Local staging of ipsilateral breast tumor recurrence: mammography, ultrasound, or MRI?

Coco J E F Walstra,Robert-Jan Schipper,Adri C Voogd,Marie-Jeanne T F D Vrancken Peeters,Claudette E Loo,Regina G H Beets-Tan,Grard A P Nieuwenhuijzen,Gonneke A Winter-Warnars

doi:10.1007/s10549-020-05850-9

Abstract

BackgroundDespite increasingly effective curative breast-conserving treatment (BCT) regimens for primary breast cancer, patients remain at risk for an ipsilateral breast tumor recurrence (IBTR). With increasing interest for repeat BCT in selected patients with IBTR, a reliable assessment of the size of IBTR is important for surgical planning.AimThe primary aim of this study is to establish the performance in size estimation of XMG, US, and breast MRI in patients with IBTR. The secondary aim is to compare the detection of multifocality and contralateral lesions between XMG and MRI.Patients and methodsThe sizes of IBTR on mammography (XMG), ultrasound (US), and magnetic resonance imaging (MRI) in 159 patients were compared to the sizes at final histopathology. The accuracy of the size estimates was addressed using Pearson’s coefficient and Bland–Altman plots. Secondary outcomes were the detection of multifocality and contralateral lesions between XMG and MRI.ResultsBoth XMG and US significantly underestimated the tumor size by 3.5 and 4.8 mm, respectively, while MRI provided accurate tumor size estimation with a mean underestimation of 1.1 mm. The sensitivity for the detection of multifocality was significantly higher for MRI compared to XMG (25.5% vs. 5.5%). A contralateral malignancy was found in 4.4% of patients, and in 1.9%, it was detected by MRI only.ConclusionThe addition of breast MRI to XMG and US in the preoperative workup of IBTR allows for more accurate size estimation. MRI provides a higher sensitivity for the detection of multifocality compared to XMG.

Highlights

Despite increasingly effective curative treatments for patients with primary breast cancer, women remain at risk for ipsilateral breast tumor recurrence (IBTR), with a cumulative risk of approximately 15% within 20 years [1]
Breast magnetic resonance imaging (MRI) is frequently used in the workup for primary breast cancer patients to assess tumor size and multifocality, as this provides important information for eligibility for breast-conserving treatment (BCT) and surgical planning
Multiple studies showed that while the addition of MRI in the workup of primary breast cancer led to a higher mastectomy rate, this had no effect on prognosis [7], except for patients with invasive lobular carcinoma (ILC) [10]

Summary

Introduction

Despite increasingly effective curative treatments for patients with primary breast cancer, women remain at risk for ipsilateral breast tumor recurrence (IBTR), with a cumulative risk of approximately 15% within 20 years [1]. Breast MRI is frequently used in the workup for primary breast cancer patients to assess tumor size and multifocality, as this provides important information for eligibility for BCT and surgical planning. Multiple studies showed that while the addition of MRI in the workup of primary breast cancer led to a higher mastectomy rate, this had no effect on prognosis [7], except for patients with invasive lobular carcinoma (ILC) [10]. Despite increasingly effective curative breast-conserving treatment (BCT) regimens for primary breast cancer, patients remain at risk for an ipsilateral breast tumor recurrence (IBTR). Aim The primary aim of this study is to establish the performance in size estimation of XMG, US, and breast MRI in patients with IBTR. MRI provides a higher sensitivity for the detection of multifocality compared to XMG

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Conclusion