Stephanie Aroney, Thomas Lloyd, Simone Birch, Belinda Godwin, Kylie Walters, Jeremy Khoo, Simone Geere, Linda Shen, Petar Vujovic, Ian Bennett, Gorane Santamaría
{"title":"Preoperative breast MR imaging influences surgical management in patients with invasive lobular carcinoma","authors":"Stephanie Aroney, Thomas Lloyd, Simone Birch, Belinda Godwin, Kylie Walters, Jeremy Khoo, Simone Geere, Linda Shen, Petar Vujovic, Ian Bennett, Gorane Santamaría","doi":"10.1111/1754-9485.13754","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>The purpose of the study is to assess the role of preoperative magnetic resonance (MR) imaging on the surgical management of invasive lobular carcinoma (ILC) and to evaluate whether breast density and background parenchymal enhancement (BPE) influence surgical treatment.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This retrospective study was conducted on 56 patients who were diagnosed with ILC between 2014 and 2020. All patients had mammogram and ultrasound. Preoperative MRI was available in 34 patients. Age, menopausal status, breast density, BPE, multifocality/multicentricity and surgical treatment were collected.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Mean pathological tumour size was 36.4 mm (range 5–140 mm). Dense breasts had larger tumours compared to non-dense breasts (<i>P</i> = 0.072). Of the 34 patients with MRI, 6 opted for mastectomy. Of the remaining 28 cases, MRI findings upgraded surgery to mastectomy in 54% (15/28) because mammogram/ultrasound underestimated tumour extent in 25% (7/28), or multifocal/multicentric disease was identified in 29% (8/28). Tumour size was underestimated by MRI in 7% (2/28). In the non-MRI subgroup, 64% (14/22) of patients underwent breast-conserving surgery, but 29% of them (4/14) required a second-stage mastectomy due to extensive margin involvement. There was no difference in mastectomy rate between patients with MRI (62%) and without MRI (55%) (<i>P</i> = 0.061). Tumour size correlation between MRI and histopathology demonstrated an excellent intraclass correlation coefficient (<i>P</i> < 0.001). Surgical treatment recommendation was not significantly impacted by breast density or BPE.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Breast MRI improves surgical management of patients with ILC in providing additional diagnostic information often missed with standard imaging modalities, and without increasing mastectomy rate. Surgical treatment is not impacted by breast density or BPE.</p>\n </section>\n </div>","PeriodicalId":16218,"journal":{"name":"Journal of Medical Imaging and Radiation Oncology","volume":"68 6","pages":"680-686"},"PeriodicalIF":2.2000,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Medical Imaging and Radiation Oncology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/1754-9485.13754","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction
The purpose of the study is to assess the role of preoperative magnetic resonance (MR) imaging on the surgical management of invasive lobular carcinoma (ILC) and to evaluate whether breast density and background parenchymal enhancement (BPE) influence surgical treatment.
Methods
This retrospective study was conducted on 56 patients who were diagnosed with ILC between 2014 and 2020. All patients had mammogram and ultrasound. Preoperative MRI was available in 34 patients. Age, menopausal status, breast density, BPE, multifocality/multicentricity and surgical treatment were collected.
Results
Mean pathological tumour size was 36.4 mm (range 5–140 mm). Dense breasts had larger tumours compared to non-dense breasts (P = 0.072). Of the 34 patients with MRI, 6 opted for mastectomy. Of the remaining 28 cases, MRI findings upgraded surgery to mastectomy in 54% (15/28) because mammogram/ultrasound underestimated tumour extent in 25% (7/28), or multifocal/multicentric disease was identified in 29% (8/28). Tumour size was underestimated by MRI in 7% (2/28). In the non-MRI subgroup, 64% (14/22) of patients underwent breast-conserving surgery, but 29% of them (4/14) required a second-stage mastectomy due to extensive margin involvement. There was no difference in mastectomy rate between patients with MRI (62%) and without MRI (55%) (P = 0.061). Tumour size correlation between MRI and histopathology demonstrated an excellent intraclass correlation coefficient (P < 0.001). Surgical treatment recommendation was not significantly impacted by breast density or BPE.
Conclusion
Breast MRI improves surgical management of patients with ILC in providing additional diagnostic information often missed with standard imaging modalities, and without increasing mastectomy rate. Surgical treatment is not impacted by breast density or BPE.
期刊介绍:
Journal of Medical Imaging and Radiation Oncology (formerly Australasian Radiology) is the official journal of The Royal Australian and New Zealand College of Radiologists, publishing articles of scientific excellence in radiology and radiation oncology. Manuscripts are judged on the basis of their contribution of original data and ideas or interpretation. All articles are peer reviewed.