1
|
Nguyen DL, Lotfalla M, Cimino-Mathews A, Habibi M, Ambinder EB. Radiologic-Pathologic Correlation of Nonmass Enhancement Contiguous with Malignant Index Breast Cancer Masses at Preoperative Breast MRI. Radiol Imaging Cancer 2024; 6:e230060. [PMID: 38305717 PMCID: PMC10988334 DOI: 10.1148/rycan.230060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/04/2023] [Accepted: 12/15/2023] [Indexed: 02/03/2024]
Abstract
Purpose To determine the pathologic features of nonmass enhancement (NME) directly adjacent to biopsy-proven malignant masses (index masses) at preoperative MRI and determine imaging characteristics that are associated with a malignant pathologic condition. Materials and Methods This retrospective study involved the review of breast MRI and mammography examinations performed for evaluating disease extent in patients newly diagnosed with breast cancer from July 1, 2016, to September 30, 2019. Inclusion criteria were limited to patients with an index mass and the presence of NME extending directly from the mass margins. Wilcoxon rank sum test, Fisher exact test, and χ2 test were used to analyze cancer, patient, and imaging characteristics associated with the NME diagnosis. Results Fifty-eight patients (mean age, 58 years ± 12 [SD]; all women) were included. Malignant pathologic findings for mass-associated NME occurred in 64% (37 of 58) of patients, 43% (16 of 37) with ductal carcinoma in situ and 57% (21 of 37) with invasive carcinoma. NME was more likely to be malignant when associated with an index cancer that had a low Ki-67 index (<20%) (P = .04). The presence of calcifications at mammography correlating with mass-associated NME was not significantly associated with malignant pathologic conditions (P = .19). The span of suspicious enhancement measured at MRI overestimated the true span of disease at histologic evaluation (P < .001), while there was no evidence of a difference between span of calcifications at mammography and true span of disease at histologic evaluation (P = .27). Conclusion Mass-associated NME at preoperative MRI was malignant in most patients with newly diagnosed breast cancer. The span of suspicious enhancement measured at MRI overestimated the true span of disease found at histologic evaluation. Keywords: Breast, Mammography © RSNA, 2024 See also the commentary by Newell in this issue.
Collapse
Affiliation(s)
| | | | - Ashley Cimino-Mathews
- From the Department of Radiology, Duke University Medical Center,
Durham, NC (D.L.N.); Department of Pathology, University of South Florida Health
Morsani College of Medicine, Tampa, Fla (M.L.); and Department of Pathology
(A.C.M.), Department of Surgery (M.H.), and Russell H. Morgan Department of
Radiology and Radiological Science (E.B.A.), Johns Hopkins Medicine, 601 N
Caroline St, Baltimore, MD 21287
| | - Mehran Habibi
- From the Department of Radiology, Duke University Medical Center,
Durham, NC (D.L.N.); Department of Pathology, University of South Florida Health
Morsani College of Medicine, Tampa, Fla (M.L.); and Department of Pathology
(A.C.M.), Department of Surgery (M.H.), and Russell H. Morgan Department of
Radiology and Radiological Science (E.B.A.), Johns Hopkins Medicine, 601 N
Caroline St, Baltimore, MD 21287
| | - Emily B. Ambinder
- From the Department of Radiology, Duke University Medical Center,
Durham, NC (D.L.N.); Department of Pathology, University of South Florida Health
Morsani College of Medicine, Tampa, Fla (M.L.); and Department of Pathology
(A.C.M.), Department of Surgery (M.H.), and Russell H. Morgan Department of
Radiology and Radiological Science (E.B.A.), Johns Hopkins Medicine, 601 N
Caroline St, Baltimore, MD 21287
| |
Collapse
|
2
|
van Loevezijn AA, Geluk CS, van den Berg MJ, van Werkhoven ED, Vrancken Peeters MJTFD, van Duijnhoven FH, Hoornweg MJ. Immediate or delayed oncoplastic surgery after breast conserving surgery at the Netherlands Cancer Institute: a cohort study of 251 cases. Breast Cancer Res Treat 2023; 198:295-307. [PMID: 36690822 DOI: 10.1007/s10549-022-06841-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/03/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Oncoplastic surgery (OPS) after breast conserving surgery is preferably performed during the same operation. Offering delayed OPS instead of mastectomy to patients with a high risk of tumor-positive margins allows breast conservation with the option of margin re-excision during OPS, without having to dismantle the reconstruction. We aimed to evaluate surgical outcomes after immediate and delayed OPS. METHODS We included early-stage breast cancer patients who underwent OPS at the Netherlands Cancer Institute between 2016 and 2019. Patients were selected for delayed OPS after multidisciplinary consultation if the risk of tumor-positive margins with immediate OPS was considered significant (> 30%). Groups were compared on baseline characteristics and short-term surgical outcomes. RESULTS Of 242 patients with 251 OPS, 130 (52%) OPS had neoadjuvant chemotherapy. Immediate OPS was performed in 176 (70%) cases and delayed OPS in 76 (30%). Selection for delayed OPS was associated with tumor size (OR 1.03, 95% CI 1.01-1.04), ILC (OR 2.61, 95% CI 1.10-6.20), DCIS (OR 3.45, 95% CI 1.42-8.34) and bra size (OR 0.76, 95% CI 0.62-0.94). Delayed and immediate OPS differed in tissue weight (54 vs. 67 g, p = 0.034), tissue replacement (51% vs. 26%, p < .001) and tumor-positive margins (66% vs. 18%, p < .001). Re-excision was performed in 48 (63%) delayed OPS and in 11 (6%) immediate OPS. Groups did not differ in complications (21% vs. 18%, p = 0.333). Breast conservation after immediate and delayed OPS was 98% and 93%, respectively. CONCLUSION Performing delayed OPS in selected cases facilitated simultaneous margin re-excision without increasing complications, and resulted in an excellent breast conservation rate.
Collapse
Affiliation(s)
- Ariane A van Loevezijn
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Surgical Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Charissa S Geluk
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Plastic and Reconstructive Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Marieke J van den Berg
- Department of Plastic and Reconstructive Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Erik D van Werkhoven
- Department of Biometrics, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Marie-Jeanne T F D Vrancken Peeters
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Surgical Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Frederieke H van Duijnhoven
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Marije J Hoornweg
- Department of Plastic and Reconstructive Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| |
Collapse
|
3
|
Ellbrant J, Gulis K, Plasgård E, Svensjö T, Bendahl PO, Rydén L. Validated prediction model for positive resection margins in breast-conserving surgery based exclusively on preoperative data. BJS Open 2021; 5:6382014. [PMID: 34611702 PMCID: PMC8493005 DOI: 10.1093/bjsopen/zrab092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/17/2021] [Indexed: 12/14/2022] Open
Abstract
Background Positive margins after breast-conserving surgery (BCS) and subsequent second surgery are associated with increased costs and patient discomfort. The aim of this study was to develop a prediction model for positive margins based on risk factors available before surgery. Methods Patients undergoing BCS for in situ or invasive cancer between 2015 and 2016 at site A formed a development cohort; those operated during 2017 in site A and B formed two validation cohorts. MRI was not used routinely. Preoperative radiographic and tumour characteristics and method of operation were collected from patient charts. Multivariable logistic regression was used to develop a prediction model for positive margins including variables with discriminatory capacity identified in a univariable model. The discrimination and calibration of the prediction model was assessed in the validation cohorts, and a nomogram developed. Results There were 432 patients in the development cohort, and 190 and 157 in site A and B validation cohorts respectively. Positive margins were identified in 77 patients (17.8 per cent) in the development cohort. A non-linear transformation of mammographic tumour size and six variables (visible on mammography, ductal carcinoma in situ, lobular invasive cancer, distance from nipple–areola complex, calcification, and type of surgery) were included in the final prediction model, which had an area under the curve of 0.80 (95 per cent c.i. 0.75 to 0.85). The discrimination and calibration of the prediction model was assessed in the validation cohorts, and a nomogram developed. Conclusion The prediction model showed good ability to predict positive margins after BCS and might, after further validation, be used before surgery in centres without the routine use of preoperative MRI. Presented in part to the San Antonio Breast Cancer Symposium, San Antonio, Texas, USA, December 2018 and the Swedish Surgical Society Annual Meeting, Helsingborg, Sweden, August 2018.
Collapse
Affiliation(s)
- J Ellbrant
- Department of Surgery, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden
| | - K Gulis
- Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden.,Department of Surgery, Kristianstad Central Hospital, Kristianstad, Sweden
| | - E Plasgård
- Department of Surgery, Skåne University Hospital, Lund, Sweden
| | - T Svensjö
- Department of Surgery, Kristianstad Central Hospital, Kristianstad, Sweden
| | - P O Bendahl
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - L Rydén
- Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden.,Department of Surgery, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
4
|
Kim Y, Jung HK, Park AY, Ko KH, Jang H. Diagnostic value of mammography for accompanying non-mass enhancement on preoperative breast MRI. Acta Radiol 2021; 63:1032-1042. [PMID: 34260322 DOI: 10.1177/02841851211030771] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Successful surgical treatment for localized breast cancer can depend on accurate diagnosis for accompanying non-mass enhancement (NME) on preoperative breast magnetic resonance imaging (MRI). PURPOSE To evaluate the diagnostic value of mammography for accompanying NME adjacent to index cancer on preoperative breast MRI. MATERIAL AND METHODS Among 569 consecutive patients who underwent preoperative breast MRI from January 2016 to August 2018 for ultrasound-guided biopsy-proven breast cancer, 471 patients who underwent initial mammography and subsequent surgery were finally included. Two radiologists retrospectively reviewed preoperative MRI findings of the 471 patients and detected accompanying NME adjacent to index cancer. MRI, mammography, and histopathology findings of the accompanying NME were evaluated using Pearson's chi-square test, Mann-Whitney U test, and logistic regression analysis. The area under the receiver operating characteristic curve (AUC) of MRI and combined MRI and mammography was calculated in differentiating benign from malignant accompanying NME. The reference standard was surgical pathologic findings. RESULTS MRI revealed 93 accompanying NME lesions in 92 (19.5%) of the 471 patients, showing 55 (59.1%) malignant and 38 (40.9%) benign lesions. On multivariate analysis, malignant NME lesions were more associated with mammography-positive findings (P = 0.000), clumped or clustered ring internal enhancement (P = 0.015), and extensive intraductal component presence of index tumor (P = 0.007) compared with benign lesions. The AUC increased after correlation with mammography showing 0.649 (95% confidence interval [CI] 0.533-0.765) for MRI and 0.833 (95% CI 0.747-0.919) for combined MRI and mammography. CONCLUSION Mammography is valuable in predicting malignancy for accompanying NME on preoperative breast MRI.
Collapse
Affiliation(s)
- Yunju Kim
- Department of Radiology, CHA Bundang Medical Center, CHA University, Yatap-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
- Division of Radiology, Center for Breast Cancer, National Cancer Center, Madu 1-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Hae Kyoung Jung
- Department of Radiology, CHA Bundang Medical Center, CHA University, Yatap-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Ah Young Park
- Department of Radiology, CHA Bundang Medical Center, CHA University, Yatap-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Kyung Hee Ko
- Department of Radiology, CHA Bundang Medical Center, CHA University, Yatap-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Hyunkyung Jang
- Department of Radiology, CHA Kangnam Medical Center, CHA University, Yeoksam-dong, Gangnam-gu, Seoul, Republic of Korea
| |
Collapse
|
5
|
van der Noordaa MEM, Ioan I, Rutgers EJ, van Werkhoven E, Loo CE, Voorthuis R, Wesseling J, van Urk J, Wiersma T, Dezentje V, Vrancken Peeters MJTFD, van Duijnhoven FH. Breast-Conserving Therapy in Patients with cT3 Breast Cancer with Good Response to Neoadjuvant Systemic Therapy Results in Excellent Local Control: A Comprehensive Cancer Center Experience. Ann Surg Oncol 2021; 28:7383-7394. [PMID: 33978889 DOI: 10.1245/s10434-021-09865-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 03/02/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Many cT3 breast cancer patients are treated with mastectomy, regardless of response to neoadjuvant systemic therapy (NST). We evaluated local control of cT3 patients undergoing breast-conserving therapy (BCT) based on magnetic resonance imaging (MRI) evaluation post-NST. In addition, we analyzed predictive characteristics for positive margins after breast-conserving surgery (BCS). METHODS All cT3 breast cancer patients who underwent BCS after NST between 2002 and 2015 at the Netherlands Cancer Institute were included. Local recurrence-free interval (LRFI) was estimated using the Kaplan-Meier method, and predictors for positive margins were analyzed using univariable analysis and multivariable logistic regression. RESULTS Of 114 patients undergoing BCS post-NST, 75 had negative margins, 16 had focally positive margins, and 23 had positive margins. Of those with (focally) positive margins, 12 underwent radiotherapy, 6 underwent re-excision, and 21 underwent mastectomy. Finally, 93/114 patients were treated with BCT (82%), with an LRFI of 95.9% (95% confidence interval [CI] 91.5-100%) after a median follow-up of 7 years. Predictors for positive margins in univariable analysis were hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) subtype, lobular carcinoma, and non-mass enhancement (NME) on pre-NST MRI. MRI response was not correlated to positive margins. In multivariable regression, the odds of positive margins were decreased in patients with HER2-positive (HER2+; odds ratio [OR] 0.27, 95% CI 0.10-0.73; p = 0.01) and TN tumors (OR 0.17, 95% CI 0.03-0.82; p = 0.028). A trend toward positive margins was observed in patients with NME (OR 2.38, 95% CI 0.98-5.77; p = 0.055). CONCLUSION BCT could be performed in 82% of cT3 patients in whom BCT appeared feasible on post-NST MRI. Local control in these patients was excellent. In those patients with HR+/HER2- tumors, NME on MRI, or invasive lobular carcinoma, the risk of positive margins should be considered preoperatively.
Collapse
Affiliation(s)
| | - Ileana Ioan
- Department of Radiology, Policlinico San Donato, Milan, Italy
| | - Emiel J Rutgers
- Department of Surgical Oncology, NKI-AVL, Amsterdam, The Netherlands.,Department of Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Claudette E Loo
- Department of Radiology, NKI-AVL, Amsterdam, The Netherlands
| | - Rosie Voorthuis
- Department of Surgical Oncology, NKI-AVL, Amsterdam, The Netherlands
| | - Jelle Wesseling
- Department of Pathology, NKI-AvL and Leiden University Medical Center, Amsterdam, The Netherlands
| | - Japke van Urk
- Department of Radiology, NKI-AVL, Amsterdam, The Netherlands
| | - Terry Wiersma
- Department of Radiation Oncology, NKI-AVL, Amsterdam, The Netherlands
| | - Vincent Dezentje
- Department of Medical Oncology, NKI-AVL, Amsterdam, The Netherlands
| | - Marie-Jeanne T F D Vrancken Peeters
- Department of Surgical Oncology, NKI-AVL, Amsterdam, The Netherlands.,Department of Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|