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Washington I, Palm RF, White J, Rosenberg SA, Ataya D. The Role of MRI in Breast Cancer and Breast Conservation Therapy. Cancers (Basel) 2024; 16:2122. [PMID: 38893241 PMCID: PMC11171236 DOI: 10.3390/cancers16112122] [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] [Revised: 05/19/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Contrast-enhanced breast MRI has an established role in aiding in the detection, evaluation, and management of breast cancer. This article discusses MRI sequences, the clinical utility of MRI, and how MRI has been evaluated for use in breast radiotherapy treatment planning. We highlight the contribution of MRI in the decision-making regarding selecting appropriate candidates for breast conservation therapy and review the emerging role of MRI-guided breast radiotherapy.
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Affiliation(s)
- Iman Washington
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA;
| | - Russell F. Palm
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA;
| | - Julia White
- Department of Radiation Oncology, The University of Kansas Medical Center, 4001 Rainbow Blvd, Kansas City, KS 66160, USA;
| | - Stephen A. Rosenberg
- Department of Radiation Therapy, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA;
| | - Dana Ataya
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center & Research Institute, 10920 N. McKinley Drive, Tampa, FL 33612, USA;
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Yan Q, Yan X, Yang X, Li S, Song J. The use of PET/MRI in radiotherapy. Insights Imaging 2024; 15:63. [PMID: 38411742 PMCID: PMC10899128 DOI: 10.1186/s13244-024-01627-6] [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: 09/19/2023] [Accepted: 01/21/2024] [Indexed: 02/28/2024] Open
Abstract
Positron emission tomography/magnetic resonance imaging (PET/MRI) is a hybrid imaging technique that quantitatively combines the metabolic and functional data from positron emission tomography (PET) with anatomical and physiological information from MRI. As PET/MRI technology has advanced, its applications in cancer care have expanded. Recent studies have demonstrated that PET/MRI provides unique advantages in the field of radiotherapy and has become invaluable in guiding precision radiotherapy techniques. This review discusses the rationale and clinical evidence supporting the use of PET/MRI for radiation positioning, target delineation, efficacy evaluation, and patient surveillance.Critical relevance statement This article critically assesses the transformative role of PET/MRI in advancing precision radiotherapy, providing essential insights into improved radiation positioning, target delineation, efficacy evaluation, and patient surveillance in clinical radiology practice.Key points• The emergence of PET/MRI will be a key bridge for precise radiotherapy.• PET/MRI has unique advantages in the whole process of radiotherapy.• New tracers and nanoparticle probes will broaden the use of PET/MRI in radiation.• PET/MRI will be utilized more frequently for radiotherapy.
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Affiliation(s)
- Qi Yan
- Cancer Center, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Taiyuan, China
| | - Xia Yan
- Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Shanxi Provincial Key Laboratory for Translational Nuclear Medicine and Precision Protection, Taiyuan, China
| | - Xin Yang
- Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Sijin Li
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, China.
| | - Jianbo Song
- Cancer Center, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Taiyuan, China.
- Shanxi Provincial Key Laboratory for Translational Nuclear Medicine and Precision Protection, Taiyuan, China.
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Jones BM, Green S. Modern radiation techniques in early stage breast cancer for the breast radiologist. Clin Imaging 2021; 80:19-25. [PMID: 34224950 DOI: 10.1016/j.clinimag.2021.06.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/12/2021] [Accepted: 06/28/2021] [Indexed: 01/22/2023]
Abstract
Partial breast irradiation (PBI) and ultra-hypofractionated whole breast irradiation (uWBI) are contemporary alternatives to conventional and standard hypofractionated whole breast irradiation (WBI), which shorten treatment from 3 to 6 weeks to 1-2 weeks for select patients. PBI and accelerated PBI (APBI) can be delivered with external beam radiation (3D conformal radiation therapy (3D-CRT) or intensity modulated radiation therapy (IMRT)), intraoperative radiation (IORT), or brachytherapy. These new radiation techniques offer the advantage of convenience and lower cost, which ultimately improves access to care. Globally, the COVID 19 pandemic has accelerated APBI/PBI and ultra-hypofractionated regimens into routine practice for carefully selected patients. Recent long-term data from randomized controlled trials (RCTs) have demonstrated these techniques are safe and effective in suitable patients demonstrating equivalent or improved local recurrence, acute/late toxicity, and cosmesis. PBI and APBI should be limited to low risk unifocal invasive ductal carcinoma and ductal carcinoma in situ with tumor size < 2 cm, clear margins (≥2 mm), ER+, and negative nodes. Based on the results from UK Fast-Forward and UK FAST ultra-hypofractionated breast radiation can be safely employed for early stage node negative patients, but is not yet considered an international standard of care. In this review, authors will appraise recent data for these shorter course radiation treatment regimens, as well as, considerations for breast radiologists including surveillance imaging and radiographic findings.
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Affiliation(s)
- Brianna M Jones
- Icahn School of Medicine at Mount Sinai, United States of America.
| | - Sheryl Green
- Icahn School of Medicine at Mount Sinai, United States of America.
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Brown E, Dundas K, Surjan Y, Miller D, Lim K, Boxer M, Ahern V, Papadatos G, Batumalai V, Harvey J, Lee D, Delaney GP, Holloway L. The effect of imaging modality (magnetic resonance imaging vs. computed tomography) and patient position (supine vs. prone) on target and organ at risk doses in partial breast irradiation. J Med Radiat Sci 2021; 68:157-166. [PMID: 33283982 PMCID: PMC8168067 DOI: 10.1002/jmrs.453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 11/12/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Conventionally computed tomography (CT) has been used to delineate target volumes in radiotherapy; however, magnetic resonance imaging (MRI) is being continually integrated into clinical practice; therefore, the investigation into targets derived from MRI is warranted. The purpose of this study was to evaluate the impact of imaging modality (MRI vs. CT) and patient positioning (supine vs. prone) on planning target volumes (PTVs) and organs at risk (OARs) for partial breast irradiation (PBI). METHODS A retrospective data set, of 35 patients, was accessed where each patient had undergone MRI and CT imaging for tangential whole breast radiotherapy in both the supine and prone position. PTVs were defined from seroma cavity (SC) volumes delineated on each respective image, resulting in 4 PTVs per patient. PBI plans were generated with 6MV external beam radiotherapy (EBRT) using the TROG 06.02 protocol guidelines. A prescription of 38.5Gy in 10 fractions was used for all cases. The impact analysis of imaging modality and patient positioning included dose to PTVs, and OARs based on agreed criteria. Statistical analysis was conducted though Mann-Whitey U, Fisher's exact and chi-squared testing (P < 0.005). RESULTS Twenty-four patients were eligible for imaging analysis. However, positioning analysis could only be investigated on 19 of these data sets. No statistically significant difference was found in OAR doses based on imaging modality. Supine patient position resulted in lower contralateral breast dose (0.10Gy ± 0.35 vs. 0.33Gy ± 0.78, p = 0.011). Prone positioning resulted in a lower dose to ipsilateral lung volumes (10.85Gy ± 11.37 vs. 3.41Gy ± 3.93, P = <0.001). CONCLUSIONS PBI plans with PTVs derived from MRI exhibited no clinically significant differences when compared to plans created from CT in relation to plan compliance and OAR dose. Patient position requires careful consideration regardless of imaging modality chosen. Although there was no proven superiority of MRI derived target volumes, it indicates that MRI could be considered for PBI target delineation.
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Affiliation(s)
- Emily Brown
- Medical Radiation Science (MRS)School of Health SciencesThe University of NewcastleCallaghanNSWAustralia
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
- Ingham Institute for Applied Medical ResearchLiverpoolNSWAustralia
| | - Kylie Dundas
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
- Ingham Institute for Applied Medical ResearchLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
| | - Yolanda Surjan
- Medical Radiation Science (MRS)School of Health SciencesThe University of NewcastleCallaghanNSWAustralia
| | - Daniela Miller
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
| | - Karen Lim
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
| | - Miriam Boxer
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
| | - Verity Ahern
- Crown Princess Mary Cancer CentreWestmead HospitalSydneyNSWAustralia
- Westmead Clinical SchoolUniversity of SydneySydneyNSWAustralia
| | - George Papadatos
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
| | - Vikneswary Batumalai
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
- Ingham Institute for Applied Medical ResearchLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
| | - Jennifer Harvey
- School of MedicineUniversity of QueenslandBrisbaneQLDAustralia
- Princess Alexandra HospitalBrisbaneQLDAustralia
| | - Debra Lee
- Medical Radiation Science (MRS)School of Health SciencesThe University of NewcastleCallaghanNSWAustralia
| | - Geoff P. Delaney
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
- Ingham Institute for Applied Medical ResearchLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
- School of MedicineUniversity of Western SydneySydneyNSWAustralia
| | - Lois Holloway
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
- Ingham Institute for Applied Medical ResearchLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
- Centre for Medical Radiation PhysicsFaculty of Engineering and Information SciencesUniversity of WollongongWollongongNSWAustralia
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Narayanan D, Berg WA. Use of Breast-Specific PET Scanners and Comparison with MR Imaging. Magn Reson Imaging Clin N Am 2018; 26:265-272. [PMID: 29622131 DOI: 10.1016/j.mric.2017.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The goals of this article are to discuss the role of breast-specific PET imaging of women with breast cancer, compare the clinical performance of positron emission mammography (PEM) and MR imaging for current indications, and provide recommendations for when women should undergo PEM instead of breast MR imaging.
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Affiliation(s)
- Deepa Narayanan
- SBIR Development Center, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA.
| | - Wendie A Berg
- Department of Radiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, 300 Halket Street, Pittsburgh, PA 15213, USA
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Dundas K, Pogson EM, Batumalai V, Delaney GP, Boxer MM, Yap ML, Ahern V, Chan C, David S, Dimigen M, Harvey JA, Koh ES, Lim K, Papadatos G, Lazarus E, Descellar J, Metcalfe P, Holloway L. The impact of imaging modality (CT vs MRI) and patient position (supine vs prone) on tangential whole breast radiation therapy planning. Pract Radiat Oncol 2017; 8:e87-e97. [PMID: 28993138 DOI: 10.1016/j.prro.2017.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/11/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the impact of magnetic resonance imaging (MRI) versus computed tomography (CT)-derived planning target volumes (PTVs), in both supine and prone positions, for whole breast (WB) radiation therapy. METHODS AND MATERIALS Four WB radiation therapy plans were generated for 28 patients in which PTVs were generated based on CT or MRI data alone in both supine and prone positions. A 6-MV tangential intensity modulated radiation therapy technique was used, with plans designated as ideal, acceptable, or noncompliant. Dose metrics for PTVs and organs at risk were compared to analyze any differences based on imaging modality (CT vs MRI) or patient position (supine vs prone). RESULTS With respect to imaging modality 2/11 whole breast planning target volume (WB_PTV) dose metrics (percentage of PTV receiving 90% and 110% of prescribed dose) displayed statistically significant differences; however, these differences did not alter the average plan compliance rank. With respect to patient positioning, the odds of having an ideal plan versus a noncompliant plan were higher for the supine position compared with the prone position (P = .026). The minimum distance between the seroma cavity planning target volume (SC_PTV) and the chest wall was increased with prone positioning (P < .001, supine and prone values 1.1 mm and 8.7 mm, respectively). Heart volume was greater in the supine position (P = .005). Heart doses were lower in the supine position than prone (P < .01, mean doses 3.4 ± 1.55 Gy vs 4.4 ± 1.13 Gy for supine vs prone, respectively). Mean lung doses met ideal dose constraints in both positions, but were best spared in the prone position. The contralateral breast maximum dose to 1cc (D1cc) showed significantly lower doses in the supine position (P < .001, 4.64 Gy vs 9.51 Gy). CONCLUSIONS Planning with PTVs generated from MRI data showed no clinically significant differences from planning with PTVs generated from CT with respect to PTV and doses to organs at risk. Prone positioning within this study reduced mean lung dose and whole heart volumes but increased mean heart and contralateral breast doses compared with supine.
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Affiliation(s)
- Kylie Dundas
- Centre for Medical Radiation Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW, Australia; Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia.
| | - Elise M Pogson
- Centre for Medical Radiation Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW, Australia; Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia; Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia
| | - Vikneswary Batumalai
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Geoff P Delaney
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia; School of Medicine, University of Western Sydney, Sydney, NSW, Australia
| | - Miriam M Boxer
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Mei Ling Yap
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia; School of Medicine, University of Western Sydney, Sydney, NSW, Australia
| | - Verity Ahern
- Crown Princess Mary Cancer Care Centre, Westmead Hospital, NSW, Australia
| | - Christine Chan
- Department of Radiology, Liverpool Hospital, NSW, Australia
| | - Steven David
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Marion Dimigen
- Department of Radiology, Liverpool Hospital, NSW, Australia
| | - Jennifer A Harvey
- School of Medicine, University of Queensland, QLD, Australia; Princess Alexandra Hospital, QLD, Australia
| | - Eng-Siew Koh
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Karen Lim
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - George Papadatos
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia
| | | | - Joseph Descellar
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Peter Metcalfe
- Centre for Medical Radiation Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW, Australia; Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia
| | - Lois Holloway
- Centre for Medical Radiation Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW, Australia; Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
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8
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McCray DKS, Grobmyer SR, Pederson HJ. Impact of value based breast cancer care pathway implementation on pre-operative breast magnetic resonance imaging utilization. Gland Surg 2017; 6:57-63. [PMID: 28210553 DOI: 10.21037/gs.2017.01.03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Bilateral breast magnetic resonance imaging (MRI) is commonly used in the diagnostic workup of breast cancer (BC) to assess extent of disease and identify occult foci of disease. However, evidence for routine use of pre-operative MRI is lacking. Breast MRI is costly and can lead to unnecessary tests and treatment delays. Clinical care pathways (care paths) are value-based guidelines, which define management recommendations derived by expert consensus and available evidence based data. At Cleveland Clinic, care paths created for newly diagnosed BC patients recommend selective use of pre-operative MRI. We evaluated the number of pre-operative MRIs ordered before and after implementing an institution wide BC care paths in April 2014. METHODS A retrospective review was conducted of BC cases during the years 2012, 2014, and part of 2015. Patient, tumor and treatment characteristics were collected. Pre-operative MRI utilization was compared before and after care path implementation. RESULTS We identified 1,515 BC patients during the study period. Patients were more likely to undergo pre-operative MRI in 2012 than 2014 (OR: 2.77; P<0.001; 95% CI: 1.94-3.94) or 2015 (OR: 4.14; P<0.001; 95% CI: 2.51-6.83). There was a significant decrease in pre-operative MRI utilization between 2012 and 2014 (P<0.001) after adjustment for pre-operative MRIs ordered for care path indications. CONCLUSIONS Implementation of online BC care paths at our institution was associated with a decreased use of pre-operative MRI overall and in patients without a BC care path indication, driving value based care through the reduction of pre-operative breast MRIs.
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Affiliation(s)
| | | | - Holly J Pederson
- Breast Services Department, Cleveland Clinic, Cleveland, OH, USA
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Rabasco P, Caivano R, Dinardo G, Gioioso M, Lotumolo A, Iannelli G, Villonio A, La Torre G, D'Errico S, Macarini L, Guglielmi G, Cammarota A. Magnetic Resonance Imaging in the Pre-Surgical Staging of Breast Cancer: Our Experience. Cancer Invest 2017; 35:43-50. [PMID: 27901596 DOI: 10.1080/07357907.2016.1251943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To investigate the clinical impact of magnetic resonance imaging (MRI) in the detection of multifocal-multicentric breast cancers, already identified by mammography and ultrasound, and analyzed histologically, to evaluate its role in preoperative staging. MATERIALS AND METHODS From January 2012 to February 2014, 188 patients, aged 28 to 74 years, newly diagnosed with breast cancer on conventional imaging (mammography and ultrasound) were enrolled. They underwent preoperative contrast-enhanced 3T MRI. Patients underwent surgery according to international guidelines. Results of all diagnostic procedures were compared. RESULTS Among the 188 patients, 163 (87%) had a unilateral and unifocal tumor at both conventional imaging; MRI diagnosed 22/22 (100%) of multifocal and multicentric tumors, the combination of mammography and ultrasound diagnosed 12/22 (54%), and mammography alone diagnosed 8/22 (36%) multifocal and multicentric tumors. MRI prompted a change in surgical strategy in 10/188 (5%) patients. This change comprised mastectomy instead of conservative surgery (n = 7) and more extensive conservative surgery (n = 3). CONCLUSIONS MRI was confirmed to show higher sensitivity than conventional imaging in detecting multifocal and multicentric breast cancers.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Luca Macarini
- b Department of Radiology , University of Foggia , Foggia , Italy
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Krengli M, Pisani C, Deantonio L. Patient selection for partial breast irradiation by intraoperative radiation therapy: can magnetic resonance imaging be useful?-perspective from radiation oncology point of view. J Thorac Dis 2016; 8:E987-E992. [PMID: 27747042 DOI: 10.21037/jtd.2016.09.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The guidelines of the European and American Societies of Radiation Oncology (GEC-ESTRO and ASTRO) defined the selection criteria to offer partial breast irradiation (PBI) after lumpectomy in patients with low risk breast cancer regardless pre-operative staging. A recent publication by Tallet et al. explored the impact of preoperative magnetic resonance imaging (MRI) on patient eligibility for PBI. From their study, an ipsilateral BC was detected in 4% of patients, excluding these patients from intraoperative radiotherapy (IORT). The authors suggested that preoperative MRI should be used routinely for patient's candidate to IORT, because of the rate of ipsilateral breast cancer detected. In view of Tallet's article, we analyzed some aspects of this issue in order to envisage some possible perspective on how to better identify those patients who could benefit from PBI, especially using IORT. From historical studies, the risk of breast cancer recurrence outside index quadrant without irradiation is in the range of 1.5-3.5%. MRI sensitivity for detection of invasive cancer is reported up to 100%, and it is particularly useful in dense breast. Other imaging technique did not achieve the same sensibility and specificity as conventional MRI. Of note, none of randomized trials published and ongoing on PBI included preoperative MRI as part of staging. To perform a preoperative MRI in PBI setting is an interesting issue, but the available data suggest that this issue should be preferably studied in the setting of prospective clinical trials to clarify the role of MRI and the clinical meaning of the discovered additional foci.
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Affiliation(s)
- Marco Krengli
- Division of Radiotherapy, University Hospital Maggiore della Carità, Novara, Italy; ; Department of Translational Medicine, University of "Piemonte Orientale", Novara, Italy
| | - Carla Pisani
- Division of Radiotherapy, University Hospital Maggiore della Carità, Novara, Italy; ; Department of Translational Medicine, University of "Piemonte Orientale", Novara, Italy
| | - Letizia Deantonio
- Division of Radiotherapy, University Hospital Maggiore della Carità, Novara, Italy; ; Department of Translational Medicine, University of "Piemonte Orientale", Novara, Italy
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Mukherjee SD, Hodgson N, Lovrics PJ, Dhamanaskar K, Minuk T, Chambers S, Sussman J. A Retrospective Study Evaluating the Impact of Preoperative Breast MRI on Surgical Decision-Making in Young Patients (≤50 Years) with Invasive Breast Cancer. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2016; 10:53-60. [PMID: 27226720 PMCID: PMC4871200 DOI: 10.4137/bcbcr.s38432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/28/2016] [Accepted: 03/30/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Breast magnetic resonance imaging (MRI) is considered a more sensitive diagnostic test for detecting invasive breast cancer than mammography or breast ultrasound. Breast MRI may be particularly useful in younger premenopausal women with higher density breast tissue for differentiating between dense fibroglandular breast tissue and breast malignancies. The main objective of this study was to determine the impact of preoperative breast MRI on surgical decision-making in young women with breast cancer. METHODS A retrospective review of patients with newly diagnosed invasive breast cancer and age of ≤50 years was performed. All patients underwent physical examination, preoperative mammogram, breast ultrasound, and bilateral breast MRI. Two breast cancer surgeons reviewed the preoperative mammogram report, breast ultrasound report, and physical examination summary and were asked if they would recommend a lumpectomy, a quandrantectomy, or a mastectomy. A few weeks later, the two surgeons were shown the same information with the breast MRI report and were asked what type of surgery they would now recommend. In each case, MRI was classified by two adjudicators as having affected the surgical outcome in a positive, negative, or neutral fashion. A positive impact was defined as the situation where breast MRI detected additional disease that was not found on physical examination, mammogram, or breast ultrasound and led to an appropriate change in surgical management. A negative impact was defined as the situation where breast MRI led the surgeon to recommend more extensive surgery, with less extensive disease actually found at pathology. No impact was defined as the situation where MRI findings did not alter surgical recommendations or outcomes. RESULTS Of 37 patients whose charts were reviewed, five patients were deemed to be ineligible due to having received neoadjuvant chemotherapy, having previous breast implants, or having had their tumor fully excised during biopsy. In total, 32 patients met the inclusion criteria of this study and were appropriate for analysis. The median age of our study patient population was 42 years. The pathologic diagnosis was invasive ductal carcinoma in 91% (29/32) of patients and invasive lobular carcinoma in 9% (3/32) of patients. For surgeon A, clinical management was altered in 21/32 (66%) patients, and for surgeon B, management was altered in 13/32 (41%) patients. The most common change in surgical decision-making after breast MRI was from breast-conserving surgery to a mastectomy. Mastectomy rates were similar between both surgeons after breast MRI. After reviewing the pathology results and comparing them with the breast MRI results, it was determined that breast MRI led to a positive outcome in 13/32 (41%) patients. Breast MRI led to no change in surgical management in 15/32 (47%) patients and resulted in a negative change in surgical management in 4/32 (13%) patients. Bilateral breast MRI detected a contralateral breast cancer in 2/32 (6%) patients. CONCLUSIONS Preoperative breast MRI alters surgical management in a significant proportion of younger women diagnosed with breast cancer. Prospective studies are needed to confirm these findings and to help determine if this change in surgical decision-making will result in improved local control.
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Affiliation(s)
- Som D Mukherjee
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Nicole Hodgson
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Peter J Lovrics
- Department of Surgery, McMaster University, Hamilton, ON, Canada.; St. Joseph's Hospital, Hamilton, ON, Canada
| | | | - Terry Minuk
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Shelley Chambers
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Jonathan Sussman
- Department of Oncology, McMaster University, Hamilton, ON, Canada
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Ruschin M, Davidson SRH, Phounsy W, Yoo TS, Chin L, Pignol JP, Ravi A, McCann C. Technical Note: Multipurpose CT, ultrasound, and MRI breast phantom for use in radiotherapy and minimally invasive interventions. Med Phys 2016; 43:2508. [DOI: 10.1118/1.4947124] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Assessment of MRI image quality for various setup positions used in breast radiotherapy planning. Radiother Oncol 2016; 119:57-60. [PMID: 26970675 DOI: 10.1016/j.radonc.2016.02.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 01/27/2016] [Accepted: 02/19/2016] [Indexed: 11/20/2022]
Abstract
This study investigates breast magnetic resonance imaging (MRI) image quality for 3 different breast radiotherapy positions (prone, supine flat and supine inclined) and associated choice of breast coils. Supine breast MRI has comparable image quality to prone breast MRI for the purposes of radiotherapy delineation for T2-weighted sequences.
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Rivera R, Banks A, Casillas-Lopez A, Rashtian A, Lewinsky B, Sheth P, Hovannesian-Larsen L, Brousseau D, Iyengar G, Holmes DR. Targeted Intraoperative Radiotherapy for the Management of Ductal Carcinoma In Situ of the Breast. Breast J 2015; 22:63-74. [PMID: 26534876 DOI: 10.1111/tbj.12516] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Multiple long-term studies have demonstrated a propensity for breast cancer recurrences to develop near the site of the original breast cancer. Recognition of this local recurrence pattern laid the foundation for the development of accelerated partial breast irradiation (APBI) approaches designed to limit the radiation treatment field to the site of the malignancy. However, there is a paucity of data regarding the efficacy of APBI in general, and intraoperative radiotherapy (IORT), in particular, for the management of ductal carcinoma in situ (DCIS). As a result, use of APBI, remains controversial. A prospective nonrandomized trial was designed to determine if patients with pure DCIS considered eligible for concurrent IORT based on preoperative mammography and contrast-enhanced magnetic resonance imaging (CE-MRI) could be successfully treated using IORT with minimal need for additional therapy due to inadequate surgical margins or excessive tumor size. Between November 2007 and June 2014, 35 women underwent bilateral digital mammography and bilateral breast CE-MRI prior to selection for IORT. Patients were deemed eligible for IORT if their lesion was ≤4 cm in maximal diameter on both digital mammography and CE-MRI, pure DCIS on minimally invasive breast biopsy or wide local excision, and considered resectable with clear surgical margins using breast-conserving surgery (BCS). Postoperatively, the DCIS lesion size determined by imaging was compared with lesion size and surgical margin status obtained from the surgical pathology specimen. Thirty-five patients completed IORT. Median patient age was 57 years (range 42-79 years) and median histologic lesion size was 15.6 mm (2-40 mm). No invasive cancer was identified. In more than half of the patients in our study (57.1%), MRI failed to detect a corresponding lesion. Nonetheless, 30 patients met criteria for negative margins (i.e., margins ≥2 mm) whereas five patients had positive margins (<2 mm). Two of the five patients with positive margins underwent mastectomy due to extensive imaging-occult DCIS. Three of the five patients with positive margins underwent successful re-excision at a subsequent operation prior to subsequent whole breast irradiation. A total of 14.3% (5/35) of patients required some form of additional therapy. At 36 months median follow-up (range of 2-83 months, average 42 months), only two patients experienced local recurrences of cancer (DCIS only), yielding a 5.7% local recurrence rate. No deaths or distant recurrences were observed. Imaging-occult DCIS is a challenge for IORT, as it is for all forms of breast-conserving therapy. Nonetheless, 91.4% of patients with DCIS were successfully managed with BCS and IORT alone, with relatively few patients requiring additional therapy.
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Affiliation(s)
- Ronald Rivera
- University of California, Los Angeles - David Geffen School of Medicine, Los Angeles, California
| | - Alexandra Banks
- California Hospital Medical Center - Los Angeles Center for Women's Health, Los Angeles, California
| | - America Casillas-Lopez
- University of Southern California - Norris Comprehensive Cancer Center, Los Angeles, California
| | - Afshin Rashtian
- Cancer Center Riverside Community Hospital, Los Angeles, California
| | - Bernie Lewinsky
- California Hospital Medical Center - Los Angeles Center for Women's Health, Los Angeles, California
| | - Pulin Sheth
- University of Southern California - Norris Comprehensive Cancer Center, Los Angeles, California
| | | | - David Brousseau
- California Hospital Medical Center - Los Angeles Center for Women's Health, Los Angeles, California
| | - Geeta Iyengar
- Medical Imaging Center of Southern California, Los Angeles, California
| | - Dennis R Holmes
- California Hospital Medical Center - Los Angeles Center for Women's Health, Los Angeles, California
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Di Leo G, Trimboli RM, Benedek A, Jereczek-Fossa BA, Fossati P, Leonardi MC, Carbonaro LA, Orecchia R, Sardanelli F. MR Imaging for Selection of Patients for Partial Breast Irradiation: A Systematic Review and Meta-Analysis. Radiology 2015; 277:716-26. [PMID: 26043263 DOI: 10.1148/radiol.2015142508] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To systematically review articles that estimated the ineligibility for partial breast irradiation (PBI) after magnetic resonance (MR) imaging. MATERIALS AND METHODS No ethics committee approval was needed. A systematic search was performed by using MEDLINE and EMBASE. The rate of patients eligible at standard assessment (ie, clinical examination, mammography, and/or ultrasonography) but ineligible after MR imaging was a study outcome. Odds ratios (ORs) were calculated to identify predictors. Quality was appraised by using the Strengthening Reporting of Observational Studies in Epidemiology checklist. RESULTS Of 93 retrieved articles, six were included (total, 3136 patients). For PBI eligibility, all studies applied National Surgical Adjuvant Breast and Bowel Project B-39 criteria. Ineligibility at standard assessment varied from 21% to 80%; MR imaging prompted ineligibility for PBI in 6%-25% of patients who were initially deemed eligible or in 2%-20% if calculated on the overall number of patients initially screened. Meta-regression showed a negative correlation between ineligibility at standard assessment and ineligibility after MR imaging (P < .001). The pooled percentage of patients eligible at standard assessment but ineligible after MR imaging was 11% (95% confidence interval [CI]: 6%, 19%). Predictors for ineligibility after MR imaging were cancers stage pT2 or greater versus less than stage pT2 (OR, 8.8 [95% CI: 4.7, 16.7]; P < .001), invasive lobular histopathologic results versus invasive ductal pathologic results (OR, 3.0 [95% CI: 1.6, 6.6]; P = .007), pre- versus postmenopausal status (OR, 1.9 [95% CI: 1.3, 2.6]; P < .001), invasive cancer versus ductal carcinoma in situ (OR, 1.6 [95% CI: 1.0, 2.4]; P = .031). Study quality ranged from 17 to 20 (maximum quality, 22). The risk of publication bias was moderate. CONCLUSION One of nine women (11%), who on the sole basis of standard assessment were candidates to undergo PBI, was found to be ineligible after undergoing MR imaging. Breast MR imaging should be used to select patients for PBI.
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Affiliation(s)
- Giovanni Di Leo
- From the Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097 San Donato Milanese, Italy (G.D.L., R.M.T., A.B., L.A.C., F.S.); Department of Radiation Oncology, European Institute of Oncology, Università degli Studi di Milano, Milan, Italy (B.A.J.F., P.F., M.C.L., R.O.); CNAO, Pavia, Italy (P.F., R.O.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (F.S.)
| | - Rubina Manuela Trimboli
- From the Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097 San Donato Milanese, Italy (G.D.L., R.M.T., A.B., L.A.C., F.S.); Department of Radiation Oncology, European Institute of Oncology, Università degli Studi di Milano, Milan, Italy (B.A.J.F., P.F., M.C.L., R.O.); CNAO, Pavia, Italy (P.F., R.O.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (F.S.)
| | - Adrienn Benedek
- From the Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097 San Donato Milanese, Italy (G.D.L., R.M.T., A.B., L.A.C., F.S.); Department of Radiation Oncology, European Institute of Oncology, Università degli Studi di Milano, Milan, Italy (B.A.J.F., P.F., M.C.L., R.O.); CNAO, Pavia, Italy (P.F., R.O.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (F.S.)
| | - Barbara Alicja Jereczek-Fossa
- From the Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097 San Donato Milanese, Italy (G.D.L., R.M.T., A.B., L.A.C., F.S.); Department of Radiation Oncology, European Institute of Oncology, Università degli Studi di Milano, Milan, Italy (B.A.J.F., P.F., M.C.L., R.O.); CNAO, Pavia, Italy (P.F., R.O.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (F.S.)
| | - Piero Fossati
- From the Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097 San Donato Milanese, Italy (G.D.L., R.M.T., A.B., L.A.C., F.S.); Department of Radiation Oncology, European Institute of Oncology, Università degli Studi di Milano, Milan, Italy (B.A.J.F., P.F., M.C.L., R.O.); CNAO, Pavia, Italy (P.F., R.O.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (F.S.)
| | - Maria Cristina Leonardi
- From the Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097 San Donato Milanese, Italy (G.D.L., R.M.T., A.B., L.A.C., F.S.); Department of Radiation Oncology, European Institute of Oncology, Università degli Studi di Milano, Milan, Italy (B.A.J.F., P.F., M.C.L., R.O.); CNAO, Pavia, Italy (P.F., R.O.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (F.S.)
| | - Luca Alessandro Carbonaro
- From the Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097 San Donato Milanese, Italy (G.D.L., R.M.T., A.B., L.A.C., F.S.); Department of Radiation Oncology, European Institute of Oncology, Università degli Studi di Milano, Milan, Italy (B.A.J.F., P.F., M.C.L., R.O.); CNAO, Pavia, Italy (P.F., R.O.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (F.S.)
| | - Roberto Orecchia
- From the Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097 San Donato Milanese, Italy (G.D.L., R.M.T., A.B., L.A.C., F.S.); Department of Radiation Oncology, European Institute of Oncology, Università degli Studi di Milano, Milan, Italy (B.A.J.F., P.F., M.C.L., R.O.); CNAO, Pavia, Italy (P.F., R.O.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (F.S.)
| | - Francesco Sardanelli
- From the Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097 San Donato Milanese, Italy (G.D.L., R.M.T., A.B., L.A.C., F.S.); Department of Radiation Oncology, European Institute of Oncology, Università degli Studi di Milano, Milan, Italy (B.A.J.F., P.F., M.C.L., R.O.); CNAO, Pavia, Italy (P.F., R.O.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (F.S.)
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Affiliation(s)
- Constance D Lehman
- University of Washington and Seattle Cancer Care Alliance, Seattle, WA 98109, USA.
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Kowalchik KV, Vallow LA, McDonough M, Thomas CS, Heckman MG, Peterson JL, Adkisson CD, Serago C, McLaughlin SA. Classification system for identifying women at risk for altered partial breast irradiation recommendations after breast magnetic resonance imaging. Int J Radiat Oncol Biol Phys 2013; 87:127-33. [PMID: 23920391 DOI: 10.1016/j.ijrobp.2013.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 04/22/2013] [Accepted: 05/08/2013] [Indexed: 01/21/2023]
Abstract
PURPOSE To study the utility of preoperative breast MRI for partial breast irradiation (PBI) patient selection, using multivariable analysis of significant risk factors to create a classification rule. METHODS AND MATERIALS Between 2002 and 2009, 712 women with newly diagnosed breast cancer underwent preoperative bilateral breast MRI at Mayo Clinic Florida. Of this cohort, 566 were retrospectively deemed eligible for PBI according to the National Surgical Adjuvant Breast and Bowel Project Protocol B-39 inclusion criteria using physical examination, mammogram, and/or ultrasound. Magnetic resonance images were then reviewed to determine their impact on patient eligibility. The patient and tumor characteristics were evaluated to determine risk factors for altered PBI eligibility after MRI and to create a classification rule. RESULTS Of the 566 patients initially eligible for PBI, 141 (25%) were found ineligible because of pathologically proven MRI findings. Magnetic resonance imaging detected additional ipsilateral breast cancer in 118 (21%). Of these, 62 (11%) had more extensive disease than originally noted before MRI, and 64 (11%) had multicentric disease. Contralateral breast cancer was detected in 28 (5%). Four characteristics were found to be significantly associated with PBI ineligibility after MRI on multivariable analysis: premenopausal status (P=.021), detection by palpation (P<.001), first-degree relative with a history of breast cancer (P=.033), and lobular histology (P=.002). Risk factors were assigned a score of 0-2. The risk of altered PBI eligibility from MRI based on number of risk factors was 0:18%; 1:22%; 2:42%; 3:65%. CONCLUSIONS Preoperative bilateral breast MRI altered the PBI recommendations for 25% of women. Women who may undergo PBI should be considered for breast MRI, especially those with lobular histology or with 2 or more of the following risk factors: premenopausal, detection by palpation, and first-degree relative with a history of breast cancer.
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Horst KC, Fero KE, Ikeda DM, Daniel BL, Dirbas FM. Defining an optimal role for breast magnetic resonance imaging when evaluating patients otherwise eligible for accelerated partial breast irradiation. Radiother Oncol 2013; 108:220-5. [DOI: 10.1016/j.radonc.2013.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 01/07/2013] [Accepted: 01/14/2013] [Indexed: 10/27/2022]
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Dorn PL, Al-Hallaq HA, Haq F, Goldberg M, Abe H, Hasan Y, Chmura SJ. A prospective study of the utility of magnetic resonance imaging in determining candidacy for partial breast irradiation. Int J Radiat Oncol Biol Phys 2013; 85:615-22. [PMID: 22836047 PMCID: PMC4280848 DOI: 10.1016/j.ijrobp.2012.06.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 06/01/2012] [Accepted: 06/11/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Retrospective data have demonstrated that breast magnetic resonance imaging (MRI) may change a patient's eligibility for partial breast irradiation (PBI) by identifying multicentric, multifocal, or contralateral disease. The objective of the current study was to prospectively determine the frequency with which MRI identifies occult disease and to establish clinical factors associated with a higher likelihood of MRI prompting changes in PBI eligibility. METHODS AND MATERIALS At The University of Chicago, women with breast cancer uniformly undergo MRI in addition to mammography and ultrasonography. From June 2009 through May 2011, all patients were screened prospectively in a multidisciplinary conference for PBI eligibility based on standard imaging, and the impact of MRI on PBI eligibility according to National Surgical Adjuvant Breast and Bowel Project protocol B-39/Radiation Therapy Oncology Group protocol 0413 entry criteria was recorded. Univariable analysis was performed using clinical characteristics in both the prospective cohort and in a separate cohort of retrospectively identified patients. Pooled analysis was used to derive a scoring index predictive of the risk that MRI would identify additional disease. RESULTS A total of 521 patients were screened for PBI eligibility, and 124 (23.8%) patients were deemed eligible for PBI based on standard imaging. MRI findings changed PBI eligibility in 12.9% of patients. In the pooled univariable analysis, tumor size ≥ 2 cm on mammography or ultrasonography (P=.02), age <50 years (P=.01), invasive lobular histology (P=.01), and HER-2/neu amplification (P=.01) were associated with a higher likelihood of MRI changing PBI eligibility. A predictive score was generated by summing the number of significant risk factors. Patients with a score of 0, 1, 2, and 3 had changes to eligibility based on MRI findings in 2.8%, 13.2%, 38.1%, and 100%, respectively (P<.0001). CONCLUSIONS MRI identified additional disease in a significant number of patients eligible for PBI, based on standard imaging. Clinical characteristics may be useful in directing implementation of MRI in the staging of PBI candidates.
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Affiliation(s)
- Paige L. Dorn
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, Illinois
| | - Hania A. Al-Hallaq
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, Illinois
| | - Farah Haq
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, Illinois
| | - Mira Goldberg
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, Illinois
| | - Hiroyuki Abe
- Department of Radiology, University of Chicago Medical Center, Chicago, Illinois
| | - Yasmin Hasan
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, Illinois
| | - Steven J. Chmura
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, Illinois
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Chung AP, Huynh K, Kidner T, Mirzadehgan P, Sim MS, Giuliano AE. Comparison of outcomes of breast conserving therapy in multifocal and unifocal invasive breast cancer. J Am Coll Surg 2012; 215:137-46; discussion 146-7. [PMID: 22608402 DOI: 10.1016/j.jamcollsurg.2012.05.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 04/30/2012] [Accepted: 05/02/2012] [Indexed: 01/16/2023]
Abstract
BACKGROUND There is controversy about whether breast conserving therapy (BCT) should be contraindicated in multifocal (MF) breast cancer. Few studies have reported on the oncologic safety of BCT in MF breast cancer. STUDY DESIGN We reviewed a prospective database of 1,169 women with invasive breast cancer who were treated with segmentectomy and whole breast irradiation from 1991 through 2009 and followed at our institution. Multifocal breast cancer was defined as 2 or more distinct tumors excised with a single incision or segmentectomy. We compared 2 groups, MF and unifocal breast cancer patients, with respect to demographics, tumor characteristics, adjuvant systemic therapy, local recurrence (LR), disease-free survival (DFS), and overall survival (OS). RESULTS One hundred sixty-four patients with MF and 999 with unifocal invasive breast cancer were treated with BCT. Median follow-up was 112 months. Compared with the unifocal group, patients in the MF group had higher 10-year LR (0.6% vs 6.1%, p < 0.001) and lower 10-year DFS (97.7% vs 89.3%, p < 0.001) and OS (98.4% vs 85.8%, p < 0.001). On multivariable analysis, multifocality was independently significantly associated with local recurrence-free survival (LRFS), DFS, and OS. CONCLUSIONS Our data suggest that BCT in MF breast cancer is oncologically safe but may result in a slightly inferior outcome compared with BCT in unifocal breast cancer.
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Affiliation(s)
- Alice P Chung
- Department of Surgery, Division of Surgical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
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Kowalchik KV, Vallow LA, McDonough M, Thomas CS, Heckman MG, Peterson JL, Adkisson CD, Serago C, Buskirk SJ, McLaughlin SA. The role of preoperative bilateral breast magnetic resonance imaging in patient selection for partial breast irradiation in ductal carcinoma in situ. Int J Surg Oncol 2012; 2012:206342. [PMID: 22655183 PMCID: PMC3359656 DOI: 10.1155/2012/206342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 02/20/2012] [Accepted: 03/05/2012] [Indexed: 12/03/2022] Open
Abstract
Purpose. Women with ductal carcinoma in situ (DCIS) are often candidates for breast-conserving therapy, and one option for radiation treatment is partial breast irradiation (PBI). This study evaluates the use of preoperative breast magnetic resonance imaging (MRI) for PBI selection in DCIS patients. Methods. Between 2002 and 2009, 136 women with newly diagnosed DCIS underwent a preoperative bilateral breast MRI at Mayo Clinic in Florida. One hundred seventeen women were deemed eligible for PBI by the NSABP B-39 (National Surgical Adjuvant Breast and Bowel Project, Protocol B-39) inclusion criteria using physical examination, mammogram, and/or ultrasound. MRIs were reviewed for their impact on patient eligibility, and findings were pathologically confirmed. Results. Of the 117 patients, 23 (20%) were found ineligible because of pathologically proven MRI findings. MRI detected additional ipsilateral breast cancer in 21 (18%) patients. Of these women, 15 (13%) had more extensive disease than originally noted before MRI, and 6 (5%) had multicentric disease in the ipsilateral breast. In addition, contralateral breast cancer was detected in 4 (4%). Conclusions. Preoperative breast MRI altered the PBI recommendations for 20% of women. Bilateral breast MRI should be an integral part of the preoperative evaluation of all patients with DCIS being considered for PBI.
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Affiliation(s)
- Kristin V. Kowalchik
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Laura A. Vallow
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Michelle McDonough
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Colleen S. Thomas
- Biostatistics Unit, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Michael G. Heckman
- Biostatistics Unit, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Jennifer L. Peterson
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Cameron D. Adkisson
- General Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Christopher Serago
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Steven J. Buskirk
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Sarah A. McLaughlin
- General Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
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Skandarajah AR, Mann GB. The role of magnetic resonance imaging in early breast cancer. Asia Pac J Clin Oncol 2012; 8:24-30. [PMID: 22369441 DOI: 10.1111/j.1743-7563.2012.01517.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Despite recent evidence that fails to detect a benefit in surgical and local recurrence outcomes in those who receive optimal surgery and adjuvant systemic and radiotherapy, magnetic resonance imaging (MRI) is still being employed. We review the recent literature to clarify the role in the use of MRI in early breast cancer. A literature search using the Medline and Ovid databases was conducted between 2004 and 2011 using the terms "magnetic resonance imaging' and 'early breast cancer'. Only articles with clinical trials published in English in adult humans with available abstracts were included. Articles on high-risk women, response to neoadjuvant therapy, advanced breast cancer, the occult primary, the contralateral breast and technical articles were excluded. Articles examining the role of MRI in the staging of early breast cancer were retained. Over 260 articles regarding breast MRI have been published in the last 5 years. Additional foci may be found in 16% of patients but the impact on the extent of surgery and local recurrence rate is yet to be defined. Certain sub-groups who may benefit include those with invasive lobular carcinoma and mammographically dense breasts and those for consideration of partial breast irradiation. With standard adjuvant radiotherapy, there is no benefit in routine MRI with respect surgical extent and local recurrence. Should MRI be used, pre-operative biopsy to confirm additional disease must be undertaken prior to a change in surgical extent of resection. However, MRI may be useful in the evaluation of those who can be considered for partial breast irradiation. Centres undertaking breast MRI must have MRI-biopsy capabilities and constantly audit the reporting of MRI with correlation to the final pathology.
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Affiliation(s)
- Anita R Skandarajah
- Department of Surgery, University of Melbourne, Royal Melbourne and Royal Women's Hospital, Melbourne, Victoria, Australia.
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Kühr M, Wolfgarten M, Stölzle M, Leutner C, Höller T, Schrading S, Kuhl C, Schild H, Kuhn W, Braun M. Potential Impact of Preoperative Magnetic Resonance Imaging of the Breast on Patient Selection for Accelerated Partial Breast Irradiation. Int J Radiat Oncol Biol Phys 2011; 81:e541-6. [PMID: 21664064 DOI: 10.1016/j.ijrobp.2011.04.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 04/14/2011] [Accepted: 04/19/2011] [Indexed: 10/18/2022]
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Orecchia R, Leonardo MC. Intraoperative radiation therapy: is it a standard now? Breast 2011; 20 Suppl 3:S111-5. [DOI: 10.1016/s0960-9776(11)70307-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Ojeda-Fournier H, Olson LK, Rochelle M, Hodgens BD, Tong E, Yashar CM. Accelerated Partial Breast Irradiation and Posttreatment Imaging Evaluation. Radiographics 2011; 31:1701-16. [DOI: 10.1148/rg.316115517] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Breast magnetic resonance (MR) is highly sensitive in the detection of invasive breast malignancies. As technology improves, as interpretations and reporting by radiologists become standardized through the development of guidelines by expert consortiums, and as scientific investigation continues, the indications and uses of breast MR as an adjunct to mammography continue to evolve. This article discusses the current clinical indications for breast MR including screening for breast cancer, diagnostic indications for breast MR, and MR guidance for interventional procedures.
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Affiliation(s)
- Eren D Yeh
- Division of Breast Imaging, Department of Radiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA.
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Effect of Magnetic Resonance Imaging on Breast Conservation Therapy versus Mastectomy: A Review of the Literature. Int J Surg Oncol 2011; 2011:428653. [PMID: 22312507 PMCID: PMC3263668 DOI: 10.1155/2011/428653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 12/21/2010] [Accepted: 02/24/2011] [Indexed: 12/26/2022] Open
Abstract
The utilization of MRI in the workup of breast cancer has played a controversial role in the surgical treatment of this disease. With the higher resolution of breast tissue afforded, additional lesions are being identified that often warrant additional procedures, subsequently affecting the decision to proceed with breast conservation therapy versus mastectomy. In this paper, a literature review is presented to help illuminate some of the benefits and pitfalls of employing MRI as a diagnostic tool in the care of breast cancer, while additionally providing insight into the management alterations this imaging modality can engender. Though further research is required in a randomized prospective form to fully answer this question, evidence for and against its use continues to mount, especially for select patient groups.
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Nichols EM, Dhople AA, Mohiuddin MM, Flannery TW, Yu CX, Regine WF. Comparative Analysis of the Post-Lumpectomy Target Volume Versus the Use of Pre-Lumpectomy Tumor Volume for Early-Stage Breast Cancer: Implications for the Future. Int J Radiat Oncol Biol Phys 2010; 77:197-202. [DOI: 10.1016/j.ijrobp.2009.04.063] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 03/02/2009] [Accepted: 04/21/2009] [Indexed: 10/19/2022]
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Yeh ED. Breast Magnetic Resonance Imaging: Current Clinical Indications. Magn Reson Imaging Clin N Am 2010; 18:155-69, vii. [DOI: 10.1016/j.mric.2010.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bloom S, Morrow M. A Clinical Oncologic Perspective on Breast Magnetic Resonance Imaging. Magn Reson Imaging Clin N Am 2010; 18:277-94, ix. [DOI: 10.1016/j.mric.2010.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sardanelli F, Boetes C, Borisch B, Decker T, Federico M, Gilbert FJ, Helbich T, Heywang-Köbrunner SH, Kaiser WA, Kerin MJ, Mansel RE, Marotti L, Martincich L, Mauriac L, Meijers-Heijboer H, Orecchia R, Panizza P, Ponti A, Purushotham AD, Regitnig P, Del Turco MR, Thibault F, Wilson R. Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group. Eur J Cancer 2010; 46:1296-316. [PMID: 20304629 DOI: 10.1016/j.ejca.2010.02.015] [Citation(s) in RCA: 624] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Accepted: 02/11/2010] [Indexed: 12/22/2022]
Abstract
The use of breast magnetic resonance imaging (MRI) is rapidly increasing. EUSOMA organised a workshop in Milan on 20-21st October 2008 to evaluate the evidence currently available on clinical value and indications for breast MRI. Twenty-three experts from the disciplines involved in breast disease management - including epidemiologists, geneticists, oncologists, radiologists, radiation oncologists, and surgeons - discussed the evidence for the use of this technology in plenary and focused sessions. This paper presents the consensus reached by this working group. General recommendations, technical requirements, methodology, and interpretation were firstly considered. For the following ten indications, an overview of the evidence, a list of recommendations, and a number of research issues were defined: staging before treatment planning; screening of high-risk women; evaluation of response to neoadjuvant chemotherapy; patients with breast augmentation or reconstruction; occult primary breast cancer; breast cancer recurrence; nipple discharge; characterisation of equivocal findings at conventional imaging; inflammatory breast cancer; and male breast. The working group strongly suggests that all breast cancer specialists cooperate for an optimal clinical use of this emerging technology and for future research, focusing on patient outcome as primary end-point.
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Affiliation(s)
- Francesco Sardanelli
- Dipartimento di Scienze Medico-Chirurgiche, Università degli Studi di Milano, IRCCS Policlinico San Donato, Unit of Radiology, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy.
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Overview of the role of pre-operative breast MRI in the absence of evidence on patient outcomes. Breast 2010; 19:3-6. [DOI: 10.1016/j.breast.2009.11.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys 2009; 74:987-1001. [PMID: 19545784 DOI: 10.1016/j.ijrobp.2009.02.031] [Citation(s) in RCA: 598] [Impact Index Per Article: 39.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 02/25/2009] [Indexed: 01/05/2023]
Abstract
PURPOSE To present guidance for patients and physicians regarding the use of accelerated partial-breast irradiation (APBI), based on current published evidence complemented by expert opinion. METHODS AND MATERIALS A systematic search of the National Library of Medicine's PubMed database yielded 645 candidate original research articles potentially applicable to APBI. Of these, 4 randomized trials and 38 prospective single-arm studies were identified. A Task Force composed of all authors synthesized the published evidence and, through a series of meetings, reached consensus regarding the recommendations contained herein. RESULTS The Task Force proposed three patient groups: (1) a "suitable" group, for whom APBI outside of a clinical trial is acceptable, (2) a "cautionary" group, for whom caution and concern should be applied when considering APBI outside of a clinical trial, and (3) an "unsuitable" group, for whom APBI outside of a clinical trial is not generally considered warranted. Patients who choose treatment with APBI should be informed that whole-breast irradiation (WBI) is an established treatment with a much longer track record that has documented long-term effectiveness and safety. CONCLUSION Accelerated partial-breast irradiation is a new technology that may ultimately demonstrate long-term effectiveness and safety comparable to that of WBI for selected patients with early breast cancer. This consensus statement is intended to provide guidance regarding the use of APBI outside of a clinical trial and to serve as a framework to promote additional clinical investigations into the optimal role of APBI in the treatment of breast cancer.
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