Julia Krammer1,2, Elissa R Price3, Maxine S Jochelson4, Elizabeth Watson4, Melissa P Murray5, Stefan O Schoenberg6, Elizabeth A Morris4. 1. Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. Julia.Krammer@medma.uni-heidelberg.de. 2. Breast Imaging Section, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY, 10021, USA. Julia.Krammer@medma.uni-heidelberg.de. 3. Department of Radiology and Biomedical Imaging, Division of Women's Imaging, University of California, San Francisco, 1600 Divisadero Street, San Francisco, CA, 94115, USA. 4. Breast Imaging Section, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY, 10021, USA. 5. Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA. 6. Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Abstract
OBJECTIVES: To determine the accuracy of post-operative MR in predicting residual disease in women with positive margins, emphasizing the size thresholds at which residual disease can be confidently identified. METHODS: This IRB-approved HIPAA-compliant retrospective study included 175 patients with MR after positive margins following initial surgery for breast cancer. Two expert readers independently re-evaluated MR images for evidence of residual disease at the surgical cavity and multifocal/multicentric disease. All patients underwent definitive surgery and MR findings were correlated to histopathology. RESULTS: 139/175 (79.4%) patients had residual disease at surgery. Average overall sensitivity, specificity, PPV and NPV for residual disease at the surgical cavity were 73%, 72%, 91% and 45%, respectively. The readers identified 42/45 (93%, reader 1) and 43/45 (95%, reader 2) patients with residual invasive disease at the cavity of ≥5 mm and 22/22 (100%, both readers) patients with disease ≥10 mm. Average sensitivity, specificity, PPV and NPV for unknown multifocal/multicentric disease were 90%, 96%, 93% and 86%, respectively. CONCLUSIONS: Post-operative breast MR can accurately depict ≥5-mm residual disease at the surgical cavity and unsuspected multifocal/multicentric disease. These findings have the potential to lead to more appropriate selection of second surgical procedures in women with positive margins. KEY POINTS: • Post-operative breast MRI accurately defines residual disease of ≥5 mm. • Surgical cavity sensitivities were high for both invasive carcinoma and DCIS. • Post-surgical changes and very small residual disease (<5 mm) may overlap. • Post-operative breast MRI may help planning an accurate re-resection.
OBJECTIVES: To determine the accuracy of post-operative MR in predicting residual disease in women with positive margins, emphasizing the size thresholds at which residual disease can be confidently identified. METHODS: This IRB-approved HIPAA-compliant retrospective study included 175 patients with MR after positive margins following initial surgery for breast cancer. Two expert readers independently re-evaluated MR images for evidence of residual disease at the surgical cavity and multifocal/multicentric disease. All patients underwent definitive surgery and MR findings were correlated to histopathology. RESULTS: 139/175 (79.4%) patients had residual disease at surgery. Average overall sensitivity, specificity, PPV and NPV for residual disease at the surgical cavity were 73%, 72%, 91% and 45%, respectively. The readers identified 42/45 (93%, reader 1) and 43/45 (95%, reader 2) patients with residual invasive disease at the cavity of ≥5 mm and 22/22 (100%, both readers) patients with disease ≥10 mm. Average sensitivity, specificity, PPV and NPV for unknown multifocal/multicentric disease were 90%, 96%, 93% and 86%, respectively. CONCLUSIONS: Post-operative breast MR can accurately depict ≥5-mm residual disease at the surgical cavity and unsuspected multifocal/multicentric disease. These findings have the potential to lead to more appropriate selection of second surgical procedures in women with positive margins. KEY POINTS: • Post-operative breast MRI accurately defines residual disease of ≥5 mm. • Surgical cavity sensitivities were high for both invasive carcinoma and DCIS. • Post-surgical changes and very small residual disease (<5 mm) may overlap. • Post-operative breast MRI may help planning an accurate re-resection.
Entities:
Keywords:
Breast cancer; Breast-conserving therapy; Magnetic resonance imaging; Positive margins; Residual disease
Authors: Bernard Fisher; Jong-Hyeon Jeong; Stewart Anderson; John Bryant; Edwin R Fisher; Norman Wolmark Journal: N Engl J Med Date: 2002-08-22 Impact factor: 91.245
Authors: Janie M Lee; Susan G Orel; Brian J Czerniecki; Lawrence J Solin; Mitchell D Schnall Journal: AJR Am J Roentgenol Date: 2004-02 Impact factor: 3.959
Authors: M Van Goethem; K Schelfout; E Kersschot; C Colpaert; I Verslegers; I Biltjes; W A Tjalma; A De Schepper; J Weyler; P M Parizel Journal: Eur J Radiol Date: 2007-01-12 Impact factor: 3.528
Authors: Christiane K Kuhl; Simone Schrading; Heribert B Bieling; Eva Wardelmann; Claudia C Leutner; Roy Koenig; Walther Kuhn; Hans H Schild Journal: Lancet Date: 2007-08-11 Impact factor: 79.321
Authors: Matthew M Poggi; David N Danforth; Linda C Sciuto; Sharon L Smith; Seth M Steinberg; David J Liewehr; Cynthia Menard; Marc E Lippman; Allen S Lichter; Rosemary M Altemus Journal: Cancer Date: 2003-08-15 Impact factor: 6.860