The Contribution of 3 Tesla MRI to the Preoperative Assessment of Breast Cancer

Abstract

Objectives: To compare magnetic resonance imaging (MRI) findings with postoperative pathological results and to show the effects of MRI on surgical procedures. Materials and Methods: In this study 31 breast cancer patients whose diagnosis had been proven histopatologically and examined with breast MRI were evaluated retrospectively. The size of the tumor, additional foci in the same breast, the existence of tumor in the other breast, extension to the chest wall and axillary lymph node metastasis were noted. These findings were compared with postoperative histopathological findings. Results: In 10 patients multifocal disease was identified but only in 3 patients it was proven pathologically. In 1 patient MRI could not identify the additional foci [sensitivity 66%, specificity 71%, positive predictive value (PPV) 20%, negative predictive value (NPV) 95%]. In 2 patients MRI found multicentric foci and they were confirmed with pathology. Out of 6 patients with suspicious findings in the contralateral breast, 1 patient was diagnosed as cancer (sensitivity 100%, specificity 83%, PPV 17%, NPV 100%). Thirteen patients were evaluated as positive for axillary lymph node involvement. One of them did not have axillary lymph node metastasis in the pathology specimens. In 1 patient MRI could not identify the axillary lymph node metastasis (sensitivity 92%, specificity 94%, PPV 92%, NPV 94%). Compared to histopathological measurements, we obtained a high reliability ratio (88%) for the lesion sizes. Conclusion: MRI can be used to exclude additional foci in patients who have high risks for multifocal and contralateral disease. MRI may reveal false positive results and therefore the diagnosis must be proven with pathology before surgery. Key Words: Breast Cancer, Magnetic Resonance Imaging, Preoperative MRI

Keywords

• Breast Cancer
• Magnetic Resonance Imaging
• Preoperative MRI

Meme Kanserinin Operasyon Öncesi Değerlendirilmesinde 3 Tesla Magnetik Rezonans Görüntülemenin Katkısı

Abstract

Amaç: Bu çalışmanın amacı, yeni tanı almış meme kanserli hastalarda operasyon öncesi manyetik rezonans görüntüleme (MRG) bulguları ile patoloji sonuçlarını karşılaştırmak ve MRG bulgularının cerrahi tedaviye etkisini ortaya koymaktır. Gereç ve Yöntem: Meme kanseri tanısı histopatolojik olarak doğrulanmış ve preoperatif olarak meme MRG yapılmış 31 kadın hasta retrospektif olarak değerlendirildi. MRG’de tümörün boyutu, aynı memede ek odak varlığı, karşı memede tümör varlığı, göğüs duvarı invazyonu olup olmadığı ve aksiller patolojik özellikte lenf nodu varlığı incelendi. Bulgular cerrahi sonrası elde edilen patoloji sonuçları ile karşılaştırıldı. Bulgular: Patoloji spesmenlerindeki ölçümlerle karşılaştırıldığında MRG’de lezyon boyutlarının yüksek güvenilirlik oranı (%88) ile saptandığı görüldü. Hastaların 10’u MRG’de multifokal odak var olarak değerlendirildi. Tüm hastaların sadece 3’ünde patolojik olarak multifokal odak varlığı doğrulandı. Bu hastaların 1’inde MRG’de lezyon saptanamadı [duyarlılık %67, özgüllük %71, pozitif prediktif değer (PPD) %20, negatif prediktif değer (NPD) %95]. MRG’de multisentrik olarak değerlendirilen 2 hastada tanı patolojik olarak doğrulandı. Karşı memede malignite açısından şüpheli lezyon saptanan 6 hastanın 1’inde kanser varlığı doğrulandı (duyarlılık %100, özgüllük %83, PPD %17, NPD %100). MRG’de 13 hasta patolojik aksiller lenf nodu yönünden pozitif olarak değerlendirildi. Bütün hastaların 13’ünde patoloji sonuçlarında aksiller metastaz saptandı. Bir hastada MRG’de aksiller metastaz saptanamadı (duyarlılık %92, özgüllük %94, PPD %92, NPD %94). Sonuç: Meme MRG meme kanserli hastaların cerrahi öncesinde değerlendirilmesinde tümör boyutunun belirlenmesinde ve aksiller lenf nodu tutulumunun değerlendirilmesinde güvenilir sonuçlar vermektedir. Multifokalite ve kontralateral malignite olasılığı yüksek hastalarda ek odak varlığının dışlanmasında kullanılabilir. Ek odakların tespitinde yalancı pozitif sonuçlara neden olabileceğinden cerrahi öncesi histopatolojik örnekleme ile tanı doğrulanmalıdır. Anahtar Kelimeler: Meme Kanseri, Manyetik Rezonans Görüntüleme, Preoperatif MRG

Keywords

• Meme Kanseri
• Manyetik Rezonans Görüntüleme
• Preoperatif MRG

References

1. 1. Lee SC, Jain PA, Jethwa SC, et al. Radiologists’ role in breast cancer staging: providing key information for clinicians. Radiographics. 2014;34:330-342.
2. 2. Hirose M, Hashizume T, Seino N, et al. Atlas of breast magnetic resonance imaging. Curr Probl Diagn Radiol. 2007;36:51-65.
3. 3. Fischer U. Practical MR Mammography High-Resolution MRI of the Breast. 2nd ed. Stuttgart-New York: Thieme; 2012.
4. 4. Ong E. Preoperative imaging for breast conservation surgery-do we need more than conventional imaging for local disease assessment? Gland Surg. 2018;7:554-559.
5. 5. Berg WA, Gutierrez L, NessAiver MS, Carter WB, Bhargavan M, Lewis RS, Ioffe OB. Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology. 2004;233:830-849.
6. 6. Lee J, Jung JH, Kim WW, et al. Efficacy of breast MRI for surgical decision in patients with breast cancer: ductal carcinoma in situ versus invasive ductal carcinoma. BMC Cancer. 2020;20:934.
7. 7. Houssami N, Hayes DF. Review of preoperative magnetic resonance imaging (MRI) in breast cancer: should MRI be performed on all women with newly diagnosed, early stage breast cancer? CA Cancer J Clin. 2009;59:290-302.
8. 8. Houssami N, Ciatto S, Macaskill P, et al. Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol. 2008;26:3248-3258.

9. 9. Chou SS, Romanoff J, Lehman CD, et al. Preoperative Breast MRI for Newly Diagnosed Ductal Carcinoma in Situ: Imaging Features and Performance in a Multicenter Setting (ECOG-ACRIN E4112 Trial). Radiology. 2021;301:66-77.
10. 10. Christensen DM, Shehata MN, Javid SH, et al. Preoperative Breast MRI: Current Evidence and Patient Selection. Journal of Breast Imaging. 2023;5:112-124.
11. 11. Lehman CD, Gatsonis C, Kuhl CK, et al. MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med. 2007;356:1295-1303.
12. 12. Brennan M, Houssami N, Lord SJ, et al. Magnetic resonance imaging screening of the contralateral breast in women with newly diagnosed breast cancer: systematic review and meta-analysis of incremental cancer detection and impact on surgical management. J Clin Oncol. 2009;27:5640- 5649.
13. 13. Ashikaga T, Krag DN, Land SR, et al. Morbidity results from the NSABP B2-32 trial comparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol. 2010;102: 111-118.
14. 14. Kuijs VJ, Moossdorff M, Schipper RJ, et al. The role of MRI in axillary lymph node imaging in breast cancer patients: a systematic review. Insights Imaging. 2015;6:203-215.
15. 15. An YS, Lee DH, Yoon JK, et al. Diagnostic performance of 18F-FDG PET/CT, ultrasonography and MRI. Detection of axillary lymph node metastasis in breast cancer patients. Nuklearmedizin 2014;53:89-94.
16. 16. Lopez JK, Bassett LW. Invasive lobular carcinoma of the breast: spectrum of mammographic, US, and MR imaging findings. Radiographics. 2009;29:165- 176.
17. 17. Mann RM, Hoogeveen YL, Blickman JG, et al. MRI compared to conventional diagnostic work-up in the detection and evaluation of invasive lobular carcinoma of the breast: a review of existing literature. Breast Cancer Res Treat. 2008;107:1-14.