Top

Published in:

01-03-2006 | Breast

Contrast-enhanced MRI in breast cancer patients eligible for breast-conserving therapy: complementary value for subgroups of patients

Authors: Eline E. Deurloo, William F. A. Klein Zeggelink, H. Jelle Teertstra, Johannes L. Peterse, Emiel J. Th. Rutgers, Sara H. Muller, Harry Bartelink, Kenneth G. A. Gilhuijs

Published in: European Radiology | Issue 3/2006

Abstract

The aim of this study was to identify patients prior to breast-conserving therapy (BCT) who have complementary value of contrast-enhanced magnetic resonance imaging (MRI) over conventional imaging in the assessment of tumor extent. All patients were eligible for BCT according to conventional imaging, and underwent preoperative MRI as part of this study. One hundred and sixty-five patients (166 tumors) were included. MRI was defined to have complementary value if conventional imaging underestimated or overestimated tumor extent (by more than 10 mm compared to histology) and MRI assessed the extent accurately. Logistic regression was employed to identify characteristics that are predictive of the complementary value of preoperative MRI. MRI had complementary value in 39 cases (23%). Patients <58 years old with irregular lesion margins at mammography and discrepancy in tumor extent by more than 10 mm between mammography and ultrasonography had a 3.2× higher chance of accurate assessment at MRI (positive predictive value 50%, negative predictive value 84%, p=0.0002). Preoperative MRI in patients eligible for BCT is more accurate than conventional imaging in the assessment of tumor extent in approximately one out of four patients. Subgroups of patients in whom MRI has complementary value may be defined by the differences in clinical and imaging features.

Harris JR, Botnick L, Bloomer WD, Chaffey JT, Hellman S (1981) Primary radiation therapy for early breast cancer: the experience at The Joint Center for Radiation Therapy. Int J Radiat Oncol Biol Phys 7:1549–1552PubMed

Zafrani B, Vielh P, Fourquet A, Mosseri V, Durand JC, Salmon RJ, Vilcoq JR (1989) Conservative treatment of early breast cancer: prognostic value of the ductal in situ component and other pathological variables on local control and survival. Long-term results. Eur J Cancer Clin Oncol 25:1645–1650CrossRefPubMed

Veronesi U, Salvadori B, Luini A, Greco M, Saccozzi R, del Vecchio M, Mariani L, Zurrida S, Rilke F (1995) Breast conservation is a safe method in patients with small cancer of the breast. Long-term results of three randomised trials on 1,973 patients. Eur J Cancer 31A:1574–1579CrossRefPubMed

Bartelink H, Horiot JC, Poortmans P, Struikmans H, Van den Bogaert W, Barillot I, Fourquet A, Borger J, Jager J, Hoogenraad W, Collette L, Pierart M; European Organization for Research and Treatment of Cancer Radiotherapy and Breast Cancer Groups (2001) Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Engl J Med 345:1378–1387CrossRefPubMed

Vrieling C, Collette L, Fourquet A, Hoogenraad WJ, Horiot JH, Jager JJ, Pierart M, Poortmans PM, Struikmans H, Maat B, Van Limbergen E, Bartelink H (2000) The influence of patient, tumor and treatment factors on the cosmetic results after breast-conserving therapy in the EORTC ’boost vs. no boost’ trial. EORTC Radiotherapy and Breast Cancer Cooperative Groups. Radiother Oncol 55:219–232PubMedCrossRef

Smitt MC, Nowels KW, Zdeblick MJ, Jeffrey S, Carlson RW, Stockdale FE, Goffinet DR (1995) The importance of the lumpectomy surgical margin status in long-term results of breast conservation. Cancer 76:259–267PubMedCrossRef

Kearney TJ, Morrow M (1995) Effect of reexcision on the success of breast-conserving surgery. Ann Surg Oncol 2:303–307PubMedCrossRef

Tartter PI, Kaplan J, Bleiweiss I, Gajdos C, Kong A, Ahmed S, Zapetti D (2000) Lumpectomy margins, reexcision, and local recurrence of breast cancer. Am J Surg 179:81–85PubMedCrossRef

Schnitt SJ, Connolly JL, Khettry U, Mazoujian G, Brenner M, Silver B, Recht A, Beadle G, Harris JR (1987) Pathologic findings on re-excision of the primary site in breast cancer patients considered for treatment by primary radiation therapy. Cancer 59:675–681PubMedCrossRef

10.

Holland R, Connolly JL, Gelman R, Mravunac M, Hendriks JH, Verbeek AL, Schnitt SJ, Silver B, Boyages J, Harris JR (1990) The presence of an extensive intraductal component following a limited excision correlates with prominent residual disease in the remainder of the breast. J Clin Oncol 8:113–118PubMed

11.

Faverly DR, Hendriks JH, Holland R (2001) Breast carcinomas of limited extent: frequency, radiologic–pathologic characteristics, and surgical margin requirements. Cancer 91:647–659PubMedCrossRef

12.

Zonderland HM, Coerkamp EG, Hermans J, van de Vijver MJ, van Voorthuisen AE (1999) Diagnosis of breast cancer: contribution of US as an adjunct to mammography. Radiology 213:413–422PubMed

13.

Heywang-Kobrunner SH, Viehweg P, Heinig A, Kuchler C (1997) Contrast-enhanced MRI of the breast: accuracy, value, controversies, solutions. Eur J Radiol 24:94–108PubMedCrossRef

14.

Viehweg P, Paprosch I, Strassinopoulou M, Heywang-Kobrunner SH (1998) Contrast-enhanced magnetic resonance imaging of the breast: interpretation guidelines. Top Magn Reson Imaging 9:17–43PubMedCrossRef

15.

Boetes C, Mus RD, Holland R, Barentsz JO, Strijk SP, Wobbes T, Hendriks JH, Ruys SH (1995) Breast tumors: comparative accuracy of MR imaging relative to mammography and US for demonstrating extent. Radiology 197:743–747PubMed

16.

Van Goethem M, Schelfout K, Kersschot E, Colpaert C, Verslegers I, Biltjes I, Tjalma WA, Weyler J, De Schepper A (2004) Enhancing area surrounding breast carcinoma on MR mammography: comparison with pathological examination. Eur Radiol 14:1363–1370PubMed

17.

Mumtaz H, Hall-Craggs MA, Davidson T, Walmsley K, Thurell W, Kissin MW, Taylor I (1997) Staging of symptomatic primary breast cancer with MR imaging. AJR Am J Roentgenol 169:417–424PubMed

18.

Esserman L, Hylton N, Yassa L, Barclay J, Frankel S, Sickles E (1999) Utility of magnetic resonance imaging in the management of breast cancer: evidence for improved preoperative staging. J Clin Oncol 17:110–119PubMed

19.

Fischer U, Kopka L, Grabbe E (1999) Breast carcinoma: effect of preoperative contrast-enhanced MR imaging on the therapeutic approach. Radiology 213:881–888PubMed

20.

Drew PJ, Chatterjee S, Turnbull LW, Read J, Carleton PJ, Fox JN, Monson JR, Kerin MJ (1999) Dynamic contrast enhanced magnetic resonance imaging of the breast is superior to triple assessment for the pre-operative detection of multifocal breast cancer. Ann Surg Oncol 6:599–603CrossRefPubMed

21.

Weinstein SP, Orel SG, Heller R, Reynolds C, Czerniecki B (2001) MR Imaging of the Breast in Patients with Invasive Lobular Carcinoma. AJR Am J Roentgenol 176:399–406PubMed

22.

Munot K, Dall B, Achuthan R, Parkin G, Lane S, Horgan K (2002) Role of magnetic resonance imaging in the diagnosis and single-stage surgical resection of invasive lobular carcinoma of the breast. Br J Surg 89:1296–1301CrossRefPubMed

23.

Liberman L, Morris EA, Dershaw DD, Abramson AF, Tan LK (2003) MR imaging of the ipsilateral breast in women with percutaneously proven breast cancer. AJR Am J Roentgenol 180:901–910PubMed

24.

Kneeshaw PJ, Turnbull LW, Smith A, Drew PJ (2003) Dynamic contrast enhanced magnetic resonance imaging aids the surgical management of invasive lobular breast cancer. Eur J Surg Oncol 29:32–37CrossRefPubMed

25.

Quan ML, Sclafani L, Heerdt AS, Fey JV, Morris EA, Borgen PI (2003) Magnetic resonance imaging detects unsuspected disease in patients with invasive lobular cancer. Ann Surg Oncol 10:1048–1053PubMedCrossRef

26.

Fischer U, Zachariae O, Baum F, von Heyden D, Funke M, Liersch T (2004) The influence of preoperative MRI of the breasts on recurrence rate in patients with breast cancer. Eur Radiol 14:1725–1731PubMed

27.

Schelfout K, Van Goethem M, Kersschot E, Verslegers I, Biltjes I, Leyman P, Colpaert C, Thienpont L, Van den Haute J, Gillardin JP, Tjalma W, Buytaert P, De Schepper A (2004) Preoperative breast MRI in patients with invasive lobular breast cancer. Eur Radiol 14:1209–1216CrossRefPubMed

28.

Van Goethem M, Schelfout K, Dijckmans L, Van Der Auwera JC, Weyler J, Verslegers I, Biltjes I, De Schepper A (2004) MR mammography in the pre-operative staging of breast cancer in patients with dense breast tissue: comparison with mammography and ultrasound. Eur Radiol 14:809–816PubMedCrossRef

29.

Davis PL, Staiger MJ, Harris KB, Ganott MA, Klementaviciene J, McCarty KS Jr, Tobon H (1996) Breast cancer measurements with magnetic resonance imaging, ultrasonography, and mammography. Breast Cancer Res Treat 37:1–9CrossRefPubMed

30.

Davidson T, Mumtaz H, Hall-Craggs MA, Kissin MW, Thurell W, Taylor I (1997) Impact of magnetic resonance imaging in determining surgical management in breast cancer. Breast 6:177–182CrossRef

31.

Amano G, Ohuchi N, Ishibashi T, Ishida T, Amari M, Satomi S (2000) Correlation of three-dimensional magnetic resonance imaging with precise histopathological map concerning carcinoma extension in the breast. Breast Cancer Res Treat 60:43–55CrossRefPubMed

32.

Tan JE, Orel SG, Schnall MD, Schultz DJ, Solin LJ (1999) Role of magnetic resonance imaging and magnetic resonance imaging-guided surgery in the evaluation of patients with early-stage breast cancer for breast conservation treatment. Am J Clin Oncol 22:414–418CrossRefPubMed

33.

Bedrosian I, Mick R, Orel SG, Schnall M, Reynolds C, Spitz FR, Callans LS, Buzby GP, Rosato EF, Fraker DL, Czerniecki BJ (2003) Changes in the surgical management of patients with breast carcinoma based on preoperative magnetic resonance imaging. Cancer 98:468–473CrossRefPubMed

34.

Sardanelli F, Iozzelli A, Fausto A, Carriero A, Kirchin MA (2005) Gadobenate dimeglumine-enhanced MR imaging breast vascular maps: association between invasive cancer and ipsilateral increased vascularity. Radiology 235:791–797PubMedCrossRef

35.

Kelcz F, Furman-Haran E, Grobgeld D, Degani H (2002) Clinical testing of high-spatial-resolution parametric contrast-enhanced MR imaging of the breast. AJR Am J Roentgenol 179:1485–1492PubMed

36.

Nunes LW, Englander SA, Charafeddine R, Schnall MD (2002) Optimal post-contrast timing of breast MR image acquisition for architectural feature analysis. J Magn Reson Imaging 16:42–50CrossRefPubMed

37.

Vomweg TW, Teifke A, Kunz RP, Hintze C, Hlawatsch A, Kern A, Kreitner KF, Thelen M (2004) Combination of low and high resolution sequences in two orientations for dynamic contrast-enhanced MRI of the breast: more than a compromise. Eur Radiol 14:1732–1742CrossRefPubMed

38.

Gilhuijs KG, Deurloo EE, Muller SH, Peterse JL, Schultze Kool LJ (2002) Breast MR imaging in women at increased lifetime risk of breast cancer: clinical system for computerized assessment of breast lesions initial results. Radiology 225:907–916PubMedCrossRef

39.

Deurloo EE, Muller SH, Peterse JL, Besnard APE, Gilhuijs KGA (2005) Clinically and mammographically occult breast lesions on MR images: potential effect of computerized assessment on clinical reading. Radiology 234:693–701PubMedCrossRef

40.

van Dongen JA, Voogd AC, Fentiman IS, Legrand C, Sylvester RJ, Tong D, van der Schueren E, Helle PA, van Zijl K, Bartelink H (2000) Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst 92:1143–1150CrossRefPubMed

41.

Bartelink H, Borger JH, van Dongen JA, Peterse JL (1988) The impact of tumor size and histology on local control after breast-conserving therapy. Radiother Oncol 11:297–303CrossRefPubMed

42.

Egan RL (1982) Multicentric breast carcinomas: clinical-radiographic-pathologic whole organ studies and 10-year survival. Cancer 49:1123–1130PubMedCrossRef

43.

Zeggelink WF, Deurloo EE, Bartelink H, Rutgers EJ, Gilhuijs KG (2003) Reproducibility of the assessment of tumor extent in the breast using multiple image modalities. Med Phys 30:2919–2926CrossRefPubMed

44.

Ntzani EE, Ioannidis JP (2003) Predictive ability of DNA microarrays for cancer outcomes and correlates: an empirical assessment. Lancet 362:1439–1444CrossRefPubMed

45.

Metz CE (1986) ROC methodology in radiologic imaging. Invest Radiol 21:720–733PubMedCrossRef

46.

Deurloo EE, Peterse JL, Rutgers EJT, Besnard APE, Muller SH, Gilhuijs KGA (2005) Additional breast lesions in patients eligible for breast-conserving therapy by MRI: impact on preoperative management and potential benefit of computerised analysis. Eur J Cancer 41:1393–1401CrossRefPubMed

47.

Park CC, Mitsumori M, Nixon A, Recht A, Connolly J, Gelman R, Silver B, Hetelekidis S, Abner A, Harris JR, Schnitt SJ (2000) Outcome at 8 years after breast-conserving surgery and radiation therapy for invasive breast cancer: influence of margin status and systemic therapy on local recurrence. J Clin Oncol 18:1668–1675PubMed

48.

Kurtz JM, Amalric R, Brandone H, Ayme Y, Jacquemier J, Pietra JC, Hans D, Pollet JF, Bressac C, Spitalier JM (1989) Local recurrence after breast-conserving surgery and radiotherapy. Frequency, time course, and prognosis. Cancer 63:1912–1917PubMedCrossRef

49.

Voogd AC, van Tienhoven G, Peterse HL, Crommelin MA, Rutgers EJ, van de Velde CJ, van Geel BN, Slot A, Rodrigus PT, Jobsen JJ, von Meyenfeldt MF, Coebergh JW (1999) Local recurrence after breast conservation therapy for early stage breast carcinoma: detection, treatment, and outcome in 266 patients. Dutch Study Group on Local Recurrence after Breast Conservation (BORST). Cancer 85:437–446CrossRefPubMed

50.

Veronesi U, Luini A, Galimberti V, Zurrida S (1994) Conservation approaches for the management of stage I/II carcinoma of the breast: Milan Cancer Institute trials. World J Surg 18:70–75CrossRefPubMed

51.

Wazer DE, DiPetrillo T, Schmidt-Ullrich R, Weld L, Smith TJ, Marchant DJ, Robert NJ (1992) Factors influencing cosmetic outcome and complication risk after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol 10:356–363PubMed

52.

Hata T, Takahashi H, Watanabe K, Takahashi M, Taguchi K, Itoh T, Todo S (2004) Magnetic resonance imaging for preoperative evaluation of breast cancer: a comparative study with mammography and ultrasonography. J Am Coll Surg 198:190–197CrossRefPubMed

53.

LaTrenta LR, Menell JH, Morris EA, Abramson AF, Dershaw DD, Liberman L (2003) Breast lesions detected with MR imaging: utility and histopathologic importance of identification with US. Radiology 227:856–861PubMedCrossRef

54.

Kuhl CK, Elevelt A, Leutner CC, Gieseke J, Pakos E, Schild HH (1997) Interventional breast MR imaging: clinical use of a stereotactic localization and biopsy device. Radiology 204:667–675PubMed

55.

DeAngelis GA, Moran RE, Fajardo LL, Mugler JP, Christopher JM, Harvey JA (2000) MRI-guided needle localization: technique. Semin Ultrasound CT MR 21:337–350CrossRefPubMed

56.

Smith LF, Henry-Tillman R, Mancino AT, Johnson A, Price Jones M, Westbrook KC, Harms S, Klimberg VS (2001) Magnetic resonance imaging-guided core needle biopsy and needle localized excision of occult breast lesions. Am J Surg 182:414–418CrossRefPubMed

57.

Kuhl CK, Morakkabati N, Leutner CC, Schmiedel A, Wardelmann E, Schild HH (2001) MR imaging-guided large-core (14-gauge) needle biopsy of small lesions visible at breast MR imaging alone. Radiology 220:31–39PubMed

58.

Bedrosian I, Schlencker J, Spitz FR, Orel SG, Fraker DL, Callans LS, Schnall M, Reynolds C, Czerniecki BJ (2002) Magnetic resonance imaging-guided biopsy of mammographically and clinically occult breast lesions. Ann Surg Oncol 9:457–461CrossRefPubMed

59.

Morris EA, Liberman L, Dershaw DD, Kaplan JB, LaTrenta LR, Abramson AF, Ballon DJ (2002) Preoperative MR imaging-guided needle localization of breast lesions. AJR Am J Roentgenol 178:1211–1220PubMed

60.

Viehweg P, Heinig A, Amaya B, Alberich T, Laniado M, Heywang-Kobrunner SH (2002) MR-guided interventional breast procedures considering vacuum biopsy in particular. Eur J Radiol 42:32–39CrossRefPubMed

61.

Liberman L, Morris EA, Dershaw DD, Thornton CM, Van Zee KJ, Tan LK (2003) Fast MRI-guided vacuum-assisted breast biopsy: initial experience. AJR Am J Roentgenol 181:1283–1293PubMed

62.

Gajdos C, Tartter PI, Bleiweiss I, Hermann G, de Csepel J, Estabrook A, Rademaker AW (2002) Mammographic appearance of nonpalpable breast cancer reflects pathologic characteristics. Ann Surg Oncol 235:246–251

63.

Beron PJ, Horwitz EM, Martinez AA, Wimbish KJ, Levine AJ, Gustafson G, Chen PY, Ingold JA, Vicini FA (1996) Pathologic and mammographic findings predicting the adequacy of tumor excision before breast-conserving therapy. AJR Am J Roentgenol 167:1409–1414PubMed

64.

Liberman L, Goodstine SL, Dershaw DD, Morris EA, LaTrenta LR, Abramson AF, Van Zee KJ (2002) One operation after percutaneous diagnosis of nonpalpable breast cancer: frequency and associated factors. AJR Am J Roentgenol 178:673–680PubMed

65.

Tillman GF, Orel SG, Schnall MD, Schultz DJ, Tan JE, Solin LJ (2002) Effect of breast magnetic resonance imaging on the clinical management of women with early-stage breast carcinoma. J Clin Oncol 20:3413–3423CrossRefPubMed

66.

Morrow M (2004) Magnetic resonance imaging in breast cancer: one step forward, two steps back? JAMA 292:2779–2780CrossRefPubMed

67.

Ernster VL, Barclay J, Kerlikowske K, Grady D, Henderson C (1996) Incidence of and treatment for ductal carcinoma in situ of the breast. JAMA 275:913–918CrossRefPubMed

Title: Contrast-enhanced MRI in breast cancer patients eligible for breast-conserving therapy: complementary value for subgroups of patients
Authors: Eline E. Deurloo
William F. A. Klein Zeggelink
H. Jelle Teertstra
Johannes L. Peterse
Emiel J. Th. Rutgers
Sara H. Muller
Harry Bartelink
Kenneth G. A. Gilhuijs
Publication date: 01-03-2006
Publisher: Springer-Verlag
Published in: European Radiology / Issue 3/2006
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-005-0043-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Contrast-enhanced MRI in breast cancer patients eligible for breast-conserving therapy: complementary value for subgroups of patients

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2006

Missing data

Prediction of outcomes of renal stones from stone characteristics after shock-wave lithotripsy: Is unenhanced helical computed tomography better?

The effect of X-rays on bone: a pictorial review

Giant oesophageal fibrovascular polyp (2005:12b)

T1 and T2 relaxivity of intracellular and extracellular USPIO at 1.5T and 3T clinical MR scanning

MRI of the pelvis at 3 T: very high spatial resolution with sensitivity encoding and flip-angle sweep technique in clinically acceptable scan time