Magnetic resonance imaging in the preoperative setting for breast cancer patients with undetected additional disease.
OBJECTIVE
The last few years have witnessed a significant increase in the preoperative use of Magnetic Resonance Imaging (MRI) for staging purposes in breast cancer (BC) patients. Many studies have confirmed the improvement that MRI can provide in terms of diagnostic assessment, especially with regard to additional disease foci. In the present study, we address the advantages and disadvantages of MRI in the preoperative setting for BC patients.


METHODS
There were 1513 consecutive breast MRI studies performed in patients with either primary or recurrent BC, who were scheduled for surgery.


RESULTS
Beyond the primary lesion, 10.4% of our cases had additional disease at the final histological assessment. MRI overall sensitivity, when considering tumour size and additional foci together, was 74.3%, and 80.3% when considering additional foci exclusively. MRI specificity for additional disease was 95.3%, positive predictive value was 77.4%, and negative predictive value was 94.6%. Nevertheless, 5% of cases had additional tumours that were missed by MRI or, conversely, had additional foci on MRI that were not confirmed by histology. Age (p=0.020) and lobular carcinomas (p=0.030) showed significance in the multivariate analysis by logistic regression, using the presence of additional foci diagnosed by MRI as a dependent variable.


CONCLUSIONS
Preoperative MRI seems to have a role in preoperative tumour staging for breast cancer patients, as it discloses additional disease foci in some patients, including contralateral involvement. However, given the lack of absolute accuracy, core-needle biopsy cannot be neglected in the diagnosis of such additional malignant foci, which could result in a change in surgical treatment.
Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Spain.
Israel
I
Barco
Department of Nursing, School of Health Science TecnoCampus Mataró-Maresme, Spain.
Carolina
C
Chabrera
Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Spain; Department of Nursing, School of Health Science TecnoCampus Mataró-Maresme, Spain; Nuclear Medicine Department, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Spain; Department of Nursing, Breastfeeding Consultant, Promotion and Supporting Program, Institut Català de la Salut, ASSIR Mollet, Barcelona, Spain; Breast Unit, Department of Hemato-oncology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Spain; Breast Unit, Department of Gynecology, Hospital of Terrassa, Health Consortium of Terrassa, Spain; Breast Unit, Department of Radiology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Spain; Department of Gynecology, University Hospital of MútuaTerrassa, University of Barcelona, Spain; University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Spain; Laboratory of Toxicology, Universitat Autònoma de Barcelona, Spain; University International of Catalunya, Spain. Electronic address: drgarciafdez@hotmail.com.
Antonio
A
García-Fernández
Nuclear Medicine Department, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Spain.
Manel
M
Fraile
Department of Nursing, Breastfeeding Consultant, Promotion and Supporting Program, Institut Català de la Salut, ASSIR Mollet, Barcelona, Spain.
MCarmen
M
Vidal
Breast Unit, Department of Hemato-oncology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Spain.
Sonia
S
González
Breast Unit, Department of Gynecology, Hospital of Terrassa, Health Consortium of Terrassa, Spain.
Jose María
JM
Lain
Breast Unit, Department of Radiology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Spain.
Assumpta
A
Reñé
Breast Unit, Department of Radiology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Spain.
Lidia
L
Canales
Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Spain.
Elena
E
Vallejo
Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Spain.
Jordi
J
Deu
Department of Gynecology, University Hospital of MútuaTerrassa, University of Barcelona, Spain.
Antoni
A
Pessarrodona
University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Spain; Laboratory of Toxicology, Universitat Autònoma de Barcelona, Spain.
Nuria
N
Giménez
University International of Catalunya, Spain.
Marc
M
García-Font
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D033162:Incidental Findings; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D011300:Preoperative Care; D012680:Sensitivity and Specificity
Additional foci; Breast cancer; Magnetic resonance imaging; Sensitivity and specificity