Impact of magnetic resonance on breast cancer surgical treatment

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Impact of magnetic resonance on breast cancer
surgical treatment

• D. Martínez-Cecilia, M. Álvarez Benito, P. Rioja
  Torres, A Arjona Sánchez, C. Muñoz Villanueva,
  G. Bascuñana Estudillo, S. Rufián Peña.

Breast Multidisciplinary Unit. Hospital
Universitario Reina Sofía. Córdoba.
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(No Transcript)
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MRI in breast cancer

• Equivocal mammogram or ultrasound.
• Axillary node malignancy and unknown site of
  primary tumor.
• Monitoring response to chemotherapy .
• Screening in high-risk populations.
• Nipple discharge.
• Breast cancer staging

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Staging. What are we doing?

• Breast conserving surgery 8,8-14 recurrency
• 11-57 multifocal multicentric
• MX and US lack of sensitivity MRI 100
• MRI Occult sinchronic cancer 16-37
• MRI Treatment changes 11-18
• MRI Contralateral cancer from 3-6 to 3-19

Fisher B, Anderson S, Bryant J, et al. Twenty
year follow-up a randomized trial comparing
mastectomy, lumpectomy, and lumpectomy plus
irradiation for the treatment of invasive breast
cancer. N Engl J Med. 20023471233-1241.
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Staging Pitfalls

• MRI specificity 65-79!
• Histologic confirmation of multifocal disease
  before surgery!
• Is detection of occult synchronous cancers,
  including noninvasive ones, clinical significant?
• Does it improve the survival of our patients?

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Aims

• Accuracy of MRI for estimating tumor size vs
  conventional methods.
• Evaluate MRI ability for detecting
• Multifocality, multicentricity, bilaterality.
• Evaluate the impact in the surgical management of
  newly diagnosed breast cancers.

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Patients and methods

• Retrospective review.
• January 2005-2007 712 breast cancer pac.
• 331 MRI 1.5 tesla, gadolinium.
• New suspicious foci Mx, US, Core biopsy.
• Exclusion criteria
• Preoperative chemotherapy, recurrent cancer, lack
  of MRI or pathology

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Results Tumor size
N 249
Non parametric correlation Spearman's rank
coefficient
  Sig 0,01 (bilateral).
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Results aditional foci
20 aditional foci
N 249
18 patients 8
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Histology
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Results changes in surgical treatment
32 patients 13
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was it worthy?
11 conversion rate to mastectomy 7 beneficial
mastec. 2.4 unnecessary
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Controversies
Benefit from wider excisions in BCS
Unnecessary biopsies
78 False-positive rate
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Biliamora K, Cambic A, Hansen N, Bethke K.
Evaluating the impact of preoperative breast
magnetic resonance imaging On the surgical
management of newly diagnosed breast cancers.
Arch Surg. 2007142441-447.
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Conclusions

• MRI was the best technique in assesing tumor size
  in preoperative staging of breast cancer.
• MRI diagnosed additional disease foci in 8 of
  the patients, contralateral in 1,2.
• Mastectomy conversion rate was 11, beneficial
  mastectomies in 7.

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Conclusions

• MRI changed surgical management in 13 of the
  patients, improving it in, at least, 9.
• MRI has been incorporated to our staging protocol
  in breast cancer.
• MRI should be considered in preoperative staging
  in every patient with newly diagnosed breast
  cancer.

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