal/multicentric disease was identified in 29% (8/28). Tumour size was underestimated by MRI in 7% (2/28). In the non-MRI subgroup, 64% (14/22) of patients underwent breast-conserving surgery, but 29% of them (4/14) required a second-stage mastectomy due to extensive margin involvement. There was no difference in mastectomy rate between patients with MRI (62%) and without MRI (55%) (P = 0.061). Tumour size correlation between MRI and histopathology demonstrated an excellent intraclass correlation coefficient (P < 0.001). Surgical treatment recommendation was not significantly impacted by breast density or BPE. CONCLUSION Breast MRI improves surgical management of patients with ILC in providing additional diagnostic information often missed with standard imaging modalities, and without increasing mastectomy rate. Surgical treatment is not impacted by breast density or BPE.
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Affiliation(s)
- Stephanie Aroney
- Department of Radiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Thomas Lloyd
- Department of Radiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Simone Birch
- Department of Pathology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Belinda Godwin
- Department of Radiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Kylie Walters
- Department of Radiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Jeremy Khoo
- Department of Breast and Endocrine Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Simone Geere
- Department of Breast and Endocrine Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Linda Shen
- Department of Pathology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Petar Vujovic
- Department of Breast and Endocrine Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Ian Bennett
- Department of Breast and Endocrine Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Gorane Santamaría
- Department of Radiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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2
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Goren Z, Zioni T, Lev D, Cohen Y, Perry ZH. The impact of preoperative breast MRI on the therapeutic management of breast cancer patients. Surg Oncol 2024; 55:102095. [PMID: 38986313 DOI: 10.1016/j.suronc.2024.102095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 03/09/2024] [Accepted: 06/28/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND The role of preoperative breast MRI to evaluate the extent of disease in breast cancer patients is considered controversial. We aimed at assessing the effect of breast MRI on the management of newly diagnosed breast cancer. MATERIALS A retrospective review of 202 consecutively seen patients who were newly diagnosed with breast cancer and who underwent preoperative breast MRIs at Assuta Ashdod between June 1, 2017, and June 1, 2020. Data included discovering suspicious lesions by conventional imaging, MRI findings, and surgical pathology results. This was analyzed to determine whether the MRI changed the management and whether it had a justified or unjustified effect on the treatment. RESULTS The mean age was 54.51 (standard deviation, 11.34 years). Breast MRI revealed additional findings in 56 % of patients and modified therapeutic management in 32 % of the cases evaluated, having a justified effect in 87.6 %. Patients with changed management had a statistically significantly higher mastectomy rate (36 %) than those who did not (14 %). No statistically significant association was found between independent variables such as breast density, tumor location on the breast, type of tumor, patient's demographic information, etc. And whether MRI findings changed the initial treatment plan. CONCLUSIONS MRI played an essential role in the preoperative staging of breast cancer in our study, modifying therapeutic planning in approximately one-third of the cases and having a justified effect on most of them. We, therefore, support preoperative breast MRI in newly diagnosed breast cancer patients.
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Affiliation(s)
- Zohar Goren
- Goldman Medical School, The Faculty of Health Sciences, Ben-Gurion University, Israel
| | - Tammy Zioni
- The Breast Center, Assuta Ashdod Medical Center, Israel
| | - Dina Lev
- The Breast Center, Assuta Ashdod Medical Center, Israel
| | - Yaron Cohen
- Goldman Medical School, The Faculty of Health Sciences, Ben-Gurion University, Israel
| | - Zvi Howard Perry
- Goldman Medical School, The Faculty of Health Sciences, Ben-Gurion University, Israel; Surgery A, Soroka University Medical Center, Beer-Sheva, Israel.
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3
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Melvin Z, Lim D, Jacques A, Falkner NM, Lo G. Is staging breast magnetic resonance imaging for invasive lobular carcinoma worthwhile? ANZ J Surg 2024. [PMID: 38949091 DOI: 10.1111/ans.19140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/24/2024] [Accepted: 06/10/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Invasive lobular carcinoma (ILC) is challenging to stage accurately using mammography (MG) and ultrasound (US) with undiagnosed ipsilateral and contralateral cancer resulting in poor patient outcomes including return to surgery. Our institution employs routine staging breast MRI in ILC for this reason. However, increased time for further imaging/biopsies contributes to patient anxiety and potentially delays definite management. We aimed to quantify the frequency of staging MRI-detected additional lesions requiring biopsy or follow-up, the added cancer detection rate and MRI prompted change in surgical management. METHODS An observational study on staging breast MRI for newly diagnosed ILC at a tertiary Western Australian hospital from January 2019 to August 2022. Standardized 3T MRI protocol was performed, double read by unblinded fellowship-trained radiologists. Histopathology from biopsy, surgery, or first annual surveillance was the reference standard for additional MRI-detected lesions. RESULTS One hundred ten MRI studies demonstrated 49 (45%) patients had at least one additional clinically significant MRI-detected lesion. Thirty-one patients had an additional ipsilateral lesion detected, of which 18 (58%) proved malignant; 14 (45%) multifocal and 4 (13%) multicentric ILC. Additional work-up of MRI-detected lesions averaged a 9-day delay to definitive surgery compared to patients with a negative or definitively benign MRI. MRI changed surgical planning in 11 of 110 cases from breast conservation surgery (BCS) to mastectomy and there were two contralateral cancers diagnosed. BCS reoperation rate was 11%. CONCLUSION Staging MRI for ILC identifies clinically significant lesions in nearly half of patients, predominantly ipsilateral multifocal disease, without significant delay to definitive surgery.
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Affiliation(s)
- Zebadiah Melvin
- Diagnostic Imaging, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - David Lim
- Surgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Angela Jacques
- Institute for Health Research, The University of Notre Dame, Fremantle, Western Australia, Australia
- Department of Research, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Nathalie M Falkner
- Diagnostic Imaging, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Glen Lo
- Diagnostic Imaging, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
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Giannotti E, Van Nijnatten TJA, Chen Y, Bicchierai G, Nori J, De Benedetto D, Lalji U, Lee AHS, James J. The role of contrast-enhanced mammography in the preoperative evaluation of invasive lobular carcinoma of the breast. Clin Radiol 2024; 79:e799-e806. [PMID: 38383254 DOI: 10.1016/j.crad.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/23/2024]
Abstract
AIM To assess the performance of contrast-enhanced mammography (CEM) in the preoperative staging of invasive lobular carcinoma (ILC) of the breast. MATERIALS AND METHODS The present study was a multicentre, multivendor, multinational retrospective study of women with a histological diagnosis of ILC who had undergone CEM from December 2013 to December 2021. Index lesion size and multifocality were recorded for two-dimensional (2D) mammography, CEM, and when available magnetic resonance imaging (MRI). Comparison with histological data was undertaken for women treated by primary surgical excision. Pearson correlation coefficients and Bland-Altman's analysis of agreement were used to assess differences with a significance level of 0.05. RESULTS One hundred and fifteen ILC lesions were included, 46 (40%) presented symptomatically and 69 were screening detected. CEM demonstrated superior sensitivity when compared to standard mammography. The correlation between the histological size measured on the surgical excision specimen size was greater than with standard mammography (r=0.626 and 0.295 respectively, p=0.001), with 19% of lobular carcinomas not visible without a contrast agent. The sensitivity of CEM for multifocal disease was greater than standard mammography (70% and 20% respectively, p<0.0001). CEM overestimated tumour size by an average of 1.5 times, with the size difference increasing for larger tumour. When MRI was performed (n=22), tumour size was also overestimated by an average of 1.3 times. The degree of size overestimation was similar for both techniques, with the tumour size on CEM being on average 0.5 cm larger than MRI. CONCLUSION CEM is a useful tool for the local staging of lobular carcinomas and could be an alternative to breast MRI.
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Affiliation(s)
- E Giannotti
- Cambridge Breast Unit, Addenbrooke's Cambridge University Hospital NHS Foundation Trust, Cambridge, UK; Nottingham Breast Institute Nottingham University Hospital NHS Trust, Nottingham, UK.
| | - T J A Van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands; School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Y Chen
- University of Nottingham, School of Medicine, Division of Cancer and Stem Cells, City Hospital Campus, Nottingham, UK
| | - G Bicchierai
- Breast Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - J Nori
- Breast Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - D De Benedetto
- Breast Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - U Lalji
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - A H S Lee
- Histopathology Department, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, UK
| | - J James
- Nottingham Breast Institute Nottingham University Hospital NHS Trust, Nottingham, UK
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Eisen A, Fletcher GG, Fienberg S, George R, Holloway C, Kulkarni S, Seely JM, Muradali D. Breast Magnetic Resonance Imaging for Preoperative Evaluation of Breast Cancer: A Systematic Review and Meta-Analysis. Can Assoc Radiol J 2024; 75:118-135. [PMID: 37593787 DOI: 10.1177/08465371231184769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Purpose: Preoperative breast magnetic resonance imaging (MRI) is known to detect additional cancers that are occult on mammography and ultrasound. There is debate as to whether these additional lesions affect clinical outcomes. The objective of this systematic review was to summarize the evidence on whether additional information on disease extent obtained with preoperative breast MRI in patients with newly diagnosed breast cancer affects surgical management, rates of recurrence, survival, re-excision, and early detection of bilateral cancer. Methods: Embase, MEDLINE, and Cochrane Central Register of Controlled Trials were searched until January 2021 (partial update July 2022) for studies comparing outcomes with versus without pre-operative MRI. Included were both randomized controlled trials and other comparative studies provided MRI and control groups had equivalent disease and patient characteristics or methods such as multivariable analysis or propensity score matching were used to control potential confounders. Results: The search resulted in 26,399 citations, of which 8 randomized control trials, 1 prospective cohort study, and 42 retrospective studies met the inclusion criteria. Use of MRI resulted in decreased rates of reoperations (OR = 0.73, 95% CI = 0.63 to 0.85), re-excisions (OR = 0.63, 95% CI = 0.45 to 0.89), and recurrence (HR = 0.77, 95% CI = 0.65 to 0.90). Increased detection of synchronous contralateral breast cancers led to a reduction in metachronous contralateral breast cancer (HR = 0.71, 95% CI = 0.59 to 0.85). Hazard ratios for recurrence-free and overall survival were 0.77 (95% CI = 0.53 to 1.12) and 0.89 (95% CI = 0.74 to 1.07). Conclusion: This systematic review indicates substantial benefits of pre-operative breast MRI in decreasing reoperations and recurrence.
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Affiliation(s)
- Andrea Eisen
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences, Toronto, ON, Canada
| | - Glenn G Fletcher
- Program in Evidence-Based Care, Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Samantha Fienberg
- Ontario Breast Screening Program, Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
- Department of Medical Imaging, Lakeridge Health, Oshawa, ON, Canada
| | - Ralph George
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Claire Holloway
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Disease Pathway Management, Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Supriya Kulkarni
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jean M Seely
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Derek Muradali
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Department of Medical and Diagnostic Imaging, St. Michael's Hospital, Toronto, ON, Canada
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Christensen DM, Shehata MN, Javid SH, Rahbar H, Lam DL. Preoperative Breast MRI: Current Evidence and Patient Selection. JOURNAL OF BREAST IMAGING 2023; 5:112-124. [PMID: 38416933 DOI: 10.1093/jbi/wbac088] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Indexed: 03/01/2024]
Abstract
Breast MRI is the most sensitive imaging modality for the assessment of newly diagnosed breast cancer extent and can detect additional mammographically and clinically occult breast cancers in the ipsilateral and contralateral breasts. Nonetheless, appropriate use of breast MRI in the setting of newly diagnosed breast cancer remains debated. Though highly sensitive, MRI is less specific and may result in false positives and overestimation of disease when MRI findings are not biopsied prior to surgical excision. Furthermore, improved anatomic depiction of breast cancer on MRI has not consistently translated to improved clinical outcomes, such as lower rates of re-excision or breast cancer recurrence, though there is a paucity of well-designed studies examining these issues. In addition, current treatment paradigms have been developed in the absence of this more accurate depiction of disease span, which likely has limited the value of MRI. These issues have led to inconsistent and variable utilization of preoperative MRI across practice settings and providers. In this review, we discuss the history of breast MRI and its current use and recommendations with a focus on the preoperative setting. We review the evidence surrounding the use of preoperative MRI in the evaluation of breast malignancies and discuss the data on breast MRI in the setting of specific patient factors often used to determine breast MRI eligibility, such as age, index tumor phenotype, and breast density. Finally, we review the impact of breast MRI on surgical outcomes (re-excision and mastectomy rates) and long-term breast recurrence and survival outcomes.
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Affiliation(s)
- Diana M Christensen
- University of Washington School of Medicine, Department of Radiology, Seattle, WA, USA
| | - Mariam N Shehata
- University of Washington School of Medicine, Department of Radiology, Seattle, WA, USA
| | - Sara H Javid
- University of Washington School of Medicine, Department of Surgery, Seattle, WA, USA
| | - Habib Rahbar
- University of Washington School of Medicine, Department of Radiology, Seattle, WA, USA
| | - Diana L Lam
- University of Washington School of Medicine, Department of Radiology, Seattle, WA, USA
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Pereslucha AM, Wenger DM, Morris MF, Aydi ZB. Invasive Lobular Carcinoma: A Review of Imaging Modalities with Special Focus on Pathology Concordance. Healthcare (Basel) 2023; 11:healthcare11050746. [PMID: 36900751 PMCID: PMC10000992 DOI: 10.3390/healthcare11050746] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Invasive lobular cancer (ILC) is the second most common type of breast cancer. It is characterized by a unique growth pattern making it difficult to detect on conventional breast imaging. ILC can be multicentric, multifocal, and bilateral, with a high likelihood of incomplete excision after breast-conserving surgery. We reviewed the conventional as well as newly emerging imaging modalities for detecting and determining the extent of ILC- and compared the main advantages of MRI vs. contrast-enhanced mammogram (CEM). Our review of the literature finds that MRI and CEM clearly surpass conventional breast imaging in terms of sensitivity, specificity, ipsilateral and contralateral cancer detection, concordance, and estimation of tumor size for ILC. Both MRI and CEM have each been shown to enhance surgical outcomes in patients with newly diagnosed ILC that had one of these imaging modalities added to their preoperative workup.
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Affiliation(s)
- Alicia M Pereslucha
- Department of Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85006, USA
| | - Danielle M Wenger
- College of Medicine-Phoenix, University of Arizona, Phoenix, AZ 85004, USA
| | - Michael F Morris
- Division of Diagnostic Imaging, Banner MD Anderson Cancer Center, Phoenix, AZ 85006, USA
- Department of Radiology, Banner University Medical Center-Phoenix, Phoenix, AZ 85006, USA
| | - Zeynep Bostanci Aydi
- Department of Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85006, USA
- Department of Surgical Oncology, Banner MD Anderson Cancer Center, Phoenix, AZ 85006, USA
- Correspondence:
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8
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The Association of Preoperative Magnetic Resonance Imaging (MRI) With Surgical Management in Patients With Early-Stage Breast Cancer. J Surg Res 2022; 280:114-122. [PMID: 35964483 DOI: 10.1016/j.jss.2022.06.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/18/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The rate of mastectomy in lumpectomy-eligible patients with unilateral breast cancer is increasing. We sought to investigate the association between magnetic resonance imaging (MRI) and surgical management of patients with early-stage breast cancer by comparing the rate of mastectomy as first surgery in patients with and without preoperative MRI. METHODS A bi-institutional retrospective study included patients diagnosed between 2016 and 2020. Lumpectomy-eligible patients with in situ and invasive cancer were included. Those receiving preoperative therapy, MRI before diagnosis, or with known bilateral cancer were excluded. The risk factors for bilateral and multicentric disease were accounted for. Fisher's exact and chi-square tests compared categorical variables, Wilcoxon two-sample test analyzed continuous variables, and multivariate analyses were performed with Poisson regression. RESULTS Four hundred twenty-eight participants met inclusion criteria. Patients who received MRI were younger (58 versus 67 y; P < 0.001) and had denser breasts (group 3 or 4; 61% versus 25%; P < 0.001). Mastectomy rate was twice as high in patients undergoing MRI (32% versus 15%, rate ratio 2.16; P < 0.001), which remained significant in multivariate analysis (rate ratio 2.0; P < 0.001). Contralateral mastectomy (12% versus 4%; P = 0.466) and reexcision (13% versus 12%; P = 0.519) rates were similar. Time to surgery was greater in those receiving MRI alone and MRI biopsy (34 [no MRI] versus 45 [MRI] versus 62 [MRI biopsy]; P < 0.001 for both). CONCLUSIONS MRI receipt is associated with a doubled rate of mastectomy in lumpectomy-eligible patients. Future work is needed to standardize patient selection for MRI to those with the highest likelihood of having additional undiagnosed disease.
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Van Baelen K, Geukens T, Maetens M, Tjan-Heijnen V, Lord CJ, Linn S, Bidard FC, Richard F, Yang WW, Steele RE, Pettitt SJ, Van Ongeval C, De Schepper M, Isnaldi E, Nevelsteen I, Smeets A, Punie K, Voorwerk L, Wildiers H, Floris G, Vincent-Salomon A, Derksen PWB, Neven P, Senkus E, Sawyer E, Kok M, Desmedt C. Current and future diagnostic and treatment strategies for patients with invasive lobular breast cancer. Ann Oncol 2022; 33:769-785. [PMID: 35605746 DOI: 10.1016/j.annonc.2022.05.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/06/2022] [Accepted: 05/17/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Invasive lobular breast cancer (ILC) is the second most common type of breast cancer after invasive breast cancer of no special type (NST), representing up to 15% of all breast cancers. DESIGN Latest data on ILC are presented, focusing on diagnosis, molecular make-up according to the European Society for Medical Oncology Scale for Clinical Actionability of molecular Targets (ESCAT) guidelines, treatment in the early and metastatic setting and ILC-focused clinical trials. RESULTS At the imaging level, magnetic resonance imaging-based and novel positron emission tomography/computed tomography-based techniques can overcome the limitations of currently used imaging techniques for diagnosing ILC. At the pathology level, E-cadherin immunohistochemistry could help improving inter-pathologist agreement. The majority of patients with ILC do not seem to benefit as much from (neo-)adjuvant chemotherapy as patients with NST, although chemotherapy might be required in a subset of high-risk patients. No differences in treatment efficacy are seen for anti-human epidermal growth factor receptor 2 (HER2) therapies in the adjuvant setting and cyclin-dependent kinases 4 and 6 inhibitors in the metastatic setting. The clinical utility of the commercially available prognostic gene expression-based tests is unclear for patients with ILC. Several ESCAT alterations differ in frequency between ILC and NST. Germline BRCA1 and PALB2 alterations are less frequent in patients with ILC, while germline CDH1 (gene coding for E-cadherin) alterations are more frequent in patients with ILC. Somatic HER2 mutations are more frequent in ILC, especially in metastases (15% ILC versus 5% NST). A high tumour mutational burden, relevant for immune checkpoint inhibition, is more frequent in ILC metastases (16%) than in NST metastases (5%). Tumours with somatic inactivating CDH1 mutations may be vulnerable for treatment with ROS1 inhibitors, a concept currently investigated in early and metastatic ILC. CONCLUSION ILC is a unique malignancy based on its pathological and biological features leading to differences in diagnosis as well as in treatment response, resistance and targets as compared to NST.
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Affiliation(s)
- K Van Baelen
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium; Departments of Gynaecology and Obstetrics, UZ Leuven, Leuven, Belgium
| | - T Geukens
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium; General Medical Oncology, UZ Leuven, Leuven, Belgium
| | - M Maetens
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium
| | - V Tjan-Heijnen
- Medical Oncology Department, Maastricht University Medical Center (MUMC), School of GROW, Maastricht, The Netherlands
| | - C J Lord
- The CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - S Linn
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Medical Oncology, Amsterdam, The Netherlands; Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - F-C Bidard
- Department of Medical Oncology, Institut Curie, UVSQ/Paris-Saclav University, Paris, France
| | - F Richard
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium
| | - W W Yang
- The CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - R E Steele
- The CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - S J Pettitt
- The CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - C Van Ongeval
- Departments of Radiology, UZ Leuven, Leuven, Belgium
| | - M De Schepper
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium; Pathology, UZ Leuven, Leuven, Belgium
| | - E Isnaldi
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium
| | | | - A Smeets
- Surgical Oncology, UZ Leuven, Leuven, Belgium
| | - K Punie
- General Medical Oncology, UZ Leuven, Leuven, Belgium
| | - L Voorwerk
- Departments of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Tumour Biology and Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H Wildiers
- General Medical Oncology, UZ Leuven, Leuven, Belgium
| | - G Floris
- Pathology, UZ Leuven, Leuven, Belgium
| | | | - P W B Derksen
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P Neven
- Departments of Gynaecology and Obstetrics, UZ Leuven, Leuven, Belgium
| | - E Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - E Sawyer
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, Guy's Cancer Centre, King's College London, London, UK
| | - M Kok
- Departments of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Tumour Biology and Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C Desmedt
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium.
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Carmon E, Alster T, Maly B, Kadouri L, Kleinman TA, Sella T. Preoperative MRI for evaluation of extent of disease in IDC compared to ILC. Clin Breast Cancer 2022; 22:e745-e752. [DOI: 10.1016/j.clbc.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/18/2022] [Accepted: 07/17/2022] [Indexed: 11/26/2022]
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11
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Ozcan LC, Donovan CA, Srour M, Chung A, Mirocha J, Frankel SD, Hakim P, Giuliano AE, Amersi F. Invasive Lobular Carcinoma-Correlation Between Imaging and Final Pathology: Is MRI Better? Am Surg 2022:31348221101600. [PMID: 35639048 DOI: 10.1177/00031348221101600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Invasive lobular carcinoma (ILC) is associated with high re-excision rates following breast-conserving surgery (BCS). The correlation between lesion size on different imaging modalities and final tumor size has not been well characterized. METHODS A prospective database of patients with stage I-III breast cancer undergoing BCS between 2006 and 2016 was reviewed. Pearson correlation analysis was used to correlate tumor size on breast imaging to final pathology. RESULTS Of these, 111 patients with ILC were identified. Mean lesion size was 1.93 cm for MMG, 1.61 cm for US, and 2.51 cm for MRI. Mean tumor size on surgical excision was 2.64 cm. The correlation coefficient between pathology and the different imaging modalities were as follows: MMG .17, US 0.37, and MRI .58. Actual tumor size was underestimated by 1 cm in 27.1% of MMGs, 50% of USs, and in 13.3% of MRIs. 38 patients (34.2%) underwent re-excision. No differences in re-excision rates were noted in patients with and without MRI, 30.3% vs 40.0%, respectively (P = .31). CONCLUSION While MRI provides a better estimate of tumor size than MMG and US, the size of the tumor on imaging only weakly correlated with pathology. The use of MRI does not decrease re-excision rates.
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Affiliation(s)
- Lerna C Ozcan
- Division of Surgical Oncology, Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Cory A Donovan
- Division of Surgical Oncology, Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Marissa Srour
- Division of Surgical Oncology, Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alice Chung
- Division of Surgical Oncology, Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - James Mirocha
- Biostatistics Core, Research Institute and Samuel-Oschin Cancer Center, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Steven D Frankel
- Department of Breast Imaging, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Paul Hakim
- Department of Breast Imaging, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Armando E Giuliano
- Division of Surgical Oncology, Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Farin Amersi
- Division of Surgical Oncology, Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
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12
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Li L, Zhang Q, Qian C, Lin H. Impact of Preoperative Magnetic Resonance Imaging on Surgical Outcomes in Women with Invasive Breast Cancer: A Systematic Review and Meta-Analysis. Int J Clin Pract 2022; 2022:6440952. [PMID: 36081810 PMCID: PMC9436630 DOI: 10.1155/2022/6440952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/02/2022] [Accepted: 08/06/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Currently, whether magnetic resonance imaging (MRI) should be routinely applied to patients with breast cancer before surgery remains controversial. A pooled analysis of the association between preoperative MRI and surgical outcomes in female patients with newly diagnosed invasive breast cancer was conducted to provide evidence-based medicine for clinical practice. METHODS Three independent researchers searched the following databases: PubMed, Medline, Embase, Ovid, Cochrane Library, and Web of Science from inception to April 2022. Literature was included and excluded according to Cochrane's principles. The basic information from eligible documents was extracted. Systematic evaluation and meta-analysis were performed, and the odds ratio (OR) was analyzed by the random-effect model. The quality of the literature was assessed using the modified Jadad scale and the Newcastle-Ottawa (NOS) mean scale. RESULTS A total of 19 studies were included, including 4 randomized controlled trials and 15 observational comparative studies. Among them, most studies were not limited to a specific pathological type, with the exception of 3 that were limited to invasive lobular carcinoma. The results showed that preoperative MRI examination would significantly reduce the reoperation rate (OR = 0.77, P=0.02) and increase the mastectomy rate (OR = 1.36, P=0.001). In comparison, preoperative MRI did not significantly affect the rate of secondary mastectomy (OR = 0.77, P=0.02), the rate of positive margin (OR = 1.08, P=0.66), the rate of mastectomy (OR = 1.00, P < 0.05), and reoperations (OR = 0.65, P=0.19) in the subgroup analysis of patients with invasive lobular carcinoma. CONCLUSION Available evidence suggests that preoperative MRI examination increases the rate of mastectomy and reduces the rate of reoperations. The results indicate that preoperative MRI examination has the potential to benefit patients with breast cancer, but more high-quality studies are needed for confirmation.
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Affiliation(s)
- Li Li
- Department of Medical Imaging, Haikou Maternal and Child Health Hospital, Haikou 570203, China
| | - Qinghong Zhang
- Department of Breast Surgery, Haikou Maternal and Child Health Hospital, Haikou 570203, China
| | - Chunrui Qian
- Department of Radiology, Haikou Hospital of Traditional Chinese Medicine, Haikou 570216, China
| | - Huien Lin
- Department of Medical Imaging, Haikou Maternal and Child Health Hospital, Haikou 570203, China
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13
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Zeng Z, Amin A, Roy A, Pulliam NE, Karavites LC, Espino S, Helenowski I, Li X, Luo Y, Khan SA. Preoperative magnetic resonance imaging use and oncologic outcomes in premenopausal breast cancer patients. NPJ Breast Cancer 2020; 6:49. [PMID: 33083528 PMCID: PMC7532157 DOI: 10.1038/s41523-020-00192-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 08/21/2020] [Indexed: 12/21/2022] Open
Abstract
Breast magnetic resonance imaging (MRI) delineates disease extent sensitively in newly diagnosed breast cancer patients, but improved cancer outcomes are uncertain. Young women, for whom mammography is less sensitive, are expected to benefit from MRI-based resection. We identified 512 women aged ≤50 years, undergoing breast-conserving treatment (BCT: tumor-free resection margins and radiotherapy) during 2006–2013 through Northwestern Medicine database queries; 64.5% received preoperative MRI and 35.5% did not. Tumor and treatment parameters were similar between groups. We estimated the adjusted hazard ratios (aHR) for local and distant recurrences (LR and DR), using multivariable regression models, accounting for important therapeutic and prognostic parameters. LR rate with MRI use was 7.9 vs. 8.2% without MRI, aHR = 1.03 (95% CI 0.53–1.99). DR rate was 6.4 vs. 6.6%, aHR = 0.89 (95% CI 0.43–1.84). In 119 women aged ≤40, results were similar to LR aHR = 1.82 (95% CI 0.43–7.76) and DR aHR = 0.93 (95% CI 0.26–3.34). Sensitivity analyses showed similar results. The use of preoperative MRI in women aged ≤50 years should be reconsidered until there is proof of benefit.
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Affiliation(s)
- Zexian Zeng
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL USA.,Department of Data Sciences, Dana-Farber Cancer Institute, Harvard T.H.Chan School of Public Health, Boston, MA USA
| | - Amanda Amin
- Department of Surgery, Kansas University Medical Center, Kansas City, KS USA
| | - Ankita Roy
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Natalie E Pulliam
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Lindsey C Karavites
- Department of Surgery, University of Illinois College of Medicine at Mt. Sinai Hospital, Chicago, IL USA
| | - Sasa Espino
- Department of Surgery, Kansas University Medical Center, Kansas City, KS USA
| | - Irene Helenowski
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | | | - Yuan Luo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Seema A Khan
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL USA
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14
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Imaging of Breast Cancers With Predilection for Nonmass Pattern of Growth: Invasive Lobular Carcinoma and DCIS-Does Imaging Capture It All? AJR Am J Roentgenol 2020; 215:1504-1511. [PMID: 33021831 DOI: 10.2214/ajr.19.22027] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE. Invasive lobular carcinoma (ILC) and ductal carcinoma in situ (DCIS) are distinct histopathologic entities with several commonalities: both have subtle clinical and imaging presentation, have been linked with controversy regarding optimal imaging techniques and management, and exemplify the codependence of adequate imaging evaluation and optimal treatment strategies in breast care. CONCLUSION. We review molecular mechanisms and histopathologic patterns that define the biologic behavior of both ILC and DCIS and discuss how these mechanisms translate into distinct clinical and imaging presentations that affect the staging workup and patient management algorithm.
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15
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Yoon J, Kim EK, Kim MJ, Moon HJ, Yoon JH, Park VY. Preoperative Magnetic Resonance Imaging Features Associated with Positive Resection Margins in Patients with Invasive Lobular Carcinoma. Korean J Radiol 2020; 21:946-954. [PMID: 32677379 PMCID: PMC7369210 DOI: 10.3348/kjr.2019.0674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To investigate preoperative magnetic resonance imaging (MRI) findings associated with resection margin status in patients with invasive lobular carcinoma (ILC) who underwent breast-conserving surgery. MATERIALS AND METHODS One hundred and one patients with ILC who underwent preoperative MRI were included. MRI (tumor size, multifocality, type of enhancing lesion, distribution of non-mass enhancement [NME], and degree of background parenchymal enhancement) and clinicopathological features (age, pathologic tumor size, presence of ductal carcinoma in situ [DCIS] or lobular carcinoma in situ, presence of lymph node metastases, and estrogen receptor/progesterone receptor/human epidermal growth factor receptor type 2 status) were analyzed. A positive resection margin was defined as the presence of invasive cancer or DCIS at the inked surface. Logistic regression analysis was performed to determine pre- and postoperative variables associated with positive resection margins. RESULTS Among the 101 patients, 21 (20.8%) showed positive resection margins. In the univariable analysis, NME, multifocality, axillary lymph node metastasis, and pathologic tumor size were associated with positive resection margins. With respect to preoperative MRI findings, multifocality (odds ratio [OR] = 3.977, p = 0.009) and NME (OR = 2.741, p = 0.063) were associated with positive resection margins in the multivariable analysis, although NME showed borderline significance. CONCLUSION In patients with ILC, multifocality and the presence of NME on preoperative breast MRI were associated with positive resection margins.
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MESH Headings
- Adult
- Aged
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Female
- Humans
- Lymphatic Metastasis/pathology
- Magnetic Resonance Imaging/methods
- Margins of Excision
- Mastectomy, Segmental/methods
- Middle Aged
- Retrospective Studies
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Affiliation(s)
- Jiyoung Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Vivian Y Park
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
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16
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Bae MS, Bernard-Davila B, Sung JS, Morris EA. Preoperative breast MRI features associated with positive or close margins in breast-conserving surgery. Eur J Radiol 2019; 117:171-177. [PMID: 31307644 DOI: 10.1016/j.ejrad.2019.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 05/31/2019] [Accepted: 06/11/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE To determine preoperative magnetic resonance imaging (MRI) features associated with positive or close margins in patients with breast cancer who underwent breast-conserving surgery (BCS). MATERIALS AND METHODS A retrospective review identified 249 patients with invasive ductal carcinoma (IDC) who underwent preoperative MRI and BCS as a primary procedure between 2008 and 2010. The MR images were reviewed for descriptions of findings with no new interpretations made. Margins were defined as positive (tumor touching the inked specimen margin), close (<2 mm tumor-free margin), or negative (≥2 mm tumor-free margin). Multivariate logistic regression analysis was performed to evaluate imaging and clinical factors predictive of positive or close margins. RESULTS Of the 249 patients, 83 (33.3%) had positive or close margins and 166 (66.7%) had negative margins on the initial BCS specimen. Multivariate analysis showed that multifocal disease (odds ratio, 4.8; 95% CI, 1.9-12.2; p = 0.001), nonmass enhancement lesion (odds ratio, 3.0; 95% CI, 1.5-6.2, p = 0.003), greater background parenchymal enhancement (odds ratio, 2.5; 95% CI, 1.1-5.6; p = 0.023), larger lesion size (odds ratio, 1.3; 95% CI, 1.0-1.7, p = 0.032), and presence of ductal carcinoma in situ on needle biopsy (odds ratio, 2.4; 95% CI, 1.3-4.6; p = 0.008) were independent predictors of positive or close margins. CONCLUSIONS Multifocal disease, nonmass enhancement lesion, or greater background parenchymal enhancement on preoperative breast MRI were significantly associated with positive or close margins. Identifying these MRI features before surgery can be helpful to reduce the reoperation rate in BCS.
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Affiliation(s)
- Min Sun Bae
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, United States.
| | - Blanca Bernard-Davila
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, United States.
| | - Janice S Sung
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, United States.
| | - Elizabeth A Morris
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, United States.
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17
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Mukherjee SD, Hodgson N, Lovrics PJ, Dhamanaskar K, Chambers S, Sussman J. Surgical attitudes toward preoperative breast magnetic resonance imaging in women with early-stage breast cancer. ACTA ACUST UNITED AC 2019; 26:e194-e201. [PMID: 31043827 DOI: 10.3747/co.26.4227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Preoperative breast magnetic resonance imaging (mri) is commonly requested by surgeons in the initial workup of women with breast cancer; however, its use is controversial. We performed a survey of breast cancer surgeons across Canada to investigate current knowledge about, attitudes to, and self-reported use of preoperative breast mri in a publicly funded health care system in light of the limited evidence to support it. Methods All identified general surgeons in Canada were mailed a survey instrument designed to probe current practice and knowledge of published trials. Results Of 403 responding surgeons, 233 (58%) indicated that they performed breast cancer surgery. Of those 233, 218 (94%) had access to breast mri and completed the entire survey. Overall, 54.6% of responding surgeons felt that breast mri was useful in surgical planning, and more than half (58.3%) indicated that their frequency of use was likely to increase over the next 5 years. Surgeons found preoperative mri most useful in detecting mammographically occult disease (71.5% of respondents) and in planning for breast-conserving surgery (57.3%). The main limitations reported were timely access to mri (51%) and false positives (36.7%). Responses suggest a knowledge gap in awareness of published trials in breast mri. Conclusions Our study found that, in early-stage breast cancer, self-reported use of mri by breast cancer surgeons in Canada varied widely. Reported indications did not align with published data, and significant gaps in self-reported knowledge of the data were evident. Our results would support the development and dissemination of guidelines to optimize use of mri.
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Affiliation(s)
| | - N Hodgson
- Juravinski Cancer Centre, Hamilton, ON.,Juravinski Hospital, Hamilton, ON
| | | | | | | | - J Sussman
- Juravinski Cancer Centre, Hamilton, ON.,McMaster University, Hamilton, ON
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18
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Ong E. Preoperative imaging for breast conservation surgery-do we need more than conventional imaging for local disease assessment? Gland Surg 2018; 7:554-559. [PMID: 30687628 DOI: 10.21037/gs.2018.08.05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Breast conservation surgery (BCS) is offered for early breast cancer. Conventional imaging with mammography and ultrasound would have been performed prior to surgery. This article considers other imaging modalities available [such as 3D tomosynthesis, magnetic resonance imaging (MRI), contrast-enhanced spectral mammography, positron emission mammography (PEM), breast-specific gamma imaging (BSGI) and cone beam computed tomography (CBCT)] and discusses the evidence for these in terms of diagnostic accuracy and clinical outcomes.
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Affiliation(s)
- Eugene Ong
- Diagnostic Radiology, Mount Elizabeth Novena Hospital, Singapore
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19
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IRM mammaire : une voie pour la désescalade thérapeutique ? IMAGERIE DE LA FEMME 2018. [DOI: 10.1016/j.femme.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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20
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Vijayaraghavan GR, Vedantham S, Santos-Nunez G, Hultman R. Unifocal Invasive Lobular Carcinoma: Tumor Size Concordance Between Preoperative Ultrasound Imaging and Postoperative Pathology. Clin Breast Cancer 2018; 18:e1367-e1372. [PMID: 30131246 DOI: 10.1016/j.clbc.2018.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/17/2018] [Accepted: 07/20/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND We systematically analyzed the extent of disease in unifocal invasive lobular carcinoma (ILC) using ultrasonography, with the histopathologic findings as the reference standard. PATIENTS AND METHODS In the present single-institution retrospective study, 128 cases of ILC were identified during a 5-year period. After exclusions, the analyzed cohort included 66 cases. Ultrasound measurements of the tumor extent along 3 axes were obtained. The tumor size was determined as the largest extent among the 3 axes and the tumor volume by ellipsoidal approximation. Pathology review provided the tumor size and volume. Correlation and regression analyses of tumor size and volume from the ultrasound and pathologic examinations were performed. The tumor stage from the ultrasound and pathologic examinations were used for the concordance analyses. RESULTS The median and quartiles (Q1, Q3) of tumor size from ultrasonography and pathology were 12.5 mm (Q1, 9 mm; Q3, 19 mm) and 17 mm (Q1, 12 mm; Q3, 25 mm), respectively. The corresponding data for tumor volume were 0.52 cm3 (Q1, 0.18 cm3; Q3, 1.92 cm3) and 1.04 cm3 (Q1, 0.45 cm3; Q3, 2.49 cm3). The ultrasound measurements correlated with the pathology-reported tumor size (Spearman ρ = 0.678; P < .0001) and volume (Spearman ρ = 0.699; P < .0001). The ultrasound-measured size and volume differed from the pathology-reported size and volume (P < .0001; Wilcoxon signed ranks test). Concordance between the clinical tumor size stage from ultrasound (cT) and pathology tumor size stage (pT) varied with the pT stage (P = .0003, Fisher's exact test), with the greatest concordance rate of 95.7% (95% confidence limit, 85.2%-99.5%) observed for pT1 tumors. CONCLUSION Ultrasonography underestimates the tumor size and volume, with the underestimation increasing for larger tumors. Hence, the concordance rate in tumor size stage between ultrasonography and pathology is tumor size dependent, with the greatest concordance rate observed for pT1 tumors.
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21
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Farrokh A, Maass N, Treu L, Heilmann T, Schäfer FK. Accuracy of tumor size measurement: comparison of B-mode ultrasound, strain elastography, and 2D and 3D shear wave elastography with histopathological lesion size. Acta Radiol 2018; 60:451-458. [PMID: 30043622 DOI: 10.1177/0284185118787354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Predicting the exact extent of a breast tumor is of great importance for oncologic treatment strategies. Different types of elastography can be used as new tools for measuring lesion size. PURPOSE To provide evidence regarding the accuracy of tumor size measurement of strain elastography (SE), two-dimensional (2D) and three-dimensional (3D) shear wave elastography (SWE), and conventional B-image ultrasound. MATERIAL AND METHODS In this prospective study, the diameter of 105 malignant breast lesions was measured by SE, 2D and 3D SWE, and B-mode ultrasound. The histopathological lesion size was compared to all imaging-based measuring methods. RESULTS The mean lesion size of all breast carcinomas was 1.54 cm. B-mode ultrasound underestimates breast cancer size in 65.7 % of all cases in this study ( P < 0.0001). Mean lesion size was more accurately determined by SE, 2D and 3D SWE compared to B-mode ultrasound. Absolute differences between measured and actual lesion are smaller for B-mode ultrasound (0.26 cm) than for SE (0.41 cm) and 2D and 3D SWE (0.41 cm and 0.44 cm, respectively). CONCLUSION B-mode ultrasound allows more accurate lesion size measurement than SE and 2D or 3D SWE but has a significantly higher risk of underestimating tumor size which could lead to incomplete margins during surgery. 3D SWE was not superior to 2D SWE or SE but by trend more precise in predicting the size of invasive lobular carcinoma.
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Affiliation(s)
- André Farrokh
- 1 Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Nicolai Maass
- 1 Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Linn Treu
- 3 Department of Gynecology and Obstetrics, Imland Klinik Rendsburg, Rendsburg, Germany
| | - Thorsten Heilmann
- 1 Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Fritz Kw Schäfer
- 2 Breast Imaging and Interventions, Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Kiel, Germany
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22
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Selvi V, Nori J, Meattini I, Francolini G, Morelli N, Di Benedetto D, Bicchierai G, Di Naro F, Gill MK, Orzalesi L, Sanchez L, Susini T, Bianchi S, Livi L, Miele V. Role of Magnetic Resonance Imaging in the Preoperative Staging and Work-Up of Patients Affected by Invasive Lobular Carcinoma or Invasive Ductolobular Carcinoma. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1569060. [PMID: 30046588 PMCID: PMC6038675 DOI: 10.1155/2018/1569060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 05/22/2018] [Accepted: 06/03/2018] [Indexed: 01/06/2023]
Abstract
Purpose The prevalence of invasive lobular carcinoma (ILC), the second most common type of breast cancer, accounts for 5%-15% of all invasive breast cancer cases. Its histological feature to spread in rows of single cell layers explains why it often fails to form a palpable lesion and the lack of sensitivity of mammography and ultrasound (US) to detect it. It also has a higher incidence of multifocal, multicentric, and contralateral disease when compared to the other histological subtypes. The clinicopathologic features and outcomes of Invasive Ductolobular Carcinoma (IDLC) are very similar to the ILC. The purpose of our study is to assess the importance of MRI in the preoperative management and staging of patients affected by ILC or IDLC. Materials and Methods We identified women diagnosed with ILC or IDLC. We selected the patients who had preoperative breast MRI. For each patient we identified the areas of multifocal, multicentric, or contralateral disease not visible to standard exams and detected by preoperative MRI. We analyzed the potential correlation between additional cancer areas and histological cancer markers. Results Of the 155 women who met our inclusion criteria, 93 (60%) had additional cancer areas detected by MRI. In 61 women, 39,4% of the overall population, the additional cancer areas were confirmed by US/tomosynthesis second look and biopsy. Presurgical MRI staging changed surgical management in the 37,4% of the patients. Only six patients of the overall population needed a reoperation after the initial surgery. No statistically significant correlation was found between MRI overestimation and the presence of histological peritumoral vascular/linfatic invasion. No statistically significant correlation was found between additional cancer areas and histological cancer markers. Conclusions Our study suggests that MRI is an important tool in the preoperative management and staging of patients affected by lobular or ductolobular invasive carcinoma.
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Affiliation(s)
- Valeria Selvi
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Icro Meattini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Noemi Morelli
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Diego Di Benedetto
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Federica Di Naro
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | | | - Lorenzo Orzalesi
- Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Luis Sanchez
- Breast Surgery Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Tommaso Susini
- Department of Gynecology, Perinatology and Human Reproduction, University of Florence, Florence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
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23
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Ha SM, Chae EY, Cha JH, Kim HH, Shin HJ, Choi WJ. Breast MR Imaging before Surgery: Outcomes in Patients with Invasive Lobular Carcinoma by Using Propensity Score Matching. Radiology 2018; 287:771-777. [DOI: 10.1148/radiol.2018171472] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Su Min Ha
- From the Department of Radiology, Research Institute of Radiology, Chung-Ang University Hospital, Seoul, Korea (S.M.H.); and Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul 05505, Korea (E.Y.C., J.H.C., H.H.K., H.J.S., W.J.C.)
| | - Eun Young Chae
- From the Department of Radiology, Research Institute of Radiology, Chung-Ang University Hospital, Seoul, Korea (S.M.H.); and Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul 05505, Korea (E.Y.C., J.H.C., H.H.K., H.J.S., W.J.C.)
| | - Joo Hee Cha
- From the Department of Radiology, Research Institute of Radiology, Chung-Ang University Hospital, Seoul, Korea (S.M.H.); and Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul 05505, Korea (E.Y.C., J.H.C., H.H.K., H.J.S., W.J.C.)
| | - Hak Hee Kim
- From the Department of Radiology, Research Institute of Radiology, Chung-Ang University Hospital, Seoul, Korea (S.M.H.); and Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul 05505, Korea (E.Y.C., J.H.C., H.H.K., H.J.S., W.J.C.)
| | - Hee Jung Shin
- From the Department of Radiology, Research Institute of Radiology, Chung-Ang University Hospital, Seoul, Korea (S.M.H.); and Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul 05505, Korea (E.Y.C., J.H.C., H.H.K., H.J.S., W.J.C.)
| | - Woo Jung Choi
- From the Department of Radiology, Research Institute of Radiology, Chung-Ang University Hospital, Seoul, Korea (S.M.H.); and Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul 05505, Korea (E.Y.C., J.H.C., H.H.K., H.J.S., W.J.C.)
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Abstract
Breast magnetic resonance imaging (MRI) is the most sensitive of the available imaging modalities to characterize breast cancer. Breast MRI has gained clinical acceptance for screening high-risk patients, but its role in the preoperative imaging of breast cancer patients remains controversial. This review focuses on the current indications for staging breast MRI, the evidence for and against the role of breast MRI in the preoperative staging workup, and the evaluation of treatment response of breast cancer patients.
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Evaluating the Impact of Breast Density on Preoperative MRI in Invasive Lobular Carcinoma. J Am Coll Surg 2018; 226:925-932. [DOI: 10.1016/j.jamcollsurg.2018.01.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 11/17/2022]
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Henderson LM, Hubbard RA, Zhu W, Weiss J, Wernli KJ, Goodrich ME, Kerlikowske K, DeMartini W, Ozanne EM, Onega T. Preoperative Breast Magnetic Resonance Imaging Use by Breast Density and Family History of Breast Cancer. J Womens Health (Larchmt) 2018; 27:987-993. [PMID: 29334616 DOI: 10.1089/jwh.2017.6428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Use of preoperative breast magnetic resonance imaging (MRI) among women with a new breast cancer has increased over the past decade. MRI use is more frequent in younger women and those with lobular carcinoma, but associations with breast density and family history of breast cancer are unknown. MATERIALS AND METHODS Data for 3075 women ages >65 years with stage 0-III breast cancer who underwent breast conserving surgery or mastectomy from 2005 to 2010 in the Breast Cancer Surveillance Consortium were linked to administrative claims data to assess associations of preoperative MRI use with mammographic breast density and first-degree family history of breast cancer. Multivariable logistic regression estimated adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for the association of MRI use with breast density and family history, adjusting for woman and tumor characteristics. RESULTS Overall, preoperative MRI use was 16.4%. The proportion of women receiving breast MRI was similar by breast density (17.6% dense, 16.9% nondense) and family history (17.1% with family history, 16.5% without family history). After adjusting for potential confounders, we found no difference in preoperative MRI use by breast density (OR = 0.95 for dense vs. nondense, 95% CI: 0.73-1.22) or family history (OR = 0.99 for family history vs. none, 95% CI: 0.73-1.32). CONCLUSIONS Among women aged >65 years with breast cancer, having dense breasts or a first-degree relative with breast cancer was not associated with greater preoperative MRI use. This utilization is in keeping with lack of evidence that MRI has higher yield of malignancy in these subgroups.
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Affiliation(s)
- Louise M Henderson
- 1 Department of Radiology, The University of North Carolina , Chapel Hill, North Carolina
| | - Rebecca A Hubbard
- 2 Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Weiwei Zhu
- 3 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Julie Weiss
- 4 Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire
| | - Karen J Wernli
- 3 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Martha E Goodrich
- 4 Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire
| | - Karla Kerlikowske
- 5 Departments of Medicine and Epidemiology and Biostatistics, University of California , San Francisco, San Francisco, California
| | - Wendy DeMartini
- 6 Department of Radiology, Stanford University , Stanford, California
| | - Elissa M Ozanne
- 7 Department of Population Health Sciences, University of Utah School of Medicine , Salt Lake City, Utah
| | - Tracy Onega
- 8 The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center , Geisel School of Medicine at Dartmouth, Lebanon , New Hampshire
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Hlubocky J, Bhavnagri S, Swinford A, Mitri C, Rebner M, Pai V. Does the use of pretreatment MRI change the management of patients with newly diagnosed breast cancer? Breast J 2017; 24:309-313. [PMID: 29105963 DOI: 10.1111/tbj.12946] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 04/08/2017] [Accepted: 04/11/2017] [Indexed: 11/27/2022]
Abstract
Breast MRI plays a critical role in the diagnosis and management of breast cancer. The purpose of this study is to evaluate the effect of preoperative breast MRI on the management of a large cohort of breast cancer patients at our institution. This study is a retrospective chart review of all newly diagnosed breast cancer patients who underwent preoperative breast MRI at our institution between January 1, 2004 and December 31, 2009. 1352 patients comprised the study population. 241 (17.8%) patients underwent a change in surgical management as a result of preoperative MRI. Patients with tumors in the lower inner quadrant and the central breast and those with pathology of invasive lobular carcinoma were significantly more likely to have their management changed by preoperative MRI. There was also a significant trend for larger tumors to be associated with a change in surgical management. No statistically significant association was found between breast density and change in management. This study supports the recommendation for the use of preoperative breast MRI in the majority of newly diagnosed breast cancer patients, especially those with larger tumors, pathology of invasive lobular carcinoma, and tumors in the lower inner quadrant. Preoperative breast MRI is a useful tool for the evaluation of additional disease that led to a change in the surgical management of 17.8% of patients.
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Monticciolo DL. Practical Considerations for the Use of Breast MRI for Breast Cancer Evaluation in the Preoperative Setting. Acad Radiol 2017. [PMID: 28647387 DOI: 10.1016/j.acra.2017.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Preoperative contrast-enhanced (CE) breast magnetic resonance imaging (MRI) remains controversial in the newly diagnosed breast cancer patient. Additional lesions are frequently discovered in these patients with CE breast MRI. As staging and treatment planning evolve to include more information on tumor biology and aggression, so should our consideration of extent of disease. Directing CE breast MRI to those patients most likely to have additional disease may be beneficial. We sought to develop practical guidance for the use of preoperative CE breast MRI in the newly diagnosed breast cancer patient based on recent scientific data. Our review suggests several populations for whom preoperative breast MRI is most likely to find additional disease beyond that seen on conventional imaging. These can be viewed in three categories: (1) tumor biology-patients with invasive lobular carcinoma or aggressive tumors such as triple negative breast cancer (estrogen receptor negative, progesterone receptor negative, and human epidermal growth factor receptor 2 (HER2) negative) and HER2 positive tumors; (2) patient characteristics-dense breast tissue or younger age, especially those age <60; and (3) clinical scenarios-patients with more sonographic disease than expected or those who are node positive at initial diagnosis. Focusing breast MRI on patients with any of the aforementioned characteristics may help utilize preoperative breast MRI where it is likely to have the most impact.
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Dratwa C, Sebbag-Sfez D, Thibault F. IRM du sein dans le carcinome lobulaire infiltrant : aspects diagnostiques, bilan préthérapeutique, évaluation sous hormono- ou chimio-néo-adjuvante. IMAGERIE DE LA FEMME 2017. [DOI: 10.1016/j.femme.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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30
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Yang M, Bao W, Zhang X, Kang Y, Haffty B, Zhang L. Short-term and long-term clinical outcomes of uncommon types of invasive breast cancer. Histopathology 2017; 71:874-886. [DOI: 10.1111/his.13328] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/21/2017] [Accepted: 07/24/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Mu Yang
- Department of Pathology; University Medical Center of Princeton; Plainsboro NJ UK
| | - Wei Bao
- Department of Epidemiology; College of Public Health; University of Iowa; Iowa City; IA USA
| | - Xinmin Zhang
- Department of Pathology; Cooper University Hospital; Camden NJ USA
| | - Yibin Kang
- Department of Molecular Biology; Princeton University; Princeton NJ USA
| | - Bruce Haffty
- Rutgers Cancer Institute of New Jersey; New Brunswick NJ USA
| | - Lanjing Zhang
- Department of Pathology; University Medical Center of Princeton; Plainsboro NJ UK
- Rutgers Cancer Institute of New Jersey; New Brunswick NJ USA
- Department of Biological Sciences; Rutgers University; Newark NJ USA
- Department of Chemical Biology; Ernest Mario School of Pharmacy, Rutgers University; Piscataway NJ USA
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Houssami N, Turner RM, Morrow M. Meta-analysis of pre-operative magnetic resonance imaging (MRI) and surgical treatment for breast cancer. Breast Cancer Res Treat 2017; 165:273-283. [PMID: 28589366 PMCID: PMC5580248 DOI: 10.1007/s10549-017-4324-3] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/29/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Although there is no consensus on whether pre-operative MRI in women with breast cancer (BC) benefits surgical treatment, MRI continues to be used pre-operatively in practice. This meta-analysis examines the association between pre-operative MRI and surgical outcomes in BC. METHODS A systematic review was performed to identify studies reporting quantitative data on pre-operative MRI and surgical outcomes (without restriction by type of surgery received or type of BC) and using a controlled design. Random-effects logistic regression calculated the pooled odds ratio (OR) for each surgical outcome (MRI vs. no-MRI groups), and estimated ORs stratified by study-level age. Subgroup analysis was performed for invasive lobular cancer (ILC). RESULTS Nineteen studies met eligibility criteria: 3 RCTs and 16 comparative studies that included newly diagnosed BC of any type except for three studies restricted to ILC. Primary analysis (85,975 subjects) showed that pre-operative MRI was associated with increased odds of receiving mastectomy [OR 1.39 (1.23, 1.57); p < 0.001]; similar findings were shown in analyses stratified by study-level median age. Secondary analyses did not find statistical evidence of an effect of MRI on the rates of re-excision, re-operation, or positive margins; however, MRI was significantly associated with increased odds of receiving contralateral prophylactic mastectomy [OR 1.91 (1.25, 2.91); p = 0.003]. Subgroup analysis for ILC did not find any association between MRI and the odds of receiving mastectomy [OR 1.00 (0.75, 1.33); p = 0.988] or the odds of re-excision [OR 0.65 (0.35, 1.24); p = 0.192]. CONCLUSIONS Pre-operative MRI is associated with increased odds of receiving ipsilateral mastectomy and contralateral prophylactic mastectomy as surgical treatment in newly diagnosed BC patients.
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Affiliation(s)
- Nehmat Houssami
- Sydney School of Public Health (A27), Sydney Medical School, University of Sydney, Sydney, 2006, Australia.
| | - Robin M Turner
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Greenwood HI, Freimanis RI, Carpentier BM, Joe BN. Clinical Breast Magnetic Resonance Imaging: Technique, Indications, and Future Applications. Semin Ultrasound CT MR 2017; 39:45-59. [PMID: 29317039 DOI: 10.1053/j.sult.2017.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Breast magnetic resonance imaging (MRI) is the most sensitive imaging modality for the detection of breast cancer, and it is indicated for breast cancer screening in patients at high-risk of developing breast cancer. It is limited to this group given the high cost. In addition, breast MRI is also indicated for evaluating the extent of disease in patients with new breast cancer diagnoses, monitoring the response to neoadjuvant treatment, and evaluating implant integrity. New promising innovations in breast MRI include fast abbreviated MRI, and functional techniques including diffusion-weighted imaging and magnetic resonance spectroscopy are promising particularly as regards to treatment response.
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Affiliation(s)
- Heather I Greenwood
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA.
| | - Rita I Freimanis
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Bianca M Carpentier
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Bonnie N Joe
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
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Morrow M, Hawley ST, McLeod MC, Hamilton AS, Ward KC, Katz SJ, Jagsi R. Surgeon Attitudes and Use of MRI in Patients Newly Diagnosed with Breast Cancer. Ann Surg Oncol 2017; 24:1889-1896. [PMID: 28332033 PMCID: PMC5784437 DOI: 10.1245/s10434-017-5840-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Usage of magnetic resonance imaging (MRI) in newly diagnosed breast cancer patients is increasing, despite scant evidence that it improves outcomes. Little is known about the knowledge, perspectives, and clinical characteristics of surgeons associated with MRI use. METHODS Women with early-stage breast cancer undergoing definitive surgery between July 2013 and August 2015 were identified from the Los Angeles and Georgia Surveillance, Epidemiology and End Results (SEER) registries and were asked to name their attending surgeons. The 489 surgeons were sent a questionnaire; 77% (n = 377) responded. Questions that addressed the likelihood of ordering an MRI in different scenarios were used to create a scale to measure surgeon propensity for MRI use. Knowledge and practice characteristics also were assessed. RESULTS Mean surgeon age was 54 years, 25% were female, and median number of years in practice was 21. Wide MRI use variation was observed, with 26% obtaining MRI for a clinical stage I screen-detected breast cancer and 72% for infiltrating lobular cancer. High users of MRI were significantly more likely to be higher-volume surgeons (p < 0.001) and to have misconceptions about MRI benefits (p < 0.001). Of surgeons who felt they used MRI more often, 60% were high MRI users; only 6% were low MRI users. CONCLUSIONS Our findings suggest relatively frequent use of MRI, even in uncomplicated clinical scenarios, in the absence of evidence of benefit, and use was more common among high-volume surgeons. A substantial number of surgeons who are high MRI users harbor misconceptions about MRI benefit, suggesting an opportunity for education and consensus building regarding appropriate use.
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Affiliation(s)
- Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Sarah T Hawley
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Veterans Administration Center for Clinical Management Research, Ann Arbor VA Health Care System, Ann Arbor, MI, USA
| | - M Chandler McLeod
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Steven J Katz
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Reshma Jagsi
- Department of Radiation Oncology, School of Medicine, University of Michigan, Ann Arbor, MI, USA
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35
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Tseng J, Kyrillos A, Liederbach E, Spear GG, Ecanow J, Wang CH, Czechura T, Kantor O, Miller M, Winchester DJ, Pesce CE, Rabbitt S, Yao K. Clinical accuracy of preoperative breast MRI for breast cancer. J Surg Oncol 2017; 115:924-931. [PMID: 28409837 DOI: 10.1002/jso.24616] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 02/12/2017] [Accepted: 02/18/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND It is unclear if breast magnetic resonance imaging (MRI) is more accurate than mammography (MGM) and ultrasound (U/S) in aggregate for patients with invasive cancer. METHODS We compared concordance of combined tumor size and tumor foci between MRI and MGM and U/S combined to pathological tumor size and foci as the gold standard from 2009 to 2015. Tumor size was nonconcordant if it differed from the pathologic size by ≥33% and tumor foci was nonconcordant if >1 foci were seen. If one or both of the MGM or U/S was nonconcordant and the MRI was concordant, MRI provided greater accuracy. RESULTS Of 471 patients with MGM, US, and MRI, MRI was more accurate for 32.9% of patients for tumor size and for 21.9% for tumor foci. Patients for whom MRI had greater accuracy were compared to those who did not for clinical and tumor factors. The only significant factor was calcifications on mammography. Tumor size, stage, molecular subtype, histology, grade, patient BMI, age, mammographic density, and use of hormone replacement therapy were not significantly different. CONCLUSIONS Breast MRI provides greater accuracy for a third of patients undergoing preoperative MGM and U/S. Mammographic calcifications were associated with MRI clinical accuracy for patients with invasive cancer.
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Affiliation(s)
- Jennifer Tseng
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Alexandra Kyrillos
- Department of Surgery, NorthShore University Health System, Evanston, Illinois
| | - Erik Liederbach
- Department of Surgery, NorthShore University Health System, Evanston, Illinois
| | - Georgia G Spear
- Department of Radiology, NorthShore University Health System, Evanston, Illinois
| | - Jacob Ecanow
- Department of Radiology, NorthShore University Health System, Evanston, Illinois
| | - Chi-Hsiung Wang
- Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, Illinois
| | - Tom Czechura
- Department of Surgery, NorthShore University Health System, Evanston, Illinois
| | - Olga Kantor
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Megan Miller
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - David J Winchester
- Department of Surgery, NorthShore University Health System, Evanston, Illinois
| | - Catherine E Pesce
- Department of Surgery, NorthShore University Health System, Evanston, Illinois
| | - Sarah Rabbitt
- Department of Surgery, NorthShore University Health System, Evanston, Illinois
| | - Katharine Yao
- Department of Surgery, NorthShore University Health System, Evanston, Illinois
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Preoperative Breast MRI: Surgeons' Patient Selection Patterns and Potential Bias in Outcomes Analyses. AJR Am J Roentgenol 2017; 208:923-932. [DOI: 10.2214/ajr.16.17038] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kim OH, Kim SJ, Lee JS. Enhancing patterns of breast cancer on preoperative dynamic contrast-enhanced magnetic resonance imaging and resection margin in breast conserving therapy. Breast Dis 2017; 36:27-35. [PMID: 27177341 DOI: 10.3233/bd-150195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The association between enhancing patterns of preoperative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and resection margins after BCS has not been studied in detail before. OBJECTIVE We investigated the association between surgical outcomes and enhancing patterns observed on DCE-MRI. METHODS 269 enhancing patterns on DCE-MRI scans were selected, and subdivided into the following groups: (1) a single mass-like enhancement, (2) a single non-mass-like enhancement (NME), (3) mass-like enhancing breast cancer with other mass-like enhancing lesions, and (4) mass-like enhancing breast cancer with additional NMEs. Associations between enhancing patterns on DCE-MRI and re-excision rate, size of specimen, and ratio of tumor/specimen were evaluated retrospectively. RESULTS The conversion rate from breast conserving therapy (BCT) to mastectomy as a result of MRI findings was 13.4%, re-excision rate during BCT was 8.2% and excision rate of another suspicious lesion was 7.4%. The single NME group had the highest re-excision rate after BCT (22.2%) (p = 0.02). The ratio of tumor/specimen (p = 0.61) and mean specimen size (p = 0.38) were not influenced by enhancement patterns. The false positive rate and positive predictive values of using DCE-MRI for defining the extension of breast cancer was 22.2% and 71.4%, respectively. CONCLUSION Enhancement patterns on DCE- MRI, especially NME, could increase re-excision rates.
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Affiliation(s)
- Ok Hwa Kim
- Department of Diagnostic Radiology, College of Medicine, Sungkyunkwan University, Samsungchangwon hospital, Changwon, Korea
| | - Suk Jung Kim
- Department of Diagnostic Radiology, College of Medicine, Inje University, Busan, Korea
| | - Jung Sun Lee
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Korea
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Bae MS, Lee SH, Chu AJ, Shin SU, Ryu HS, Moon WK. Preoperative MR Imaging in Women with Breast Cancer Detected at Screening US. Radiology 2017; 282:681-689. [DOI: 10.1148/radiol.2016160706] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Min Sun Bae
- From the Departments of Radiology (M.S.B., S.H.L., S.U.S., W.K.M.) and Pathology (H.S.R.), Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; and Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea (A.J.C.)
| | - Su Hyun Lee
- From the Departments of Radiology (M.S.B., S.H.L., S.U.S., W.K.M.) and Pathology (H.S.R.), Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; and Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea (A.J.C.)
| | - A Jung Chu
- From the Departments of Radiology (M.S.B., S.H.L., S.U.S., W.K.M.) and Pathology (H.S.R.), Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; and Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea (A.J.C.)
| | - Sung Ui Shin
- From the Departments of Radiology (M.S.B., S.H.L., S.U.S., W.K.M.) and Pathology (H.S.R.), Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; and Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea (A.J.C.)
| | - Han Suk Ryu
- From the Departments of Radiology (M.S.B., S.H.L., S.U.S., W.K.M.) and Pathology (H.S.R.), Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; and Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea (A.J.C.)
| | - Woo Kyung Moon
- From the Departments of Radiology (M.S.B., S.H.L., S.U.S., W.K.M.) and Pathology (H.S.R.), Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; and Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea (A.J.C.)
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Ozanne EM, Weiss JE, Onega T, DeMartini W, Kerlikowske K, Buist DSM, Henderson L, Hubbard RA, Goodrich M, Tosteson ANA, Virnig BA, O'Donoghue C. Locoregional treatment of breast cancer in women with and without preoperative magnetic resonance imaging. Am J Surg 2016; 213:132-139.e2. [PMID: 27421187 DOI: 10.1016/j.amjsurg.2016.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 03/16/2016] [Accepted: 03/31/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Preoperative magnetic resonance imaging (MRI) use has increased among older women diagnosed with breast cancer. MRI detects additional malignancy, but its impact on locoregional surgery and radiation treatment remains unclear. METHODS We examined the associations of preoperative MRI with initial locoregional treatment type (mastectomy, breast conserving surgery [BCS] with radiation therapy [RT], and BCS without RT) and BCS reoperation rates for Surveillance, Epidemiology, and End Results Medicare women diagnosed with stages 0 to III breast cancer from 2005 to 2009 (n = 55,997). RESULTS We found no association of initial locoregional treatment of mastectomy (odds ratios [OR], 1.04; 95% confidence intervals, .98 to 1.11) or reoperation after initial BCS (OR, .96; 95% confidence intervals, .89 to 1.03) between women with preoperative MRI (16.2%) compared to women without MRI. However, women with MRI who had initial BCS were more likely to undergo RT (OR, 1.09 [1.02 to 1.16]). CONCLUSIONS Preoperative breast MRI in Medicare-enrolled women with stages 0 to III breast cancer was not associated with increased mastectomy. However, in older women with MRI undergoing BCS, there was a greater use of RT.
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Affiliation(s)
- Elissa M Ozanne
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Julie E Weiss
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Suite 105, Lebanon, NH 03766, USA.
| | - Tracy Onega
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Suite 105, Lebanon, NH 03766, USA
| | - Wendy DeMartini
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Karla Kerlikowske
- Department of Medicine, University of California, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Diana S M Buist
- Department of Epidemiology, Group Health Research Institute, Seattle, WA, USA
| | - Louise Henderson
- Department of Radiology, The University of North Carolina, Chapel Hill, NC, USA
| | - Rebecca A Hubbard
- Department of Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Martha Goodrich
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Suite 105, Lebanon, NH 03766, USA
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Beth A Virnig
- Department of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Cristina O'Donoghue
- Department of Surgical Oncology, Surgical Oncology, Moffitt Cancer Center, Tampa, FL, USA
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40
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Zheng T, Zhang X, Wang Y, Yu X. Predicting associations between microRNAs and target genes in breast cancer by bioinformatics analyses. Oncol Lett 2016; 12:1067-1073. [PMID: 27446395 DOI: 10.3892/ol.2016.4731] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 05/26/2016] [Indexed: 11/06/2022] Open
Abstract
Breast cancer is the leading type of cancer among females. However, the association between microRNAs (miRNAs) and target genes in breast tumorigenesis is poorly studied. The original data set GSE26659 was downloaded from the Gene Expression Omnibus, and then the differentially expressed miRNAs among 77 breast cancer patients and 17 controls were identified using the Limma package in R software. Furthermore, breast cancer-related differentially expressed miRNAs were selected from a human miRNA disease database and their target genes were selected from five miRNA databases. Then, functional analysis was performed for the target genes followed by construction of a miRNA-target gene network. A total of 34 differentially expressed miRNAs were identified, including 13 breast cancer-related miRNAs. Moreover, the target genes of the 13 miRNAs were significantly enriched in regulation of transcription (P=7.43E-09) and pathways related to cancer (P=3.33E-11). Finally, eight upregulated miRNAs (including hsa-miR-425) and five downregulated miRNAs (including hsa-miR-143, hsa-miR-145 and hsa-miR-125b) were identified in the miRNA-target gene network. In conclusion, using bioinformatics approaches, we demonstrate that the changes in regulation of transcription and cancer pathways may play significant roles in the process of breast cancerogenesis. Differentially expressed miRNAs and their target genes may be new targets for breast cancer therapy.
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Affiliation(s)
- Tianying Zheng
- Department of Chemotherapy, Cancer Center, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Xing Zhang
- Department of Chemotherapy, Cancer Center, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Yonggang Wang
- Department of Chemotherapy, Cancer Center, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Xiucui Yu
- Department of Chemotherapy, Cancer Center, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
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41
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Derias M, Subramanian A, Allan S, Shah E, Teraifi HE, Howlett D. The Role of Magnetic Resonance Imaging in the Investigation and Management of Invasive Lobular Carcinoma-A 3-Year Retrospective Study in Two District General Hospitals. Breast J 2016; 22:384-9. [DOI: 10.1111/tbj.12594] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Mina Derias
- Breast Surgery Department - East Sussex Healthcare NHS Trust; Eastbourne District General Hospital; Eastbourne UK
| | - Ashok Subramanian
- Breast Surgery Department - East Sussex Healthcare NHS Trust; Eastbourne District General Hospital; Eastbourne UK
| | - Simon Allan
- Breast Surgery Department - East Sussex Healthcare NHS Trust; Eastbourne District General Hospital; Eastbourne UK
| | - Elizabeth Shah
- Breast Surgery Department - East Sussex Healthcare NHS Trust; Eastbourne District General Hospital; Eastbourne UK
| | - Hassan El Teraifi
- Histopathology Department - East Sussex Healthcare NHS Trust; Eastbourne District General Hospital; Eastbourne UK
| | - David Howlett
- Radiology Department - East Sussex Healthcare NHS Trust; Eastbourne District General Hospital; Eastbourne UK
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42
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Sinclair K, Sakellariou S, Dawson N, Litherland J. Does preoperative breast MRI significantly impact on initial surgical procedure and re-operation rates in patients with screen-detected invasive lobular carcinoma? Clin Radiol 2016; 71:543-50. [DOI: 10.1016/j.crad.2016.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 03/10/2016] [Accepted: 03/15/2016] [Indexed: 11/30/2022]
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43
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44
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Kerger AL, Stamatis TA. Contributions and Controversies of Preoperative DCE-Breast MRI. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0143-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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45
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Savaridas SL, Bristow GD, Cox J. Invasive Lobular Cancer of the Breast: A Pictorial Essay of Imaging Findings on Mammography, Sonography, and Magnetic Resonance Imaging. Can Assoc Radiol J 2016; 67:263-76. [PMID: 27038644 DOI: 10.1016/j.carj.2015.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 09/04/2015] [Accepted: 09/07/2015] [Indexed: 11/25/2022] Open
Affiliation(s)
- Sarah L Savaridas
- North Tyneside General Hospital, North Shields, Tyne and Wear, United Kingdom
| | - Garry D Bristow
- North Tyneside General Hospital, North Shields, Tyne and Wear, United Kingdom
| | - Julie Cox
- Sunderland Royal Hospital, Sunderland, Tyne and Wear, United Kingdom.
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46
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Yngvesson SK, Karellas A, Glick S, Khan A, Siqueira PR, Kelly PA, St. Peter B. Breast cancer margin detection with a single frequency terahertz imaging system. ACTA ACUST UNITED AC 2016. [DOI: 10.1117/12.2216385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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47
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Parvaiz MA, Yang P, Razia E, Mascarenhas M, Deacon C, Matey P, Isgar B, Sircar T. Breast
MRI
in Invasive Lobular Carcinoma: A Useful Investigation in Surgical Planning? Breast J 2016; 22:143-50. [PMID: 26841281 DOI: 10.1111/tbj.12566] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Muhammad Asad Parvaiz
- Department of Breast & Oncoplastic Surgery Peterborough and Stamford Hospitals NHS Foundation Trust Peterborough Cambridgeshire UK
| | - Peiming Yang
- Department of Breast & Oncoplastic Surgery The Royal Wolverhampton Hospitals NHS Trust West Midlands UK
| | - Eisha Razia
- Department of Breast & Oncoplastic Surgery The Royal Wolverhampton Hospitals NHS Trust West Midlands UK
| | - Margaret Mascarenhas
- Department of Breast & Oncoplastic Surgery The Royal Wolverhampton Hospitals NHS Trust West Midlands UK
| | - Caroline Deacon
- Department of Radiology The Royal Wolverhampton Hospitals NHS Trust West Midlands UK
| | - Pilar Matey
- Department of Breast & Oncoplastic Surgery The Royal Wolverhampton Hospitals NHS Trust West Midlands UK
| | - Brian Isgar
- Department of Breast & Oncoplastic Surgery The Royal Wolverhampton Hospitals NHS Trust West Midlands UK
| | - Tapan Sircar
- Department of Breast & Oncoplastic Surgery The Royal Wolverhampton Hospitals NHS Trust West Midlands UK
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48
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Vos EL, Voogd AC, Verhoef C, Siesling S, Obdeijn IM, Koppert LB. Benefits of preoperative MRI in breast cancer surgery studied in a large population-based cancer registry. Br J Surg 2015; 102:1649-57. [DOI: 10.1002/bjs.9947] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/09/2015] [Accepted: 08/20/2015] [Indexed: 11/06/2022]
Abstract
Abstract
Background
Although evidence for the benefits of preoperative MRI in breast cancer is lacking, use of MRI is increasing and characterized by large interhospital variation. The aim of the study was to evaluate MRI use and surgical outcomes retrospectively.
Methods
Women with invasive breast cancer (pT1–3) or ductal carcinoma in situ (DCIS), diagnosed in 2011–2013, were selected from the Netherlands Cancer Registry and subdivided into the following groups: invasive cancer, high-grade DCIS, non-palpable cancer, age 40 years or less, and invasive lobular cancer. Associations between preoperative MRI use and initial mastectomy, resection margin after breast-conserving surgery (BCS), re-excision after BCS, and final mastectomy were analysed.
Results
In total, 5514 women were included in the study; 1637 (34·1 per cent) of 4801 women with invasive cancer and 150 (21·0 per cent) of 713 with DCIS had preoperative MRI. Positive resection margins were found in 18·1 per cent women who had MRI and in 15·1 per cent of those who did not (adjusted odds ratio (OR) 1·20, 95 per cent c.i. 1·00 to 1·45), with no differences in subgroups. Re-excision rates were 9·8 per cent in the MRI group and 7·2 per cent in the no-MRI group (adjusted OR 1·33, 1·04 to 1·70), with no differences in subgroups. In the MRI group, 38·8 per cent of patients ultimately underwent mastectomy, compared with 24·2 per cent in the no-MRI group (adjusted OR 2·13, 1·87 to 2·41). This difference was not found for patients aged 40 years or less, or for those diagnosed with lobular cancer.
Conclusion
No subgroup was identified in which preoperative MRI influenced the risk of margin involvement or re-excision rate after BCS. MRI was significantly associated with more extensive surgery, except in patients aged 40 years or less and those with invasive lobular cancer. These results suggest that use of preoperative MRI should be more targeted, and that general, widespread use be discouraged.
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Affiliation(s)
- E L Vos
- Departments of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - A C Voogd
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - C Verhoef
- Departments of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - S Siesling
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
- Department of Health Technology and Services Research, MIRA Institute of Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - I M Obdeijn
- Departments of Radiology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - L B Koppert
- Departments of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Patel BK, Shah NA, Galgano SJ, Newell M, Wang Z, Chen Z, D'Orsi CJ. Does Preoperative MRI Workup Affect Mastectomy Rates and/or Re-excision Rates in Patients with Newly Diagnosed Breast Carcinoma? A Retrospective Review. Breast J 2015; 21:604-9. [DOI: 10.1111/tbj.12490] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Bhavika K. Patel
- Emory University School of Medicine; Department of Radiology and Imaging Sciences; Emory University Hospital; Atlanta Georgia
| | - Neil A. Shah
- Emory University School of Medicine; Department of Radiology and Imaging Sciences; Emory University Hospital; Atlanta Georgia
| | - Samuel J. Galgano
- Emory University School of Medicine; Department of Radiology and Imaging Sciences; Emory University Hospital; Atlanta Georgia
| | - Mary Newell
- Emory University School of Medicine; Department of Radiology and Imaging Sciences; Emory University Hospital; Atlanta Georgia
| | - Zhibo Wang
- Emory University School of Medicine; Department of Radiology and Imaging Sciences; Emory University Hospital; Atlanta Georgia
| | - Zhengjia Chen
- Emory University School of Medicine; Department of Radiology and Imaging Sciences; Emory University Hospital; Atlanta Georgia
| | - Carl J. D'Orsi
- Emory University School of Medicine; Department of Radiology and Imaging Sciences; Emory University Hospital; Atlanta Georgia
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50
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Debald M, Abramian A, Nemes L, Döbler M, Kaiser C, Keyver-Paik MD, Leutner C, Höller T, Braun M, Kuhl C, Kuhn W, Schild HH. Who may benefit from preoperative breast MRI? A single-center analysis of 1102 consecutive patients with primary breast cancer. Breast Cancer Res Treat 2015; 153:531-7. [PMID: 26323190 DOI: 10.1007/s10549-015-3556-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 08/22/2015] [Indexed: 02/03/2023]
Abstract
Several authors question the potential benefit of preoperative magnetic resonance imaging (MRI) against the background of possible overdiagnosis, false-positive findings, and unnecessary resections in patients with newly diagnosed breast cancer. In order to reveal a better selection of patients who should undergo preoperative MRI after histological confirmed breast cancer, the present analysis was implemented. We aimed to evaluate the influence of preoperative breast MRI in patients with newly diagnosed breast cancer to find subgroups of patients that are most likely to benefit from preoperative MRI by the detection of occult malignant foci. A total of 1102 consecutive patients who underwent treatment for primary breast cancer between 2002 and 2013 were retrospectively analyzed. All patients underwent triple assessment by breast ultrasound, mammography, and bilateral breast MRI. MRI findings not seen on conventional imaging that suggested additional malignant disease was found in 344 cases (31.2 %). Histological confirmed malignant foci were found in 223 patients (20.2 %) within the index breast and in 28 patients (2.5 %) in the contralateral breast. The rate of false-negative biopsies was 31 (2.8 %) and 62 (5.6 %), respectively. Premenopausal women (p = 0.024), lobular invasive breast cancer (p = 0.02) as well as patients with high breast density [American College of Radiology (ACR) 3 + 4; p = 0.01] were significantly associated with additional malignant foci in the index breast. Multivariate analysis confirmed lobular histology (p = 0.041) as well as the co-factors "premenopausal stage" and "high breast density (ACR 3+4)" (p = 0.044) to be independently significant. Previous studies revealed that breast MRI is a reliable tool for predicting tumor extension as well as for the detection of additional ipsilateral and contralateral tumor foci in histological confirmed breast cancer. In the present study, we demonstrate that especially premenopausal patients with high breast density as well as patients with lobular histology seem to profit from preoperative MRI.
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Affiliation(s)
- Manuel Debald
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Alina Abramian
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Lisa Nemes
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Michael Döbler
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Christina Kaiser
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Mignon-Denise Keyver-Paik
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Claudia Leutner
- Department of Radiology, Centre for Integrated Oncology, University of Bonn, Bonn, Germany
| | - Tobias Höller
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University of Bonn, Bonn, Germany
| | - Michael Braun
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.,Department of Gynecology, Red Cross Women's Clinic Munich, Munich, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, University of Aachen RWTH, Aachen, Germany
| | - Walther Kuhn
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Hans H Schild
- Department of Radiology, Centre for Integrated Oncology, University of Bonn, Bonn, Germany
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