Pre-treatment imaging and pathology characteristics of invasive breast cancers of limited extent: potential relevance for MRI-guided localized therapy.
OBJECTIVE
Identifying breast cancers of limited extent (BCLE) is becoming increasingly important, especially for (image guided) minimally invasive therapy and partial breast irradiation. The purpose of this study is to establish characteristics at functional imaging and pathology associated with invasive BCLE.


METHODS
Seventy-five patients (77 breasts) with invasive breast cancer were prospectively included. Excision specimens were processed using complete embedding. Microscopic findings were reconstructed and correlated with contrast-enhanced MRI. Tumors were stratified by absence or presence of occult disease ≥10 mm from the MRI-visible lesion: BCLE and non-BCLE, respectively. Imaging and pathology characteristics were evaluated for their ability to discriminate between BCLE and non-BCLE. Multivariate binary logistic regression was employed to create a prediction model for BCLE.


RESULTS
At univariate analysis, imaging as well as pathology characteristics were indicative for BCLE (39/77=51%). At multivariate analysis, a mass on mammography, the absence of tumor washout, positive ER and low quantity of DCIS in the index tumor retained significance (area under ROC curve=0.87).


CONCLUSIONS
Pre-treatment assessment of mammography findings, MRI washout kinetics, ER status and quantity of DCIS in the index tumor has the potential to accurately identify BCLE.
The Netherlands Cancer Institute, Department of Radiology, Amsterdam, The Netherlands.
Annemarie C
AC
Schmitz
Kenneth E
KE
Pengel
Claudette E
CE
Loo
Maurice A A J
MA
van den Bosch
Jelle
J
Wesseling
Maria
M
Gertenbach
Tanja
T
Alderliesten
Willem P Th M
WP
Mali
Emiel J Th
EJ
Rutgers
Harry
H
Bartelink
Kenneth G
KG
Gilhuijs
D000368:Aged; D001943:Breast Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000532:radiotherapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000532:radiotherapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D061089:Radiotherapy, Image-Guided; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis
D011960:Receptors, Estrogen; D011980:Receptors, Progesterone