Abstract
The purpose of our study was to evaluate the diagnostic performance of breast magnetic resonance imaging (MRI) in the evaluation of contralateral breast in patients with diagnosed breast cancer. A secondary objective was to determine accuracy of breast MRI in diagnosing multi-focal and multicentric lesions in the ipsilateral breast. Using a non-probability convenience sampling technique, patients with histopathologically diagnosed breast cancer with MRI of breast performed to exclude additional lesions were included. MRI findings were correlated with histopathology. In addition, follow-up imaging with mammography and ultrasound was also assessed for establishing stability of negative findings and for the detected of benign lesions. Out of 157 MRI breast conducted during the period of 2008 to 2013, 49 were performed for patients with diagnosed breast cancer. The sample comprised of all females with mean age 50.7 ± 11.0 years. The patient follow-up imaging was available for a period of 2-5 years. The sensitivity, specificity, and positive and negative predictive values of MRI in the detection of multifocal/multicenteric lesions was 85.7%, 88.8%, 60% and 96.6% respectively and for the detection of lesions in the contralateral breast were 100%, 97%, 83.3% and 100% respectively. Our study highlights the diagnostic performance and the added value of MRI in the detection of multifocal /multicenteric and contralateral malignant lesions. In patients with diagnosed breast cancer having dense breast parenchyma and with infiltrating lobular carcinoma as the index lesion MRI is particularly useful with excellent negative predictive value in the exclusion of additional malignant foci in the ipsilateral and contralateral breasts.
Highlights
Breast cancer is the most commonly diagnosed cancer in women with significant cancer related mortality in the developed and developing countries (Yusuf et al, 2013)Patients with unilateral breast cancer have an added risk of cancer in the contra lateral breast with prevalence of 1-4% (Jobsen et al, 2003)
The sensitivity of screening mammography is reduced in women with heterogeneously dense /dense breast parenchyma but whole breast ultrasounds is useful in the detection of mammographically and clinically occult ipsilateral and contra lateral breast cancer (Moon,2002; Beysebayev, 2014) with reasonably accurate estimation of invasive cancer but often underestimates the component of ductal carcinoma in situ. (DCIS) (Satake et al, 2000)
These factors restricts its usage as a screening modality for the population and it is utilized for limited indications like women with genetic predisposition, strong family history /personal history of breast cancer, women with lobular carcinoma or atypia, etc (Tilanus-Linthorst et al, 2000)
Summary
Patients with unilateral breast cancer have an added risk of cancer in the contra lateral breast with prevalence of 1-4% (Jobsen et al, 2003). These patients have a higher rate of distant metastasis and unfavorable disease specific survival as compared to those with unilateral breast tumour (Heron et al, 2000). It is important to diagnose contra lateral breast cancer at the time of initial diagnosis as the actuarial survival rates at 5 years is lower for patients with bilateral synchronous breast cancer (64.4%) as compared to patients with unilateral disease (75.8%). Screening mammography has resulted in early diagnosis of breast cancer which has led to more conservative surgical approach. The sensitivity of screening mammography is reduced in women with heterogeneously dense /dense breast parenchyma but whole breast ultrasounds is useful in the detection of mammographically and clinically occult ipsilateral and contra lateral breast cancer (Moon ,2002; Beysebayev, 2014) with reasonably accurate estimation of invasive cancer but often underestimates the component of ductal carcinoma in situ. (DCIS) (Satake et al, 2000)
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