Precise correlation between MRI and histopathology - exploring treatment margins for MRI-guided localized breast cancer therapy.
BACKGROUND
Magnetic resonance imaging (MRI) is more often considered to guide, evaluate or select patients for partial breast irradiation (PBI) or minimally invasive therapy. Safe treatment margins around the MRI-visible lesion (MRI-GTV) are needed to account for surrounding subclinical occult disease.


OBJECTIVE
To precisely compare MRI findings with histopathology, and to obtain detailed knowledge about type, rate, quantity and distance of occult disease around the MRI-GTV.


METHODS
Patients undergoing MRI and breast-conserving therapy were prospectively included. The wide local excision specimens were subjected to detailed microscopic examination. The size of the invasive (index) tumor was compared with the MRI-GTV. The gross tumor volume (GTV) was defined as the pre-treatment visible lesion. Subclinical tumor foci were reconstructed at various distances to the MRI-GTV.


RESULTS
Sixty-two patients (64 breasts) were included. The mean size difference between MRI-GTV and the index tumor was 1.3mm. Subclinical disease occurred in 52% and 25% of the specimens at distances ≥10mm and ≥20mm, respectively, from the MRI-GTV.


CONCLUSIONS
For MRI-guided minimally invasive therapy, typical treatment margins of 10mm around the MRI-GTV may include occult disease in 52% of patients. When surgery achieves a 10mm tumor-free margin around the MRI-GTV, radiotherapy to the tumor bed may require clinical target volume margins >10mm in up to one-fourth of the patients.
Schmitz
Annemarie C
AC
Department of Radiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital (NKI-AVL), Amsterdam, The Netherlands.
van den Bosch
Maurice A A J
MA
Loo
Claudette E
CE
Mali
Willem P Th M
WP
Bartelink
Harry
H
Gertenbach
Maria
M
Holland
Roland
R
Peterse
Johannes L
JL
Rutgers
Emiel J Th
EJ
Gilhuijs
Kenneth G
KG
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011880:Radiotherapy Planning, Computer-Assisted; D047368:Tumor Burden