Abstract
BackgroundThe aim of this study was the evaluation of breast MRI in determining the size and focality of invasive non-metastatic breast cancers.MethodsThe prospective, single-centre study conducted in 2015 compared preoperative MRI with histological analysis of mastectomy.ResultsOne hundred one mastectomies from 98 patients were extensively analysed. The rates of false-positive and false-negative MRI were 2 and 4% respectively. The sensitivity of breast MRI was 84.7% for the detection of all invasive foci, 69% for single foci and 65.7% for multiple foci. In the evaluation of tumour size, the Spearman rank correlation coefficient r between the sizes obtained by MRI and histology was 0.62. The MRI-based prediction of a complete response to neoadjuvant chemotherapy was 75%.DiscussionMRI exhibits high sensitivity in the detection of invasive breast cancers. False positives were linked to the inflammatory nature of the tumour bed. False negatives were associated with small or low-grade tumours and their retro-areolar location. The size of T1 tumours was overestimated by an average of 7%, but MRI was the most efficient procedure. The sensitivity of MRI for the diagnosis of unifocal tumours was higher than that for multifocal sites. Our study confirmed the positive contribution of preoperative MRI for invasive lobular carcinomas and complete response predictions after neoadjuvant chemotherapy.
Highlights
The aim of this study was the evaluation of breast Magnetic resonance imaging (MRI) in determining the size and focality of invasive non-metastatic breast cancers
MRI is usually recommended in cases of discrepancy between clinical, mammography and ultrasound before certain specific therapeutic approaches are used in young women or with a high family risk of breast cancer; in the event of multifocal tumour (MFT), it can be provided for evaluation of the contralateral breast [2]
Besides confirming the excellent positive and negative predictive value of MRI for detection of invasive lesions, the correlation between 101 whole-breast large-section histopathology datasets and preoperative MRI in our study indicates that MRI allows accurate estimation of the tumour size and focality
Summary
The aim of this study was the evaluation of breast MRI in determining the size and focality of invasive non-metastatic breast cancers. Preoperative assessment of the size and focal nature of invasive breast cancer is essential for the establishment of the global therapeutic strategy and optimized choice of surgery. The goal of the surgeon is twofold: first, the choice between performing mastectomy or more conservative treatments providing a satisfactory cosmetic outcome while minimizing possible repeat surgery for residual cancerous tissue and, second, to choose the optimal timing of this surgery, which can be initial or following neoadjuvant chemotherapy (NAC). MRI is usually recommended in cases of discrepancy between clinical, mammography and ultrasound before certain specific therapeutic approaches are used (oncoplastic surgery, NAC) in young women or with a high family risk of breast cancer; in the event of MFT, it can be provided for evaluation of the contralateral breast [2].
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