COMPARISON BETWEEN MAGNETIC RESONANCE IMAGING AND ULTRASONOGRAPHY AS THE BEST EXAMINATION TO MEASURE MALIGNANT BREAST TUMORS IN SURGICAL PLANNING
Keywords:
Breast Cancer, Ultrasonography, Magnetic Resonance Imaging, Margins of Excision, Neoplasm StagingAbstract
Objective: To evaluate which examination, ultrasonography or magnetic resonance imaging, is more accurate in the measurement of malignant breast tumors in the pre-surgical evaluation, according to hormonal status. Method: This i s a d escriptive, crosssectional study in which we compared the largest tumor-size visualized by magnetic resonance imaging and ultrasonography before excision with the largest size visualized in the anatomopathological report. The sample was divided according to hormonal status: premenopausal women, postmenopausal women who have already had hormone-replacement therapy, and postmenopausal women who have never done hormone-replacement therapy. We evaluated which of the exams had a greater correlation with the size measured by the anatomopathological report using the Pearson correlation coefficient. Results: All the 39 patients had invasive-ductal carcinoma. When the total sample was analyzed (n=39), it was observed that the correlation between the ultrasonography and the anatomopathological report (r=0.73; p<0.001) was higher than the correlation between the magnetic resonance imaging and the anatomopathological report (r=0.57; p<0.001). In the premenopausal subgroup, the correlation between the ultrasonography and the anatomopathological report (r=0.46; p=0.05) was lower than the correlation between the magnetic resonance imaging and the anatomopathological report, (r=0.56; p=0.01). In the postmenopausal subgroup, Pearson’s correlation shows that ultrasonography is better at assessing tumor size than magnetic resonance imaging, regardless of hormonereplacement therapy. Conclusion: Ultrasonography is satisfactory for pre-surgical staging in invasive-ductal carcinoma, but, when available, magnetic resonance imaging may be a better indication in premenopausal patients.
Downloads
References
Instituto Nacional de Câncer José Alencar Gomes da Silva. Estimativa 2018: incidência de câncer no Brasil. Rio de Janeiro: Instituto Nacional de Câncer José Alencar Gomes da Silva; 2018.
Fisher B, Anderson S, Bryant S, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-Year Follow-up of a Randomized
Trial Comparing Total Mastectomy, Lumpectomy, and Lumpectomy plus Irradiation for the Treatment of Invasive
Breast Cancer. N Engl J Med. 2002;347:1233-41. https://doi.org/10.1056/NEJMoa022152
Cellini C, Hollenbeck ST, Christos P, Martins D, Carson J, Kemper S, et al. Factors associated with residual breast cancer after re-excision for close or positive margins. Ann Surg Oncol. 2004;11(10):915-20. https://doi.org/10.1245/ASO.2004.12.037
Fajdic J, Djurovic D, Gotovac N, Hrgovic Z. Criteria and Procedures for Breast Conserving Surgery. Acta Informatica Medica. 2013;21(1):16-9. https://doi.org/10.5455/AIM.2013.21.16-19
Schwartz GF, Veronesi U, Clough KB, Dixon JM, Fentiman IS, Heywang-Köbrunner SH, et al. Consensus Conference on Breast Conservation. Am Coll Surg. 2006;203(2):198-207.
Morrow M, Van Zee KJ, Solin LJ, Houssami N, MacGregor MC, Harris JR, et al. Society of Surgical Oncology–American
Society for Radiation Oncology –American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery with Whole-Breast Irradiation in Ductal Carcinoma In Situ. J Clin Oncol. 2016;34(33):4040-6. https://doi.org/10.1200/JCO.2016.68.3573
Gruber IV, Rueckert M, Kagan KO, Staebler A, Siegmann KC, Hartkopf A, et al. Measurement of tumour size with mammography, sonography and magnetic resonance imaging as compared to histological tumour size in primary breast câncer. BMC Cancer. 2013;13:328. https://doi.org/10.1186/1471-2407-13-328
Lai HW, Chen CJ, Lin YJ, Chen SL, Wu HK, Wu YT, et al. Does Breast Magnetic Resonance Imaging Combined With
Conventional Imaging Modalities Decrease the Rates of Surgical Margin Involvement and Reoperation?: A Case–
Control Comparative Analysis. Ed. Mahmoud Mohamed Abdelwahab Ali. Medicine. 2016;95(22). https://doi.org/10.1097/MD.0000000000003810
Houssami N, Ciatto S, Macaskill P, Lord SJ, Warren RM, Dixon JM, et al. Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and metaanalysis in detection of multifocal and multicentric cancer. J Clin Oncol. 2008;26(19):3248-58. https://doi.org/10.1200/JCO.2007.15.2108
Houssami N, Turner R, Morrow M. Preoperative magnetic resonance imaging in breast cancer: meta-analysis of
surgical outcomes. Ann Surg. 2013;257(2):249-55. https://doi.org/10.1097/SLA.0b013e31827a8d17
Wang SYW, Long JB, Killelea BK, Evans SB, Roberts KB, Silber A, et al. Preoperative Breast Magnetic Resonance Imaging and Contralateral Breast Cancer Occurrence Among Older Women with Breast Cancer. J Clin Oncol. 2016;34(4):321-8. https://doi.org/10.1200/JCO.2015.62.9741
Fortune-Greeley AK, Wheeler SB, Meyer AM, Reeder-Hayes KE, Biddle AK, Muss HB, et al. Preoperative breast
MRI and surgical outcomes in elderly women with invasive ductal and lobular carcinoma: a populationbased
study. J Clin Oncol. 2014;143(1):203-12. https://dx.doi.org/10.1007%2Fs10549-013-2787-4
Houssami N, Macaskill P, Marinovich ML, Dixon JM, Irwig L, Brennan ME, et al. Meta-analysis of the impact of surgical margins on local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy. Eur J Cancer. 2010;46:3219-32. https://doi.org/10.1016/j.ejca.2010.07.043
Moran MS, Schnitt SJ, Giuliano EA, Harris JR, Khan SA, Horton J, et al. SSO-ASTRO Consensus Guideline on Margins
for Breast-Conserving Surgery with Whole Breast Irradiation in Stage I and II Invasive Breast Cancer. Int J Radiat Oncol, Biol, Phys. 2014;88(3):553-64. https://dx.doi.org/10.1016%2Fj. ijrobp.2013.11.012
Daniel OK, Lim SM, Kim JH, Park HS, Park S, Kim SI. Preoperative prediction of the size of pure ductal carcinoma
in situ using three imaging modalities as compared to histopathological size: does magnetic resonance imaging add
value? Breast Cancer Res Treat. 2017;164(2):437-44. https:// dx.doi.org/10.1007/s10549-017-4252-2
França LKL, Bitencourt AGV, Paiva HLS, Silva CB, Pereira NP, Paludo J, et al. Role of magnetic resonance imaging in the planning of breast cancer treatment strategies: comparison with conventional imaging techniques. Radiol Bras.
;50(2):76-81. https://doi.org/10.1590/0100-3984.2015.0124 17. Debald M, Abramian A, Nemes L, Döbler M, Kaiser C, Keyver-Paik MD, et al. Who may benefit from preoperative breast MRI? A single-center analysis of 1102 consecutive patients with primary breast cancer. Breast Cancer Res Treat. 2015;153(3):531-7. https://doi.org/10.1007/s10549-015-3556-3
Brennan ME, McKessar M, Snook K, Burgess I, Spillane AJ. Impact of selective use of breast MRI on surgical decision-making in women with newly diagnosed operable breast cancer. Breast. 2017;32:135-43. https://doi.org/10.1016/j.breast.2017.01.015
Mukherjee SD, Hodgson N, Lovrics PJ, Dhamanaskar K, Minuk T, Chambers S, et al. A Retrospective Study Evaluating the Impact of Preoperative Breast MRI on Surgical Decision-Making in Young Patients (≤50 Years) with Invasive Breast Cancer. Breast Cancer (Auckl). 2016;10:53-60. https://doi.org/10.4137/BCBCR.S38432
Persson I, Thurfjell E, Holmberg L. Effect of estrogen and estrogen-progestin replacement regimens on mammographic breast parenchymal density. J Clin Oncol. 1997;15:3201-7. https://doi.org/10.1200/JCO.1997.15.10.3201
Fancellu A, Soro D, Castiglia P, Marras V, Melis M, Cottu P, et al. Usefulness of magnetic resonance in patients with invasive cancer eligible for breast conservation: a comparative study. Clin Breast Cancer. 2014;14(2):114-21. https://doi.org/10.1016/j.clbc.2013.10.002
Kawamura A, Satake H, Ishigaki S, Ikeda M, Kimura R, Shimamoto K, et al. Prediction of background parenchymal
enhancement on breast MRI using mammography, ultrasonography, and diffusion-weighted imaging. Nagoya J
Med Sci. 2015;77(3):425-37.
Kuhl CK, Strobel K, Bieling H, Wardelmann E, Kuhn W, Maass N, et al. Impact of Preoperative Breast MR Imaging
and MR-guided Surgery on Diagnosis and Surgical Outcome of Women with Invasive Breast Cancer with and without
DCIS Component. Radiology. 2017. https://doi.org/10.1148/radiol.2017161449
Lai HW, Chen CJ, Lin YJ, Chen SL, Wu HK, Wu YT, et al. Does Breast Magnetic Resonance Imaging Combined
with Conventional Imaging Modalities Decrease the Rates of Surgical Margin Involvement and Reoperation?
Medicine (Baltimore). 2016;95(22). https://doi.org/10.1097/MD.0000000000003810
National Comprehensive Cancer Network. Breast Cancer Version 2. 2017 [acessed on May 9, 2017]. Available at: https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf
Gervais MK, Maki E, Schiller DE, Crystal P, McCready DR. Preoperative MRI of the breast and ipsilateral breast tumor recurrence: Long-term follow up. J Surg Oncol. 2017;115(3):231-7. https://doi.org/10.1002/jso.24520
Vapiwala N, Hwang WT, Kushner CJ, Schnall MD, Freedman GM, Solin LJ. No impact of breastmagnetic resonance imaging on 15-year outcomes in patients with ductal carcinoma in situ or early-stage invasive breast cancer managed with breast conservation therapy. Cancer. 2017;123(8):1324-32. https://doi.org/10.1002/cncr.30479
Saunders C, Taylor D. Expanding the indications for MRI in the diagnosis and treatment of breast cancer: what is best practice? J Med Radiat Sci. 2015;62(1):47-53. https://dx.doi.org/10.1002%2Fjmrs.95
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2018 André João Rodrigues Espelho Rossi, Ana Claudia Garabeli Cavalli Kluthcovsky, Fábio Postiglione Mansani
This work is licensed under a Creative Commons Attribution 4.0 International License.
