Increase of mastectomy rates after preoperative MRI in women with breast cancer is not influenced by patients age

Impact of breast magnetic resonance imaging on the locoregional staging and management of breast cancer

Objective

To assess the impact of magnetic resonance imaging (MRI) on the locoregional staging of breast cancer.

Materials and Methods

We evaluated 61 patients with breast cancer who underwent pre-treatment breast MRI, between August 2015 and April 2016. An experienced breast surgeon determined the surgical treatment, on the basis of the findings of conventional imaging examinations, and made a subsequent treatment recommendation based on the MRI findings, then determining whether the MRI changed the approach, as well as whether it had a positive or negative impact on the treatment.

Results

The mean age was 50.8 years (standard deviation, 12.0 years). The most common histological type was invasive breast carcinoma of no special type (in 68.9%), and the most common molecular subtype was luminal B (in 45.9%). Breast MRI modified the therapeutic management in 23.0% of the cases evaluated, having a positive impact in 82.7%.

Conclusion

Breast MRI is an useful tool for the locoregional staging of breast cancer, because it provides useful information that can have a positive impact on patient treatment.

Synergy in combining findings from mammography and ultrasonography in detecting malignancy in women with higher density breasts and lesions over 2 cm in Albania

AIM OF THE STUDY

To provide evidence of the synergy of combining findings from mammography (MM) and ultrasonography (US) in detecting malignancy in women with high-density breasts.

MATERIAL AND METHODS

A total of 245 women were screened for breast cancer using both mammography and ultrasonography at the American Hospital in Tirana during 2013-2014. The data was used to identify possible benefits in detecting malignancy, by combining the findings of MM and US and confirming them with those of the biopsy. Data on age, breast density, BI-RADS classification, and biopsy confirmations were collected and analysed.

RESULTS

Out of the 245 women, 36 biopsies were taken (17 for women classified BI-RADS 4 and 5; 19 for women with BI-RADS 3 that had grown in size from the previous examination). The accuracy in detecting malignancy for low-density-breast women was 90% for MM, 70% for US, and 90% for combined. For high-density breasts, the accuracy was 65% for MM, 79% for US, and 82% for combined findings. Multivariate analysis indicates that high-density-breast women who have a malignant finding in at least one of the examinations (MM or US) are 24 times more likely (p = 0.039) to have a positive finding in biopsy for malignancy. The odds increased 32 times for lesions over 2 cm (p = 0.056).

CONCLUSIONS

Our study results indicate additional benefits of combining findings from MM and US for high-density-breast women. Further study is warranted in a larger population and for different kinds of cancer.

DCIS of the breast: The value of preoperative MRI

INTRODUCTION

Ductal carcinoma in situ (DCIS) of the breast is commonly treated surgically. The intent of this study was to evaluate whether preoperative MRI could add to mammography in predicting the extent of the disease.

METHODS

A series of patients with DCIS attending our surgical clinic for preoperative assessment were offered MRI as part of a prospective study. The extent of the disease indicated by mammography and MRI was compared with histopathology after definitive treatment. The null hypothesis was that MRI does not add to mammography in accurately predicting disease extent.

RESULTS

Fifty patients make up the basis of this report. Mammography was concordant with the pathology in 31/50. MRI and mammography combined were concordant in 43/50. This is a statistically significant difference (P = 0.01, Fisher's exact test). Upstaging to mastectomy by MRI was correct in 7/8 patients, but downstaging was correct in only 2/4.

CONCLUSIONS

The null hypothesis is rejected. MRI does add to mammography in accurately predicting the extent of DCIS. Upstaging by MRI is usually reliable.