Abstract
BackgroundTumour size in breast cancer influences therapeutic decisions. The purpose of this study was to evaluate sizing of primary breast cancer using mammography, sonography and magnetic resonance imaging (MRI) and thereby establish which imaging method most accurately corresponds with the size of the histological result.MethodsData from 121 patients with primary breast cancer were analysed in a retrospective study. The results were divided into the groups “ductal carcinoma in situ (DCIS)”, invasive ductal carcinoma (IDC) + ductal carcinoma in situ (DCIS)”, “invasive ductal carcinoma (IDC)”, “invasive lobular carcinoma (ILC)” and “other tumours” (tubular, medullary, mucinous and papillary breast cancer). The largest tumour diameter was chosen as the sizing reference in each case. Bland-Altman analysis was used to determine to what extent the imaging tumour size correlated with the histopathological tumour sizes.ResultsTumour size was found to be significantly underestimated with sonography, especially for the tumour groups IDC + DCIS, IDC and ILC. The greatest difference between sonographic sizing and actual histological tumour size was found with invasive lobular breast cancer. There was no significant difference between mammographic and histological sizing. MRI overestimated non-significantly the tumour size and is superior to the other imaging techniques in sizing of IDC + DCIS and ILC.ConclusionsThe histological subtype should be included in imaging interpretation for planning surgery in order to estimate the histological tumour size as accurately as possible.
Highlights
Tumour size in breast cancer influences therapeutic decisions
An invasive ductal carcinoma (IDC) was present in 33.9% of the cases. 31.4% of the patients were allocated to the IDC + ductal carcinoma in situ (DCIS) tumour group, and a DCIS alone or invasive lobular carcinoma (ILC) alone were found in 12.4% and 14.9% respectively
Malignancy assessment using imaging was performed according to the Breast Imaging Reporting and Data System (BI-RADS) classification system [1], whereby 96.6% of the sonographic results, 90.9% of the mammography results and 100% of the magnetic resonance imaging (MRI) results were pre-interventionally classified as BI-RADS 4 or higher (Table 1)
Summary
Tumour size in breast cancer influences therapeutic decisions. The purpose of this study was to evaluate sizing of primary breast cancer using mammography, sonography and magnetic resonance imaging (MRI) and thereby establish which imaging method most accurately corresponds with the size of the histological result. Breast results are classified using the BI-RADS (Breast Imaging Reporting and Data System) classification [1,2]. Exact pre-therapeutic tumour sizing using imaging methods plays a central role. The possibility of breast conserving treatment significantly depends on the relationship between the tumour-to-breast size. The indication for primary systemic treatment is made, amongst other things, from the tumour size. The aim of this study was to analyse which of the given imaging methods is the most accurate in the pretherapeutic sizing of primary breast cancer
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