Multicentricity and recurrence of breast cancer

Abstract

Sacchini1Sacchini V Multicentricity and recurrence of breast cancer.Lancet. 1996; 348: 1256-1257Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar suggests that the emerging technique of magnetic resonance imaging (MRI) might be able to detect multiple foci of breast cancer in vivo. There is already evidence to this effect with the various forms of MRI mammography proving consistently better than traditional radiographic mammography in this respect.2Cross MJ Harms SE Cheek H et al.New horizons in the diagnosis and treatment of breast cancer using magnetic resonance imaging.Am J Surg. 1993; 166: 749-755Summary Full Text PDF PubMed Scopus (35) Google Scholar, 3Kerslake RW Carleton PJ Fox JN et al.Dynamic gradient-echo and fat-suppressed spin-echo contrast-enhanced MRI of the breast.Clinical Radiology. 1995; 50: 440-454Summary Full Text PDF PubMed Scopus (60) Google ScholarIn our initial series of 45 patients with invasive breast cancer, dynamic MRI mammography detected multicentric disease that had not been previously identified by clinical examination or radiographic mammography in 14 (31%) women.3Kerslake RW Carleton PJ Fox JN et al.Dynamic gradient-echo and fat-suppressed spin-echo contrast-enhanced MRI of the breast.Clinical Radiology. 1995; 50: 440-454Summary Full Text PDF PubMed Scopus (60) Google Scholar We have also used dynamic MRI mammography to screen a separate group of 105 women for residual tumour or local recurrence 1–2 years after breast-conserving surgery and radiotherapy and found clinically significant lesions in only nine (8·5%). Clinical and mammographic follow-up is continuing for these patients, and at a median of 341 (IQR 168–451) days after MR mammography no further lesions have been identified. The discrepancy between the number of multicentric lesions identified in the evaluation of the primary cancers and those discovered at follow-up implies that the radiotherapy and hormonal treatment given after breast conserving surgery might be controlling the multicentric disease not excised with the primary tumour. These findings may help to explain why local recurrence after breast conserving surgery without radiotherapy is generally accepted to be greater than 30%.4Fisher B Redmond C Poisson R et al.Eight year results of a randomised clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer.N Engl J Med. 1989; 320: 822-828Crossref PubMed Scopus (1474) Google Scholar The true rate of multicentric disease is probably even higher than that detected by MRI mammography because, at the resolution achieved with this technique, lesions less than a few millimetres in diameter can be missed. Even accepting this potential inaccuracy, we have found that only about 29% of those multicentric lesions identified by MRI are visible on X-ray mammography.The use of MRI mammography to evaluate women with primary breast cancers would undoubtedly increase the number of mastectomies done for multicentric disease that would previously have remained undetected. It is therefore important that, before MRI mammography becomes a clinically established technique, a prospective trial is done to compare the outcome of women assessed with traditional imaging techniques and those evaluated with MRI mammography. Such an investigation would establish whether any clinical benefit is accrued from the increased detection of multicentric disease. Sacchini1Sacchini V Multicentricity and recurrence of breast cancer.Lancet. 1996; 348: 1256-1257Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar suggests that the emerging technique of magnetic resonance imaging (MRI) might be able to detect multiple foci of breast cancer in vivo. There is already evidence to this effect with the various forms of MRI mammography proving consistently better than traditional radiographic mammography in this respect.2Cross MJ Harms SE Cheek H et al.New horizons in the diagnosis and treatment of breast cancer using magnetic resonance imaging.Am J Surg. 1993; 166: 749-755Summary Full Text PDF PubMed Scopus (35) Google Scholar, 3Kerslake RW Carleton PJ Fox JN et al.Dynamic gradient-echo and fat-suppressed spin-echo contrast-enhanced MRI of the breast.Clinical Radiology. 1995; 50: 440-454Summary Full Text PDF PubMed Scopus (60) Google Scholar In our initial series of 45 patients with invasive breast cancer, dynamic MRI mammography detected multicentric disease that had not been previously identified by clinical examination or radiographic mammography in 14 (31%) women.3Kerslake RW Carleton PJ Fox JN et al.Dynamic gradient-echo and fat-suppressed spin-echo contrast-enhanced MRI of the breast.Clinical Radiology. 1995; 50: 440-454Summary Full Text PDF PubMed Scopus (60) Google Scholar We have also used dynamic MRI mammography to screen a separate group of 105 women for residual tumour or local recurrence 1–2 years after breast-conserving surgery and radiotherapy and found clinically significant lesions in only nine (8·5%). Clinical and mammographic follow-up is continuing for these patients, and at a median of 341 (IQR 168–451) days after MR mammography no further lesions have been identified. The discrepancy between the number of multicentric lesions identified in the evaluation of the primary cancers and those discovered at follow-up implies that the radiotherapy and hormonal treatment given after breast conserving surgery might be controlling the multicentric disease not excised with the primary tumour. These findings may help to explain why local recurrence after breast conserving surgery without radiotherapy is generally accepted to be greater than 30%.4Fisher B Redmond C Poisson R et al.Eight year results of a randomised clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer.N Engl J Med. 1989; 320: 822-828Crossref PubMed Scopus (1474) Google Scholar The true rate of multicentric disease is probably even higher than that detected by MRI mammography because, at the resolution achieved with this technique, lesions less than a few millimetres in diameter can be missed. Even accepting this potential inaccuracy, we have found that only about 29% of those multicentric lesions identified by MRI are visible on X-ray mammography. The use of MRI mammography to evaluate women with primary breast cancers would undoubtedly increase the number of mastectomies done for multicentric disease that would previously have remained undetected. It is therefore important that, before MRI mammography becomes a clinically established technique, a prospective trial is done to compare the outcome of women assessed with traditional imaging techniques and those evaluated with MRI mammography. Such an investigation would establish whether any clinical benefit is accrued from the increased detection of multicentric disease.