Second-look axillary ultrasound after breast MRI for enhanced preoperative nodal staging in newly diagnosed breast cancer patients.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 98-98
Author(s):  
Tina J. Hieken ◽  
Katie N. Jones ◽  
Judy Caroline Boughey ◽  
Sejal Shah ◽  
Katrina N. Glazebrook
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Breast Mri ◽  
Newly Diagnosed ◽  
Nodal Staging ◽  
Breast Cancer Patients ◽  
Axillary Ultrasound ◽  
Mri Findings ◽  
Node Positive ◽  
Second Look

98 Background: Concomitant with widespread adoption of axillary ultrasound (AUS) with ultrasound-guided needle biopsy (USNB) of suspicious lymph nodes (LN) for preoperative nodal staging of breast cancer patients, utilization of breast MRI, which includes axillary imaging, has increased. Little is known about the added value of MRI imaging of the axilla in this context. We undertook this study to assess the role of breast MRI in preoperative axillary nodal staging. Methods: We studied 988 consecutive invasive breast cancers in patients undergoing primary operation including axillary surgery, without neoadjuvant therapy, from 2010-2011. Results: 505 patients (51%) underwent MRI of which 168 (33%) demonstrated suspicious findings in the axilla. Abnormal axillary MRI findings included cortical thickening, edema, enhancement, hilar effacement, and/or altered shape and size. 114 patients had findings concordant with AUS. 54 patients had suspicious LNs on MRI either without a preceding AUS (33 cases) or after an initially negative AUS (21 cases). Second look AUS was performed in 29 of these cases and was abnormal in 3 (10%) in whom USNB confirmed metastatic adenopathy. Of the 54 cases with MRI-detected suspicious LNs 20 (37%) were node positive at operation with a pN stage of N0 (63%), N0i+ (5%), N1mic (4%), N1 (20%), N2 (6%), N3 (2%); extranodal extension was seen in 7 of 20 node-positive patients (35%). Conclusions: Second look AUS, when performed secondary to suspicious axillary MRI findings, identified LN metastasis preoperatively in 10% of patients. When MRI is done to evaluate the breast in newly diagnosed breast cancer patients, axillary findings can enhance the accuracy of preoperative nodal staging. We recommend second look AUS when MRI demonstrates suspicious axillary LN findings. [Table: see text]

scholarly journals Axillary ultrasound for preoperative nodal staging in breast cancer patients: Is it of added value?

The Breast ◽  
2013 ◽  
Vol 22 (6) ◽  
pp. 1108-1113 ◽  
Author(s):  
R.J. Schipper ◽  
L.M. van Roozendaal ◽  
B. de Vries ◽  
R.M. Pijnappel ◽  
R.G.H. Beets-Tan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Added Value ◽  
Nodal Staging ◽  
Breast Cancer Patients ◽  
Axillary Ultrasound

Analysis of magnetic resonance imaging (MRI) in the detection of mammographically occult breast carcinoma

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 603-603
Author(s):  
L. Vallow ◽  
S. Packianathan ◽  
D. Feigel ◽  
E. DePeri ◽  
S. Buskirk ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma ◽  
Breast Mri ◽  
Breast Disease ◽  
Newly Diagnosed ◽  
Breast Cancer Patients ◽  
Mri Findings ◽  
Index Lesion ◽  
Cancer Management ◽  
Infiltrating Ductal Carcinoma

603 Background: Breast MRI may be useful for detecting mammographically occult ipsilateral carcinoma in newly diagnosed breast cancer. Our initial experience with breast MRI, demonstrated 16% of patients to have additional breast disease detected only by preoperative MRI. We further analyzed our findings to identify an association between patient factors and MRI detected disease. Methods: Preoperative MRI scans of 390 women with newly diagnosed breast cancer were reviewed. Using only patients with pathologic verification, the incidence of mammographically occult ipsilateral cancer was determined. Patient and tumor characteristics were further analyzed to identify factors which may predict pathologically positive MRI findings. Results: Of the 390 women undergoing preoperative MRI, 120 (31%) had ipsilateral findings requiring biopsy. Pathologically verified additional ipsilateral cancer was detected in 62 (16%). Multicentric disease was detected in 32 (52%) and multifocal or more extensive local disease in 30 (48%). The median age of all patients was 62 (27% premenopausal) whereas the median age of those with MRI detected additional carcinoma was 55 (44% premenopausal). Of those with additional disease detected by MRI, 74% had index lesions =1 cm and 63% node negative. The most common histology of the index lesion was infiltrating ductal carcinoma in 64%. In the 62 patients found to have additional disease by MRI the most common histology included infiltrating ductal carcinoma (58%), ductal carcinoma-in-situ (34%) and infiltrating lobular (8%). The histology of the MRI detected additional disease was identical to the index lesion in 71%. Conclusions: In women with newly diagnosed breast cancer, there was a 16% incidence of pathologically proven, mammographically occult ipsilateral disease detected by MRI. Patients found to have additional disease tended to be younger, premenopausal or have index tumors =1cm. The contribution of preoperative MRI in breast cancer management continues to evolve. A lower threshold for obtaining breast MRI may be appropriate in selected subsets of breast cancer patients. No significant financial relationships to disclose.

Does breast density affect the ability of MRI to detect mammographically occult cancers?

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 54-54
Author(s):  
Beth Cutler Freedman ◽  
Jocelyn Luongo ◽  
Alyssa Gillego ◽  
Tamara Fulop ◽  
Susan K. Boolbol
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Breast Density ◽  
Retrospective Chart Review ◽  
Breast Mri ◽  
Mammographic Breast Density ◽  
Breast Cancer Patients ◽  
Mri Findings ◽  
Number Of Patients ◽  
Density Methods

54 Background: In breast cancer patients, the use of preoperative MRI is increasing. A change in the operative plan due to MRI findings occurs in 8%-20% of cases. Preoperative MRI is used routinely by many surgeons and radiologists, but debate persists with regard to its indications. We evaluated whether mammographic breast density affected MRI findings. We also examined whether the number of MRI detected synchronous cancers were affected by breast density. Methods: A retrospective chart review was performed of newly diagnosed breast cancer patients who underwent preoperative MRI from 2008-2011. There were three categories of breast density: fat-replaced, scattered fibroglandular densities, and dense. We determined the number of patients in each group who underwent biopsies based on MRI findings, and evaluated the number of occult cancers diagnosed as a result of these biopsies. Results: 301 patients were included. Overall, 64 patients (21%) who underwent an image guided biopsy based on pre-operative breast MRI were diagnosed with an additional focus of cancer. Of the 17 patients with fat-replaced breasts, 4 underwent additional biopsy, and carcinoma was identified in all patients. 149 patients had scattered fibroglandular densities; 53 (36%) underwent additional biopsies. New cancers were diagnosed in 28 patients (19%). Of 135 patients with dense breasts, 61 patients (45%) had additional biopsies, and new cancers were diagnosed in 24 % of these patients. Conclusions: MRI detected additional cancer in 21% of patients in this study. MRI is sensitive and specific in patients with fat-replaced breasts (100%), but due to the small number of patients in this group, additional studies must be done to evaluate the usefulness in this group of patients. We conclude that MRI is useful for detecting additional cancers in patients of all breast densities, and may change the surgical options of the patient when multicentric or contralateral disease is diagnosed.[Table: see text]

Who is ordering breast MRIs in newly diagnosed breast cancer patients?

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 24-24
Author(s):  
Anya Romanoff ◽  
Matthew McMurray ◽  
Hank Schmidt ◽  
Parissa Tabrizian ◽  
Christina Weltz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Patients ◽  
Breast Mri ◽  
Primary Care Providers ◽  
Newly Diagnosed ◽  
Care Providers ◽  
Breast Cancer Patients ◽  
Breast Center ◽  
Breast Surgeon

24 Background: Utilization of breast MRI has increased dramatically in recent years, and there is ongoing debate regarding the role of MRI in patients with breast cancer. Guidelines for MRI use in newly diagnosed breast cancer patients have not been established; therefore, provider ordering of MRI in this population is variable. We investigated patterns of MRI ordering by healthcare providers in the setting of newly diagnosed breast cancer and analyzed predictors of MRI utilization. Methods: All newly diagnosed breast cancer patients presenting for surgical management at a single tertiary care breast center from January 2011 through December 2013 were reviewed. Cases were evaluated for the use of preoperative MRI, and medical specialty of the ordering provider was determined. Patients who presented to a specialized breast center with MRI already completed were compared to those who had MRIs ordered by their treating breast surgeon. Results: A total of 423 women with newly diagnosed breast cancer underwent MRI during the study period. In this group, 253/423 patients (60%) presented to our institution with an MRI already completed. Of MRIs performed prior to presentation, 73% were ordered by a primary care provider, and 27% were ordered by a breast specialist seen previously. Race was a significant predictor of having an MRI before presentation to a breast center (64% of white patients, 41% of black patients, 25% of Asians, and 65% of Hispanic patients, p < .001). Women with commercial insurance were significantly more likely to have an MRI completed before presentation than those with Medicaid (62% versus 37%, p = .002). Age, family history of breast cancer, genetic testing, breast density, mode of diagnosis, and biopsy pathology were not significant factors in determining whether a patient underwent MRI prior to presentation to a breast surgeon. Conclusions: In our experience, the majority of MRIs performed in newly diagnosed patients with breast cancer were ordered by primary care providers as part of their patient’s initial workup. Patient race and insurance status were significant predictors of having an MRI ordered prior to seeing a breast specialist. Further research is needed to develop guidelines for breast MRI use in newly diagnosed cancer patients.

scholarly journals Pathologic Findings in MRI-Guided Needle Core Biopsies of the Breast in Patients with Newly Diagnosed Breast Cancer

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
K. P. Siziopikou ◽  
P. Jokich ◽  
M. Cobleigh
Keyword(s):  
Breast Cancer ◽  
Breast Carcinoma ◽  
Early Stage ◽  
Benign Lesion ◽  
Breast Mri ◽  
Newly Diagnosed ◽  
Breast Cancer Patients ◽  
Mri Findings ◽  
Mri Guided ◽  
New Diagnosis

The role of MRI in the management of breast carcinoma is rapidly evolving from its initial use for specific indications only to a more widespread use on all women with newly diagnosed early stage breast cancer. However, there are many concerns that such widespread use is premature since detailed correlation of MRI findings with the underlying histopathology of the breast lesions is still evolving and clear evidence for improvements in management and overall prognosis of breast cancer patients evaluated by breast MRI after their initial cancer diagnosis is lacking. In this paper, we would like to bring attention to a benign lesion that is frequently present on MRI-guided breast biopsies performed on suspicious MRI findings in the affected breast of patients with a new diagnosis of breast carcinoma.

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