MRI and ultrasound evaluation of invasive lobular carcinoma of the breast after primary systemic therapy.
OBJECTIVE
To assess magnetic resonance imaging (MRI) and ultrasound (US) evaluation of invasive lobular carcinoma after primary systemic therapy compared to the primary surgery group.


METHODS
A total of 218 breasts with invasive lobular carcinoma (ILC), which were diagnosed by core needle biopsy and underwent surgery between 2004 and 2010 in St. Luke's International Hospital, were reviewed. Of these, 44 breasts received primary systemic therapy (PST) and the residual 174 breasts underwent surgery first. Before surgery, MRI and second-look US were performed. Patients whose extent of lesion from MRI and US was over 90° were recommended to receive total mastectomy. Diagnostic image evaluation was categorized from the final pathology. A negative margin of breast-conserving surgery (BCS) and mastectomy which has over 90° tumor extent in pathology were regarded as "appropriate". A positive margin of BCS was regarded as "underestimated". "Overestimation" was determined when the pathological extension was small enough for BCS although MRI and US diagnosis was over 90°.


RESULTS
Of 44 breasts which received PST, 26 breasts received BCS as initial surgery. Of these, 14 (53.8 %) breasts were "underestimated". Of these 14, 5 breasts received additional total mastectomy. Of 174 breasts that received surgery first, 121 (69.5 %) breasts received BCS as the initial surgery. Of these, 46 (38.0 %) breasts were "underestimated" and 6 breast of these 46 received additional total mastectomy. "Underestimated" rate was similar in the two groups, but the additional total mastectomy rate was significantly higher in the PST group (p = 0.025). There were no "overestimations". The "appropriate" rate was similar between the PST (68.2 %) and surgery-first groups (73.6 %).


CONCLUSIONS
Although 68.2 % of ILC patients were evaluated "appropriately" even after PST, higher additional total mastectomy rates should be considered when selecting the surgical procedure.
Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 2340 Sutter Street, S441, San Francisco, CA, 94115, USA, wilsonmikity@yahoo.co.jp.
Miki
M
Mori
Hiroko
H
Tsunoda
Yayoi
Y
Takamoto
Michiko
M
Murai
Mari
M
Kikuchi
Satoshi
S
Honda
Koyu
K
Suzuki
Hideko
H
Yamauchi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery / Q000628:therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D016217:Ultrasonography, Mammary