Magnetic Resonance Imaging in the Preoperative Evaluation of Invasive Lobular Carcinoma; A Useful Investigation?

The Role of Magnetic Resonance Imaging in the Preoperative Staging and Treatment of Invasive Lobular Carcinoma

Apport de l’IRM dans le diagnostic et le bilan d’extension des cancers lobulaires infiltrants

PurposeWe evaluated the utility of magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for the preoperative staging of invasive lobular carcinoma (ILC) of the breast and compared the results with those of invasive ductal carcinoma (IDC).MethodsThe study included pathologically proven 32 ILCs and 73 IDCs. We compared clinical and histopathological characteristics and the diagnostic performances of MRI and 18F-FDG PET/CT for the primary mass, additional ipsilateral and/or contralateral lesion(s), and axillary lymph node metastasis between the ILC and IDC groups.ResultsPrimary ILCs were greater in size, but demonstrated lower maximum standardized uptake values than IDCs. All primary masses were detected on MRI. The detection rate for ILCs (75.0%) was lower than that for IDCs (83.6%) on 18F-FDG PET/CT, but the difference was not significant. For additional ipsilateral lesion(s), the sensitivities and specificities of MRI were 87.5% and 58.3% for ILC and 100.0% and 66.7% for IDC, respectively; whereas the sensitivities and specificities of 18F-FDG PET/CT were 0% and 91.7% for ILC and 37.5% and 94.7% for IDC, respectively. The sensitivity of 18F-FDG PET/CT for ipsilateral lesion(s) was significantly lower in the ILC group than the IDC group. The sensitivity for ipsilateral lesion(s) was significantly higher with MRI; however, specificity was higher with 18F-FDG PET/CT in both tumor groups. There was no significant difference in the diagnostic performance for additional contralateral lesion(s) or axillary lymph node metastasis on MRI or 18F-FDG PET/CT for ILC versus IDC.ConclusionThe MRI and 18F-FDG PET/CT detection rates for the primary cancer do not differ between the ILC and IDC groups. Although 18F-FDG PET/CT demonstrates lower sensitivity for primary and additional ipsilateral lesions, it shows higher specificity for additional ipsilateral lesions, and could play a complementary role in the staging of ILC as well as IDC.

BackgroundInvasive lobular carcinoma is the second most prevalent histological subtype of breast cancer after invasive duct carcinoma, with a reported increased incidence in the last two decades. It often presents with challenging imaging characteristics that lower the sensitivity of mammography in their detection and delineation of their extent. Moreover, an increased risk of having synchronous lesions in the same or opposite breast was reported in cases with invasive lobular carcinoma. This obviates the need for other imaging modalities, specifically contrast-enhanced imaging modalities, to improve early detection as well as allow precise determination of the extent of the disease. Our aim in this study was to compare the diagnostic performance of contrast-enhanced digital mammography and dynamic contrast-enhanced magnetic resonance imaging (MRI) in the local staging of invasive lobular carcinoma regarding the size, extensions, multiplicity and bilaterality.MethodsThis study included 46 female patients with pathologically proven invasive lobular carcinoma. They underwent full-field digital mammography with a complementary ultrasound examination, contrast-enhanced digital mammography, and dynamic contrast-enhanced MRI. The findings encountered by the three imaging modalities were evaluated independently, and the results were compared with final histopathology.ResultsIn the current study, dynamic contrast-enhanced MRI study was the most sensitive modality in the detection of the index lesion, synchronous ipsilateral and contralateral lesions and achieved a sensitivity of 100% in each analysis as compared to contrast-enhanced digital mammography, which achieved a sensitivity of 97.8%, 85.7% and 80%, respectively. Regarding the assessment of the lesion extent to the surroundings, there was a tendency to overestimation by MRI examination.ConclusionsAlthough dynamic contrast-enhanced MRI is the most sensitive imaging modality for detecting the index lesion, multiplicity and bilaterality, contrast-enhanced digital mammography achieved comparable overall accuracy. Regarding the locoregional staging of invasive lobular carcinoma, there was a tendency for relative overestimation by MRI examination.

The aim of our study was to assess the performance of contrast-enhanced digital mammography (CEDM) in the preoperative loco-regional staging of invasive lobular carcinoma (ILC) patients, about the valuation of the extension of disease and in measurement of lesions. Then, we selected retrospectively, among the 1500 patients underwent to CEDM at the Breast Diagnostics Department of the Careggi University Hospital of Florence and the National Cancer Institute of Milan from September 2016 to November 2018, 31 women (mean age 57.1 aa; range 41-78 aa) with a definitive histological diagnosis of ILC. CEDM has proved to be a promising imaging technique, being characterized by a sensitivity of 100% in the detection of the index lesion, and of 84.2% in identifying any adjunctive lesions: It was the presence of a non-mass enhancement (NME) to lower the sensitivity of the technique (25% vs. 100% for mass-like enhancements or a mass closely associated with a NME). Specificity in the characterization of additional lesions was 66.7%, and the diagnosis of the extension of disease was correct in 77.4% of cases: NME also led to a decrease in diagnostic accuracy in the evaluation of disease extension up to 40% versus 85% for masses and 80% for masses associated with NME (M/NME). Moreover, in 12/31 (38.7%), CEDM allowed to correctly identify lesions not shown by mammography + ultrasonography + tomosynthesis: In the half of these (6/12), there was a multicentricity, thus allowing an adequate surgical planning change. CEDM was also very accurate in analyzing the maximum diameter of the masses, while it was much less reliable in the case of the M/NME and pure NME. In conclusion, CEDM is a new promising imaging technique in the loco-regional preoperative staging and in the evaluation of disease extension for ILC, especially in case of mass enhancement lesions.

The incidence of lobular carcinoma in situ and invasive lobular carcinoma of the breast is increasing. Recent data suggest that lobular carcinoma in situ is an indolent precursor for breast cancer, rather than a pure risk factor. This could imply free surgical margins become important. The risk of contralateral carcinoma and of multifocality of invasive lobular carcinoma is higher than for invasive ductal carcinoma. Therefore, the need for mastectomy, or even for preventative contralateral mastectomy is questioned. Conventional mammography or ultrasonography cannot always give useful preoperative information about the extent of lobular cancers. The value of dynamic contrast-enhanced magnetic resonance imaging needs to be established for these patients. The risk of invasive carcinoma after lobular carcinoma in situ is increased. Invasive carcinoma is usually located at the index point of lobular carcinoma in situ and is of lobular histology. Dynamic contrast-enhanced magnetic resonance imaging can be useful in the detection and preoperative staging of invasive lobular carcinoma. The risk of local recurrence is high in patients with invasive lobular carcinoma. Mastectomy and breast reconstruction could be an option in selected patients. The response to preoperative chemotherapy is worse for invasive lobular carcinoma compared with invasive ductal carcinoma, with a greater need for rescue mastectomy. Lobular carcinoma in situ and invasive lobular carcinoma are different entities from ductal carcinoma in situ and invasive lobular carcinoma. Their biological profile should be studied further in order to make the fine tuning of treatment possible.

Does preoperative breast MRI significantly impact on initial surgical procedure and re-operation rates in patients with screen-detected invasive lobular carcinoma?

The objective of this study was to assess whether preoperative breast magnetic resonance imaging (MRI) combined with conventional breast imaging techniques decreases the rates of margin involvement and reexcision.Data on patients who underwent surgery for primary operable breast cancer were obtained from the Changhua Christian Hospital (CCH) breast cancer database. The rate of surgical margin involvement and the rate of reoperation were compared between patients who underwent conventional breast imaging modalities (Group A: mammography and sonography) and those who received breast MRI in addition to conventional imaging (Group B: mammography, sonography, and MRI).A total of 1468 patients were enrolled in this study. Among the 733 patients in Group A, 377 (51.4%) received breast-conserving surgery (BCS) and 356 (48.6%) received mastectomy. Among the 735 patients in Group B, 348 (47.3%) received BCS and 387 (52.7%) received mastectomy. There were no significant differences in operative method between patients who received conventional imaging alone and those that received MRI and conventional imaging (P = 0.13). The rate of detection of pathological multifocal/multicentric breast cancer was markedly higher in patients who received preoperative MRI than in those who underwent conventional imaging alone (14.3% vs 8.6%, P < 0.01). The overall rate of surgical margin involvement was significantly lower in patients who received MRI (5.0%) than in those who received conventional imaging alone (9.0%) (P < 0.01). However, a significant reduction in rate of surgical margin positivity was only observed in patients who received BCS (Group A, 14.6%; Group B, 6.6%, P < 0.01). The overall BCS reoperation rates were 11.7% in the conventional imaging group and 3.2% in the combined MRI group (P < 0.01). There were no significant differences in rate of residual cancer in specimens obtained during reoperation between the 2 preoperative imaging groups (Group A, 50%; Group B, 81.8%, P = 0.09). In multivariate analysis, multifocal/multicentric breast cancer (odds ratio = 2.38, P = 0.02) and without MRI use (odds ratio = 2.35, P < 0.01) were the major predisposing factors to margin involvement in patients received BCS.Preoperative breast MRI combined with conventional breast imaging results in a lower rate of surgical margin involvement and reoperations in patients who receive BCS.

Introduction: Breast magnetic resonance imaging (MRI) has high sensitivity in detecting invasive neoplasms. However, controversy remains as to whether preoperative staging with breast MRI impacts surgical outcomes and local recurrence. Materials and Methods: BREAST-MRI is a randomized, open-label trial including female breast cancer patients older than 18 years old, with stage 0-III disease, eligible for BCS. We performed a 1:1 stratified randomization by breast density according to ACR-BIRADS to divide patients into two groups; one in which preoperative MRI was used and the control group where the MRI was not used. The primary outcome was local relapse-free survival (LR). Secondary outcomes were overall survival (OS), repeat operation, and the proportion of patients whose surgical management was modified to mastectomy. Results: 524 were randomized, 257 included in the MRI group, and 267 in the control group. The baseline characteristics were similar between groups, except for chemotherapy use (table 1). The survival analysis showed a 6-year local recurrence-free survival was 99.2% in MRI group versus 98.9% in the control group, p=0.702, overall survival of 95.3% in the MRI group versus 96.3% in the control group, p=0.481. No difference was found in reoperation rates, 22 (8.7%) in the MRI group versus 23 (8.7%) in the control group (p= 0.85)(table2). Surgical management changed in 21 ipsilateral breasts in the MRI group; 21 (8.3%) had mastectomies versus 1 in the control group (p&amp;lt; 0.01). Conclusion: Preoperative MRI evaluation increased the mastectomy rates by 8%. The use of preoperative MRI did not influence local relapse-free survival, overall survival, or reoperation rates Keywords: breast magnetic resonance imaging; breast cancer; conservative surgery; MRI accuracy, surgical outcomes, randomized clinical trial Citation Format: Bruna S. Mota, Yedda N. Reis, Nestor Barros, Natalia Cardoso, Rosa s. Mota, Carlos Shimizu, Tatiana Tucunduva, Rodrigo Gonçalves, Maira T. Doria, Vera Ferreira, Marcos Ricci, Angela Trinconi, Rachel Riera, Edmund C. Baracat, José Maria Soares Jr, Jose Roberto Filassi. PD15-08 Brazilian Randomized Study - BREAST-MRI Trial - Impact of Preoperative Magnetic Resonance in the Evaluation for Breast Cancer Conservative Surgery: Local recurrence and surgical outcomes [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD15-08.

Utility of Breast Magnetic Resonance Imaging in Determining Candidacy for Partial Breast Irradiation

Objective To investigate the clinical value of computed tamography (CT) and magnetic resonance imaging (MRI) in the preoperative staging of endometrial carcinoma. Methods The clinical data of 98 patients with endometrial cancer hopitalized in Nanshi Hospital from March 2014 to September 2016 were retrospectively analyzed. All patients underwent CT and MRI examination prior to operation. The diagnostic accuracy of preoperative staging of endometrial carcinoma by CT and MRI was analyzed with the pathological results as standard, so as to investigate the consistency of preoperative staging by CT and MRI with pathological diagnosis. Results The accuracy of preoperative staging for endometrial carcinoma diagnosed by CT was 76.53%. The paired chi square test showed that there was no significant difference between the preoperative staging by CT and pathological diagnosis for endometrial carcinoma (χ2=11.667, P=0.070), the two diagnostic methods were in consistence (Kappa=0.611, P=0.000). The accuracy of preoperative staging for endometrial carcinoma by MRI was 87.76%. The paired chi square test showed that there was no significant difference between the preoperative staging by MRI and pathological diagnosis for endometrial carcinoma (χ2=7.333, P=0.291), and preoperative staging by MRI was consistent to pathological results (Kappa=0.799, P=0.000). Theaccuracy of preoperative staging of endometrial carcinoma by MRI was higher than that by CT, and the difference was statistically significant (P<0.05). Conclusions CT and MRI can be used in preoperative staging diagnosis of endometrial carcinoma, but MRI diagnosis is more accurate, and has more clinical value. Key words: Computed tamograohy; Magnetic resonance imaging; Endometrial carcinoma; Pathological features

Magnetic resonance imaging (MRI) is highly sensitive in detecting invasive lobular carcinoma (ILC) of the breast. In our institution, patients who are deemed to be suitable for breast conserving surgery (BCS) with unifocal small ILC on standard imaging are offered breast MRI to exclude multifocal and larger ILC. Our study investigates the usefulness of breast MRI in ILC. A prospective cohort study over a 58-month period, including all consecutive patients with ILC having breast MRI. Primary objective was to find out the proportion of ILC patients where preoperative MRI caused a change in the surgical treatment. Secondary objectives included finding mastectomy rate (initial & final), re-operation rate, cancer size correlation with different imaging modalities and final histopathology, loco-regional recurrence and disease-free survival. A total of 334 bilateral breast MRI were performed including 72 (21.5%) MRI for ILC patients. All these MRI were carried out within 2 week of patients given the diagnosis (median 5.5 days). Age range was 24-83 (median 56.5) years. Nineteen of 72 ILC patients (26.4%) had a change in their planned operation from BCS to a different operation owing to MRI findings (seven patients with multifocal cancers, 10 with significantly larger size of the cancer and two with contralateral malignancy). Initial mastectomy rate was 31.9%, final mastectomy rate was 36.1% and re-operation rate in BCS group was 18.3%. MRI correlated better with ILC histopathology cancer size than mammogram and ultrasound scans. There was no statistically significant difference (p = 0.999) between the cancer size on histology (median 23 mm) and MRI (median 25 mm). However, mammogram (median 17 mm) and ultrasound (median 14.5 mm) scans showed cancer sizes significantly different to final histology cancer size (p = 0.0008 and p = 0.0021 respectively). Over a 44 months median follow-up (range 27-85), 95.8% disease-free survival and 98.6% overall survival have been observed. One out of every four patients (26.4%) with ILC had a change in their planned operation due to MRI findings. A relatively high disease-free survival over a medium-term follow-up proves the oncological safety of MRI in ILC. Our study provides evidence in support of the targeted use of preoperative breast MRI among patients with ILC to improve surgical planning.

The use of preoperative magnetic resonance (MR) imaging may have an effect on the reoperation rate in women with operable breast cancer. Retrospective cohort study. University medical center. Women with operable breast cancer treated by a single surgeon between January 1, 2006, and December 31, 2010. Selective preoperative MR imaging based on breast density and histologic findings. Reoperation rate and pathologically avoidable mastectomy at initial operation. Of 313 patients in the study, 120 underwent preoperative MR imaging. Patients undergoing MR imaging were younger (mean age, 53.6 vs 59.5 years; P < .001), were more often of non-Hispanic white race/ethnicity (61.7% vs 52.3%, P < .05), and more likely had heterogeneously dense or very dense breasts (68.4% vs 22.3%, P < .001). The incidence of lobular carcinoma (8.3% in the MR imaging group vs 5.2% in the no MR imaging group, P = .27) and the type of surgery performed (mastectomy vs partial mastectomy, P = .67) were similar in both groups. The mean pathological size of the index tumor in the MR imaging group was larger than that in the no MR imaging group (2.02 vs 1.72 cm, P = .009), but the extent of disease was comparable (75.8% in the MR imaging group vs 82.9% in the no MR imaging group had pathologically localized disease, P = .26). The reoperation rate was similar between the 2 groups (19.1% in the MR imaging group vs 17.6% in the no MR imaging group, P = .91) even when stratified by breast density (P = .76), pT2 tumor size (P = .35), or lobular carcinoma histologic findings (P = .26). Pathologically avoidable mastectomy (multifocal or multicentric MR imaging and unifocal histopathological findings) was observed in 12 of 47 patients (25.5%) with preoperative MR imaging who underwent mastectomy. The selective use of preoperative MR imaging to decrease reoperation in women with breast cancer is not supported by these data. In a considerable number of patients, MR imaging overestimates the extent of disease.

BackgroundRecurrent abdominal hernias remain a significant clinical challenge, with relatively high recurrence rates despite prosthetic mesh repair. Accurate imaging modalities are essential to assess mesh positioning and detect complications. Our study aims to compare computed tomography (CT) and magnetic resonance imaging (MRI) for mesh visualization, recurrence detection, and related postoperative outcomes in recurrent hernia patients.MethodsA systematic review and meta-analysis were conducted, including CT scan or MRI studies, to assess mesh visualization in recurrent hernia cases. A comprehensive search of PubMed, Scopus, Embase, and Web of Science was performed up to July 2024. Data were extracted for mesh visualization, recurrence rates, seroma detection, and reoperation rates. Statistical analysis employed a random-effects model with subgroup analysis for CT and MRI modalities.ResultsA total of 26 studies were included (18 for CT, and 8 for MRI). Recurrence rates were 20% (95% CI: 0–42%) for CT-based studies and 15% (95% CI: 4–26%) for MRI-based studies (p = 0.72). MRI exhibited superior mesh visualization (73%; 95% CI: 42–100%) compared to CT-(48%; 95% CI: 0–100%) (p = 0.44) studies. Seroma detection rates were similar: 12% (95% CI: 4–19%) for CT- and 10% (95% CI: 4–15%) for MRI- (p = 0.65) studies. Reoperation rates were 6% (95% CI: 1–11%) for CT- and 34% (95% CI: 3–66%) for MRI-based studies, showing a non-significant trend (p = 0.08).ConclusionCT and MRI offer distinct advantages in detecting mesh-related complications after hernia surgery. CT remains preferred for identifying recurrence and acute complications, while MRI excels in mesh visualization and soft-tissue assessment. Tailored imaging strategies based on clinical scenarios can optimize outcomes and improve postoperative care.

Mammographic detection and staging of invasive lobular carcinoma