Predicting the extent of invasive disease by MRI to enhance the use of minimally invasive techniques in the management of early stage breast carcinoma

Publisher Website
Google Scholar
Abstract
610 Background: With the advent of minimally invasive procedures such as radio-frequency ablation and vacuum-assisted core biopsy for managing early-stage invasive breast carcinoma, the ability to predict invasive disease by pre-procedure imaging is essential to achieving an adequate margin and for guiding adjuvant therapy. Magnetic resonance imaging (MRI) is a sensitive modality used in the detection of breast pathology and may provide the anatomic resolution necessary to predict the extent of invasive disease. Methods: A retrospective review was conducted on MRI and pathologic data from 24 (63%) of 38 patients with focal, invasive breast carcinoma enrolled in an ongoing multi-modality imaging study between 3/02 and 10/03. Patients were selected on the basis of the following criteria: 1) 1 or 2 suspicious focal lesions per breast detected on MRI, 2) 1 or 2 pathologically-proven foci of invasive carcinoma per breast, and 3) no chemotherapy between MRI and definitive surgery. Largest tumor dimension as measured by MRI, performed prior to definitive surgery, was compared to the largest pathologic tumor dimension. Results: Median age of selected patients was 52.0 y (range 37.9–71.1). 25 lesions were evaluated. Histology revealed 20 (80%) invasive ductal carcinomas, 3 (12%) invasive lobular carcinomas, and 2 (8%) mixed lesions. Seven patients underwent reexcision due to positive margins with no further invasive carcinoma identified. Median lesion size by MRI was 2.0 cm (0.7–3.4). Median lesion size by pathology was 1.9 cm (0.8–4.0). For lesions ≤ 2 cm by pathology (n =16), MRI size was equal to or greater than pathologic size for 14 lesions (88%) and the difference between MRI and pathologic size was within 0.5 cm in 12 lesions (75%). Conclusion: MRI was effective at estimating invasive breast carcinoma dimension in lesions less than 2 cm. MRI avoided underestimation of pathologic size in small lesions, making it a potentially safe means of identifying the target for minimally invasive techniques. No significant financial relationships to disclose.

This publication has 0 references indexed in Scilit: