Influence of preoperative MRI on the surgical management of patients with operable breast cancer

613 Background: To evaluate the impact of preoperative magnetic resonance imaging (MRI) of the breast on the clinical management of patients with operable breast cancer (BC). Methods: Retrospective analysis of 160 patients with operable breast cancer (stages Tis, through T4), who were treated from 2002 through 2004. All patients underwent a full mammographic assessment, high frequency breast ultrasound, and breast MRI. The impact of preoperative MRI was evaluated for each patient with regard to changes in the therapeutic procedure. Patient and tumor characteristics were analysed to identify possible patient subgroups that predominantly benefit from preoperative MRI. Results: Preoperative MRI affected the clinical management in 44 of 160 patients (27.5%). In 30 cases (18.75%) additional in-situ or invasive cancers or a more widespread tumor extent were diagnosed correctly which went undetected by clinical palpation, mammography, and breast ultrasound. In 14 cases (8.75%) additional, surgical procedures were performed based on suspicious MRI findings with benign pathology. Age, menopausal status, breast density, tumor characteristics (type, tumor size, grading), ER-, PR- and HER2- receptor features did not significantly differ between patients in which breast MRI affected the clinical management and patients that experienced no additional information from MRI. Conclusions: Preoperative breast MRI changes surgical management in a considerable amount of patients with operable breast cancer. MRI detects additional invasive carcinoma and proves to be a meaningful supplement to the conventional work-up in the clinical management of breast cancer. This benefit is independent from patients and tumor characteristics. No significant financial relationships to disclose.

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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 ◽

10.4137/bcbcr.s38432 ◽

2016 ◽

Vol 10 ◽

pp. BCBCR.S38432 ◽

Cited By ~ 2

Author(s):

Som D. Mukherjee ◽

Nicole Hodgson ◽

Peter J. Lovrics ◽

Kavita Dhamanaskar ◽

Terry Minuk ◽

...

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Physical Examination ◽

Surgical Management ◽

Invasive Breast Cancer ◽

Breast Mri ◽

Breast Ultrasound ◽

Surgical Decision ◽

Preoperative Breast Mri ◽

Surgical Decision Making

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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The impact of breast MRI on the surgical management of breast cancer

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2014.02.135 ◽

2014 ◽

Vol 40 (5) ◽

pp. 650

Author(s):

Suzanne Elgammal ◽

Hazem Khout ◽

Jacqueline Kelly

Keyword(s):

Breast Cancer ◽

Surgical Management ◽

Breast Mri ◽

The Impact

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Estrogen receptor positive operable breast cancer: Does menopausal status impact on HER2 and progesterone receptor status?

The Breast ◽

10.1016/j.breast.2011.05.009 ◽

2011 ◽

Vol 20 (6) ◽

pp. 519-524 ◽

Cited By ~ 3

Author(s):

Ning Wang ◽

Bin Wang ◽

Yajie Wang ◽

Jia Hu

Keyword(s):

Breast Cancer ◽

Estrogen Receptor ◽

Progesterone Receptor ◽

Menopausal Status ◽

Operable Breast Cancer ◽

Progesterone Receptor Status ◽

Receptor Status ◽

Estrogen Receptor Positive

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231. The effect of preoperative breast MRI on the surgical management of ductal carcinoma in situ and the risk of contralateral breast cancer

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2016.06.163 ◽

2016 ◽

Vol 42 (9) ◽

pp. S129

Author(s):

K. Keymeulen ◽

E. Heuts ◽

M. Lobbes ◽

A. Voogd ◽

V. Tjan-Heijnen

Keyword(s):

Breast Cancer ◽

Surgical Management ◽

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Contralateral Breast Cancer ◽

Ductal Carcinoma ◽

Breast Mri ◽

Contralateral Breast ◽

Preoperative Breast Mri

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PP-5-10 Direct comparisons of adjuvant chemo-endocrine therapy in operable breast cancer stratified by ER and menopausal status

European Journal of Cancer ◽

10.1016/0959-8049(96)84177-3 ◽

1996 ◽

Vol 32 ◽

pp. 36

Author(s):

Y. Nomura ◽

H. Tashiro ◽

M. Shirouzu ◽

T. Takayama

Keyword(s):

Breast Cancer ◽

Endocrine Therapy ◽

Menopausal Status ◽

Operable Breast Cancer

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The impact of preoperative breast MRI on the surgical management of newly diagnosed non metastatic breast cancers

International Journal of Current Research in Medical Sciences ◽

10.22192/ijcrms.2017.03.05.016 ◽

2017 ◽

Vol 3 (5) ◽

pp. 111-121

Author(s):

Col (Dr.) Puneet Takkar ◽

◽

Surg Lt Cdr (Dr.) Hari JP ◽

Surg Lt Cdr (Dr.) Khushdeep Kaur ◽

◽

...

Keyword(s):

Surgical Management ◽

Metastatic Breast ◽

Breast Mri ◽

Breast Cancers ◽

Newly Diagnosed ◽

Preoperative Breast Mri ◽

The Impact

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HIGH BODY-MASS INDEX IS NOT ASSOCIATED WITH WORSE CLINICOPATHOLOGICAL CHARACTERISTICS IN PREDOMINANTLY OBESE BREAST CANCER PATIENTS

Experimental Oncology ◽

10.31768/2312-8852.2015.37(4):281-284 ◽

2015 ◽

Vol 37 (4) ◽

pp. 281-284 ◽

Cited By ~ 1

Author(s):

Y Kemal ◽

G Demirag ◽

F Teker ◽

E Kut ◽

M Kefeli ◽

...

Keyword(s):

Breast Cancer ◽

Body Mass Index ◽

Body Mass ◽

Menopausal Status ◽

High Body Mass Index ◽

Clinicopathological Characteristics ◽

Breast Cancer Patients ◽

High Body ◽

Obese Population ◽

The Impact

Background: Breast cancer (BC) is the most common cancer among women. A high body-mass index (BMI) is related to increased incidence of BC with poorer prognosis. Aim: The aim of the study was to evaluate the association in patients with BC between BMI at the time of diagnosis and biological characteristics, according to the menopausal status. Materials and Methods: This retrospective study comprised a total of 318 women with BC. Clinicopathological differences between normal, overweight and obese patients according to menopausal status were evaluated. Results: Premenopausal women had a significantly lower BMI than postmenopausal patients (28.7 vs. 31.5, respectively; p = 0.00001). No statistically significant association was determined between BMI and clinicopathological characteristics in either the premenopausal or the postmenopausal group (all p values are > 0.05). Conclusions: There are many conflicting results in literature on this relationship. The results of this study showed that a high BMI is not associated with worse clinicopathological characteristics in a predominantly obese population. In current medical oncology practice, BC should be evaluated on an individual patient basis and the impact of obesity on BC prognosis seems to be difficult to estimate especially in an obese population.

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Using Whole Breast Ultrasound Tomography to Improve Breast Cancer Risk Assessment: A Novel Risk Factor Based on the Quantitative Tissue Property of Sound Speed

Journal of Clinical Medicine ◽

10.3390/jcm9020367 ◽

2020 ◽

Vol 9 (2) ◽

pp. 367 ◽

Cited By ~ 3

Author(s):

Neb Duric ◽

Mark Sak ◽

Shaoqi Fan ◽

Ruth M. Pfeiffer ◽

Peter J. Littrup ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factor ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Sound Speed ◽

Menopausal Status ◽

Surrogate Marker ◽

Breast Ultrasound ◽

Ultrasound Tomography ◽

Breast Cancer Risk Assessment

Mammographic percent density (MPD) is an independent risk factor for developing breast cancer, but its inclusion in clinical risk models provides only modest improvements in individualized risk prediction, and MPD is not typically assessed in younger women because of ionizing radiation concerns. Previous studies have shown that tissue sound speed, derived from whole breast ultrasound tomography (UST), a non-ionizing modality, is a potential surrogate marker of breast density, but prior to this study, sound speed has not been directly linked to breast cancer risk. To that end, we explored the relation of sound speed and MPD with breast cancer risk in a case-control study, including 61 cases with recent breast cancer diagnoses and a comparison group of 165 women, frequency matched to cases on age, race, and menopausal status, and with a recent negative mammogram and no personal history of breast cancer. Multivariable odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for the relation of quartiles of MPD and sound speed with breast cancer risk adjusted for matching factors. Elevated MPD was associated with increased breast cancer risk, although the trend did not reach statistical significance (OR per quartile = 1.27, 95% CI: 0.95, 1.70; ptrend = 0.10). In contrast, elevated sound speed was significantly associated with breast cancer risk in a dose–response fashion (OR per quartile = 1.83, 95% CI: 1.32, 2.54; ptrend = 0.0003). The OR trend for sound speed was statistically significantly different from that observed for MPD (p = 0.005). These findings suggest that whole breast sound speed may be more strongly associated with breast cancer risk than MPD and offer future opportunities for refining the magnitude and precision of risk associations in larger, population-based studies, including women younger than usual screening ages.

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