Alessandro Fancellu1, Daniela Soro2, Paolo Castiglia3, Vincenzo Marras4, Marcovalerio Melis5, Pietrina Cottu6, Alessandra Cherchi6, Angela Spanu7, Silvia Mulas6, Claudio Pusceddu8, Luca Simbula2, Giovanni B Meloni2. 1. Unit of General Surgery II, Clinica Chirurgica, University of Sassari, Sassari, Italy. Electronic address: afancel@uniss.it. 2. Department of Radiology, University of Sassari, Sassari, Italy. 3. Department of Biomedical Sciences, University of Sassari, Sassari, Italy. 4. Department of Pathology, University of Sassari, Sassari, Italy. 5. New York University School of Medicine and Department of Surgery, NY Harbor Healthcare System VAMC, New York, NY. 6. Unit of General Surgery II, Clinica Chirurgica, University of Sassari, Sassari, Italy. 7. Department of Nuclear Medicine, University of Sassari, Sassari, Italy. 8. Department of Radio-oncology, Oncological Hospital of Cagliari, Cagliari, Italy.
Abstract
BACKGROUND: The role of magnetic resonance imaging (MRI) in newly detected breast cancer remains controversial. We investigated the impact of preoperative MRI on surgical management of infiltrating breast carcinoma (IBC). METHODS: We reviewed data of 237 patients with IBC who were suitable for breast-conserving surgery (BCS) between 2009 and 2011. Of these patients, 109 underwent preoperative MRI (46%; MRI group) and 128 did not (54%; no-MRI group). We analyzed MRI-triggered changes in surgical plan and compared differences in rates of positive margins and mastectomy. RESULTS: Tumor size was larger in the MRI group (16.8 mm vs. 13.9 mm; P < .001). MRI changed the initial surgical planning in 18 of 109 patients (16.5%) because of detection of larger tumor diameter requiring wider resection (8 patients [7.3%]) or additional malignant lesions in the ipsilateral (9 patients [8.2%]) or contralateral breast (1 patient [0.9%]). MRI-triggered treatment changes included mastectomy (n = 12), wider excision (n = 5), and contralateral BCS (n = 1). Reoperation rates for positive margins after BCS appeared higher in the no-MRI group (4.1% vs. 8.6%), but the difference missed statistical significance (P = .9). Overall mastectomy rates were higher in the MRI group (13.7% vs. 7.0%; P < .05). The likelihood of having a change of treatment resulting from MRI was significantly higher for patients with tumors > 15 mm and for those with positive lymph nodes. CONCLUSION: Lymph node positivity and tumor size > 15 mm may predict an MRI-triggered change in surgical plan. Preoperative MRI resulted in higher mastectomy rates justified by biopsy-proven additional foci of carcinoma and did not significantly reduce reoperation rates for positive margins.
BACKGROUND: The role of magnetic resonance imaging (MRI) in newly detected breast cancer remains controversial. We investigated the impact of preoperative MRI on surgical management of infiltrating breast carcinoma (IBC). METHODS: We reviewed data of 237 patients with IBC who were suitable for breast-conserving surgery (BCS) between 2009 and 2011. Of these patients, 109 underwent preoperative MRI (46%; MRI group) and 128 did not (54%; no-MRI group). We analyzed MRI-triggered changes in surgical plan and compared differences in rates of positive margins and mastectomy. RESULTS:Tumor size was larger in the MRI group (16.8 mm vs. 13.9 mm; P < .001). MRI changed the initial surgical planning in 18 of 109 patients (16.5%) because of detection of larger tumor diameter requiring wider resection (8 patients [7.3%]) or additional malignant lesions in the ipsilateral (9 patients [8.2%]) or contralateral breast (1 patient [0.9%]). MRI-triggered treatment changes included mastectomy (n = 12), wider excision (n = 5), and contralateral BCS (n = 1). Reoperation rates for positive margins after BCS appeared higher in the no-MRI group (4.1% vs. 8.6%), but the difference missed statistical significance (P = .9). Overall mastectomy rates were higher in the MRI group (13.7% vs. 7.0%; P < .05). The likelihood of having a change of treatment resulting from MRI was significantly higher for patients with tumors > 15 mm and for those with positive lymph nodes. CONCLUSION: Lymph node positivity and tumor size > 15 mm may predict an MRI-triggered change in surgical plan. Preoperative MRI resulted in higher mastectomy rates justified by biopsy-proven additional foci of carcinoma and did not significantly reduce reoperation rates for positive margins.
Authors: Alessandro Fancellu; Xue Yun Zhao; Pietrina Cottu; Valeria Sanna; Yuan Ping Li; Qin Zhu; Cinzia Tanda; Ying Yi Zhang; Yan Mei Lai; Giorgio Carlo Ginesu; Shu Qin Dai; Alberto Porcu Journal: Breast Care (Basel) Date: 2020-01-21 Impact factor: 2.860
Authors: Michael R Harowicz; Ashirbani Saha; Lars J Grimm; P Kelly Marcom; Jeffrey R Marks; E Shelley Hwang; Maciej A Mazurowski Journal: J Magn Reson Imaging Date: 2017-02-09 Impact factor: 4.813
Authors: Sneha Phadke; Alexandra Thomas; Limin Yang; Catherine Moore; Chang Xia; Mary C Schroeder Journal: Clin Breast Cancer Date: 2015-08-28 Impact factor: 3.225