Value of MRI in the surgical planning of invasive lobular breast carcinoma: a prospective and a retrospective study of 57 cases: comparison with physical examination, conventional imaging, and histology.
OBJECTIVE
The objective of this study was to determine the value of magnetic resonance imaging (MRI) for the surgical planning of invasive lobular carcinoma (ILC)-a diagnostic challenge for radiologists.


METHODS
Fifty-seven patients with histologically proven ILC were studied between 1998 and 2006. All patients underwent physical examination, mammography, ultrasound, and MRI. All anomalies detected were graded using the Breast Imaging Reporting and Data System (BI-RADS) classification, and careful research was made for the presence of multifocal/multicentric disease.


RESULTS
On MRI, 72% of images were visualized as masses and 18% corresponded to non-mass-like enhancements. The size correlations, compared with histological findings, were .88 (MRI; P<.001), .57 (ultrasound), .53 (physical examination), and .40 (mammography). The kappa correlations for multifocality were .87 (MRI), .22 (ultrasound), and .22 (mammography). MRI had a sensitivity of 100% and a specificity of 87%. Forty-nine percent of therapeutic strategy cases were modified.


CONCLUSIONS
MRI is unquestionably valuable for the management of ILC. It provides the most accurate estimate of tumor size and is highly sensitive for multifocal disease. Its main drawback is its lack of specificity, which requires preoperative histological verification. MRI often justifies the modification of the initial therapeutic strategy, generally ruling out conservative procedures.
Caramella
Thomas
T
Department of Radiology, Centre Antoine Lacassagne, 33 av. de Valombrose, F-06189 Nice Cedex 2, France. caramella.t@chu-nice.fr
Chapellier
Claire
C
Ettore
Francette
F
Raoust
Ines
I
Chamorey
Emmanuel
E
Balu-Maestro
Catherine
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010808:Physical Examination; D011446:Prospective Studies; D011859:Radiography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography