title: Multicentric Cancer Detected at Breast MR Imaging and Not at Mammography: Important or Not?
abstract: OBJECTIVE
  To review the magnetic resonance (MR) imaging and pathologic features of multicentric cancer detected only at MR imaging and to evaluate its potential biologic value.
  
  
  METHODS
  This retrospective study was institutional review board approved and HIPAA compliant; informed consent was waived. A review of records from 2001 to 2011 yielded 2021 patients with newly diagnosed breast cancer who underwent biopsy after preoperative MR imaging, 285 (14%) of whom had additional cancer detected at MR imaging that was occult at mammography. In 73 patients (3.6%), MR imaging identified 87 cancers in different quadrants than the known index cancer, constituting the basis of this report. In 62 of 73 patients (85%; 95% confidence interval [CI]: 75, 92), one additional cancer was found, and in 11 of 73 (15%; 95% CI: 8, 25), multiple additional cancers were found. A χ(2) test with adjustment for multiple lesions was used to examine whether MR imaging and pathologic features differ between the index lesion and additional multicentric lesions seen only at MR imaging.
  
  
  RESULTS
  Known index cancers were more likely to be invasive than MR imaging-detected multicentric cancers (88% vs 76%, P = .023). Ductal carcinoma in situ (21 of 87 lesions [24%]; 95% CI: 15, 36) represented a minority of additional MR imaging-detected multicentric cancers. Overall, the size of MR imaging-detected multicentric invasive cancers (median, 0.6 cm; range, 0.1-6.3 cm) was smaller than that of the index cancer (median, 1.2 cm; range, 0.05-7.0 cm; P = .023), although 17 of 73 (23%) (95% CI: 14, 35) patients had larger MR imaging-detected multicentric cancers than the known index lesion, and 18 of 73 (25%) (95% CI: 15, 36) had MR imaging-detected multicentric cancers larger than 1 cm. MR imaging-detected multicentric cancers and index cancers differed in histologic characteristics, invasiveness, and grade in 27 of 73 (37%) patients (95% CI: 26, 49). In four of 73 (5%) patients (95% CI: 2, 13), MR imaging-detected multicentric cancers were potentially more biologically relevant because of the presence of unsuspected invasion or a higher grade.
  
  
  CONCLUSIONS
  Multicentric cancer detected only at MR imaging was invasive in 66 of 87 patients (76%), larger than 1 cm in 18 of 73 patients (25%), larger than the known index cancer in 17 of 73 patients (23%), and more biologically important in four of 73 women (5%). An unsuspected additional multicentric cancer seen only at MR imaging is likely clinically relevant disease.
authors.affiliation: From the Breast Unit, USL1 Massa-Carrara, Piazza Monzoni 2, 54033 Carrara, Italy (C.I.); and Departments of Pathology (L.G.), Statistics (J.Z.), Surgery (V.S.), and Radiology (E.J.S., D.D., E.A.M.), Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Chiara
authors.initials: C
authors.lastname: Iacconi
authors.affiliation: From the Breast Unit, USL1 Massa-Carrara, Piazza Monzoni 2, 54033 Carrara, Italy (C.I.); and Departments of Pathology (L.G.), Statistics (J.Z.), Surgery (V.S.), and Radiology (E.J.S., D.D., E.A.M.), Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Lanie
authors.initials: L
authors.lastname: Galman
authors.affiliation: From the Breast Unit, USL1 Massa-Carrara, Piazza Monzoni 2, 54033 Carrara, Italy (C.I.); and Departments of Pathology (L.G.), Statistics (J.Z.), Surgery (V.S.), and Radiology (E.J.S., D.D., E.A.M.), Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Junting
authors.initials: J
authors.lastname: Zheng
authors.affiliation: From the Breast Unit, USL1 Massa-Carrara, Piazza Monzoni 2, 54033 Carrara, Italy (C.I.); and Departments of Pathology (L.G.), Statistics (J.Z.), Surgery (V.S.), and Radiology (E.J.S., D.D., E.A.M.), Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Virgilio
authors.initials: V
authors.lastname: Sacchini
authors.affiliation: From the Breast Unit, USL1 Massa-Carrara, Piazza Monzoni 2, 54033 Carrara, Italy (C.I.); and Departments of Pathology (L.G.), Statistics (J.Z.), Surgery (V.S.), and Radiology (E.J.S., D.D., E.A.M.), Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Sutton
authors.affiliation: From the Breast Unit, USL1 Massa-Carrara, Piazza Monzoni 2, 54033 Carrara, Italy (C.I.); and Departments of Pathology (L.G.), Statistics (J.Z.), Surgery (V.S.), and Radiology (E.J.S., D.D., E.A.M.), Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: David
authors.initials: D
authors.lastname: Dershaw
authors.affiliation: From the Breast Unit, USL1 Massa-Carrara, Piazza Monzoni 2, 54033 Carrara, Italy (C.I.); and Departments of Pathology (L.G.), Statistics (J.Z.), Surgery (V.S.), and Radiology (E.J.S., D.D., E.A.M.), Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Morris
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008327:Mammography; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis* / Q000000981:diagnostic imaging; D016217:Ultrasonography, Mammary
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA