title: Use of preoperative magnetic resonance imaging for invasive lobular cancer: good, better, but maybe not the best?
abstract: BACKGROUND
  Invasive lobular cancer (ILC) of the breast is difficult to diagnose clinically and radiologically. It is hoped that preoperative magnetic resonance imaging (MRI) can improve evaluation of extent of disease.
  
  
  METHODS
  Patients diagnosed with ILC at a single institution from 2001 to 2008 who underwent clinical breast examination (CBE), mammography, ultrasound, and MRI were studied retrospectively. Concordance between tumor size on imaging/CBE and pathologic size was defined as size within ± 0.5 cm. Pearson correlation coefficients (R) were calculated for each modality. Local recurrence and re-excision rates were compared with those patients with ILC who did not undergo preoperative MRI.
  
  
  RESULTS
  Seventy patients with ILC had all imaging modalities, including CBE, performed preoperatively. The sensitivity for detection of ILC by MRI was 99%. MRI-based tumor size was concordant with pathologic tumor size in 56% of tumors. MRI overestimated tumor size by >0.5 cm in 31% of tumors. Correlation of tumor size on imaging with final pathology was better for MRI (R = 0.75) than for mammography (R = 0.65), CBE (R = 0.63), or ultrasound (R = 0.45, all P < 0.01). Preoperative MRI was associated with lower reoperation rates for close/positive margins (P > 0.05).
  
  
  CONCLUSIONS
  For ILC, MRI has better sensitivity of detection and correlation with tumor size at pathology than CBE, mammography, or ultrasound. However, 31% of cases are overestimated by MRI, and correlation remains only at 0.75. The select use of MRI for preoperative estimation of tumor size in ILC is supported by our data, but the need for improvement and refinement of imaging remains.
authors.affiliation: Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
authors.forename: Lee J
authors.initials: LJ
authors.lastname: McGhan
authors.forename: Nabil
authors.initials: N
authors.lastname: Wasif
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Gray
authors.forename: Marina E
authors.initials: ME
authors.lastname: Giurescu
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Pizzitola
authors.forename: Roxanne
authors.initials: R
authors.lastname: Lorans
authors.forename: Idris T
authors.initials: IT
authors.lastname: Ocal
authors.forename: Chee-Chee H
authors.initials: CC
authors.lastname: Stucky
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Pockaj
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis*; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis*; D018275:Carcinoma, Lobular / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary