Scientific Presentation Award: The impact of magnetic resonance imaging on surgical treatment of invasive breast cancer

Background

The purpose of this study was to examine the relationship between magnetic resonance imaging (MRI) and surgical treatment of invasive breast cancer (IBC).

Method

The IBC patients treated from January 2003-June 2008 were reviewed by a single institution.

Results

A total of 814 patients were treated, out of which 562 (69%) underwent breast conservation therapy (BCT), 151 (19%) chose mastectomy alone (M), and 101 (12%) chose mastectomy with reconstruction (M+ R). The mean age was comparatively low in M + R patients (P ≤ 0.001). The mean tumor size was the lowest in BCT patients (P ≤ 0.001). MRI use increased with no significant difference in type of surgery as noted by year. In multivariate analysis, type of surgery was significantly associated with tumor size, multifocality, age, and MRI use. The factors associated with MRI performance were: multifocality, younger age, tumor size, lobular histology, body mass index, and genetic testing.

Conclusions

The use of MRI in IBC patients has increased over the past 5 years, without any observable impact on surgical treatment. Similar factors are associated with mastectomy and MRI performance.     

Effect of 0.5 Tesla magnetic resonance imaging on the surgical management of breast cancer patients

BACKGROUND: This trial examines the utility of breast magnetic resonance imaging (MRI) for detection of occult breast disease and its effect on surgical treatment. METHODS: Between October 2000 and March 2002, 76 of 1289 patients underwent bilateral breast MRI within 4 months of a mammogram. The MRI scan, mammogram, pathology reports, and physicians' notes were reviewed to determine impact of MRI on surgical treatment. RESULTS: Magnetic resonance imaging detected 23 additional lesions in 19 patients not detected by mammogram. Cancer occult to mammography was detected by MRI in 6 women, constituting 7.9%. Magnetic resonance imaging impacted surgical treatment plans in 10 of 76 (13.2%) patients. CONCLUSIONS: Magnetic resonance imaging is effective at identifying new subclinical breast disease not seen on mammography. Ten of 76 patients (13.2%) who underwent MRI had their surgical management altered due to MRI findings. Specific criteria should be studied to know which subgroups would benefit most from breast MRI.     

Increased ipsilateral whole breast vascularity as measured by contrast-enhanced magnetic resonance imaging in patients with breast cancer

BACKGROUND: Tumor-induced neovessel formation identified by gadolinium-enhanced magnetic resonance imaging (MRI) is a commonly used marker for breast malignancy. The purpose of this study was to assess possible differences in whole-breast vascularity as measured by contrast-enhanced MRI in the ipsilateral and contralateral breasts of patients with unilateral breast malignancies. METHODS: Gadolinium-enhanced MRI of the breast using a Siemens 1.0-T scanner with dedicated breast coil was performed on 22 consecutive patients with histologically confirmed unilateral breast carcinoma. Whole-breast vascularity of the breast containing the carcinoma was estimated as increased, decreased, or similar compared with the contralateral unaffected breast. Breast vascularity was then correlated to clinical factors including tumor size, histology, multifocality, nodal involvement, and patient age and menopausal status. RESULTS: Twenty patients had infiltrating carcinomas, and 2 patients had ductal carcinoma in situ. Four were multifocal. Fifteen of 22 patients demonstrated clear evidence of increased whole-breast vascularity in the ipsilateral breast containing the primary breast cancer compared with the contralateral breast. Although there was no clear correlation between the presence of increased whole-breast vascularity in the cancer-bearing breast with tumor size, histology, grade, mammographic appearance, or patient age and menopausal status, increased vascularity was present in 3 of 4 patients with multifocal disease and in 4 of 5 patients with metastatic disease in the axillary nodes. CONCLUSIONS: Measurable increases in whole-breast vascularity can be identified by contrast-enhanced MRI and appear with increased frequency in the cancer-bearing breast. These findings suggest that factors other than tumor size and histology may influence development of macroscopic vessels during tumor progression and may be indicative of angiogenic tumor biology.     

fMRI(磁共振功能成像)对乳腺癌新辅助化疗评估的研究进展

【摘要】〓能够早期评估乳腺癌新辅助化疗疗效的方法很大程度上有助于病人治疗方案的制定,所以对于找寻精准且无创的方法的需求则日益上升。目前,MRI技术能够根据肿瘤大小、形态及强化程度等形态学变化对疗效进行评估,而且已有越来越多新兴技术能够从微观分子层面早期反映新辅助化疗后肿瘤变化,这些技术包括动态对比增强(DCE-MRI)、磁共振波谱(MRS)、磁共振弥散加权成像(DWI)、体素内不相干运动(IVIM)。作者综述MRI新技术在评估乳腺癌新辅助化疗疗效中的应用。     

Routine screening for local recurrence following breast-conserving therapy for cancer with dynamic contrast-enhanced magnetic resonance imaging of the breast

Background: Dynamic contrast-enhanced magnetic resonance imaging (MRI) of the breast is highly sensitive for the diagnosis of primary breast malignancy. We investigated the clinical application of dedicated dynamic breast MR for routine screening for local recurrence following breast-conserving therapy. Methods: Patients underwent a single dynamic MR of the breast routinely in the period 1 to 2 years following treatment, or earlier if recurrence was suspected. A biopsy was performed if there was suspicion of recurrence on MR. Results: One hundred and five patients with a median age of 58 years (range 50 to 65 years) were recruited for the study. Sixteen biopsies were performed and nine recurrences were confirmed histologically. Patients not undergoing biopsy have been followed up for a median of 341 days (range 168 to 451 days) following the MR. The sensitivity for clinical examination, mammography, examination combined with mammography, and MRI alone for the detection of recurrent cancer were 89%, 67%, 100%, and 100%, respectively, and the specificity was 76%, 85%, 67%, and 93%. Conclusion: Combined clinical examination and mammography are as sensitive as dedicated dynamic MR of the breast for the detection of locoregional recurrence, but breast MRI is associated with a far greater specificity. Therefore, dedicated dynamic breast MRI should be used when there is clinical or mammographic suspicion of recurrence to confirm or refute its presence.Presented at the 50th Annual Cancer Symposium of The Society of Surgical Oncology, Chicago, Illinois, March 20–23, 1997.     

Comparison of breast magnetic resonance imaging clinical tumor size with pathologic tumor size in patients status post-neoadjuvant chemotherapy

Background

Neoadjuvant chemotherapy (NACT) is used in breast cancer to evaluate the response to treatment. We examined the usefulness of breast magnetic resonance imaging (MRI) in the evaluation of tumor response after NACT.

Methods

Breast MRIs of 87 women with MRI after NACT were reviewed. The Spearman coefficient was used for estimating the correlation between MRI and pathologic tumor sizes (ypTs).

Results

The median age was 50 years (range 25 to 83 years). The median MRI size was 1.25 cm (range 0 to 10 cm). The median ypT was 1.20 cm (range 0 to 10.4 cm). The Spearman coefficient between MRI and ypT was .78 (95% confidence interval, .67 to .85; P < .0001). MRI was found to have a positive predictive value of 92% and a negative predictive value of 64% for residual in-breast disease. The sensitivity and specificity of MRI were 86% and 77%, respectively.

Conclusions

MRI correlates well with the final pathology and can be a useful modality to predict residual disease after NACT and aid in surgical planning.     

Magnetic resonance imaging as a diagnostic tool for breast cancer in premenopausal women

BACKGROUND: Screening mammography has led to earlier diagnosis of breast cancer; however, the increased tissue density of young women can complicate mammographic interpretation. We hypothesized that magnetic resonance imaging (MRI) has value in detection of mammographically occult breast cancers, particularly in premenopausal women for whom the sensitivity of mammography is compromised. METHODS: Data were available for 89 women with biopsy-proven breast cancer who had undergone both mammography and breast MRI. Variables evaluated included menopausal status and radiographic findings. Data were analyzed using Fisher's Exact test; P < .05 was considered significant. RESULTS: Of the 89 women in our study, 69 were perimenopausal or postmenopausal and 20 were premenopausal at the time of diagnosis. The malignant lesion was identified on mammography and MRI for a majority of patients. One third of premenopausal women had negative mammography but positive MRI findings. CONCLUSIONS: Our findings support a role for breast MRI in supplementing conventional mammography for early detection of breast cancer in premenopausal women.     

Evaluation of expert criteria for preoperative magnetic resonance imaging of newly diagnosed breast cancer

Despite 2 randomized trials reporting no reduction in operations or local recurrence at 1 year, preoperative magnetic resonance imaging (MRI) is increasingly used in diagnostic workup of breast cancer. We evaluated 5 utilization criteria recently proposed by experts. Of women (n = 340) newly diagnosed with unilateral breast cancer who underwent bilateral MRI, most (69.4%) met at least 1 criterion before MRI: mammographic density (44.4%), under consideration for partial breast irradiation (PBI) (19.7%), genetic-familial risk (12.9%), invasive lobular carcinoma (11.8%), and multifocal/multicentric disease (10.6%). MRI detected occult malignant lesion or extension of index lesion in 21.2% of index, 3.3% of contralateral, breasts. No expert criterion was associated with MRI-detected malignant lesion, which associated instead with pre-MRI plan of lumpectomy without PBI (48.2% of subjects): Odds Ratio 3.05, 95% CI 1.57–5.91 (p adjusted for multiple hypothesis testing = 0.007, adjusted for index-vs-contralateral breast and covariates). The expert guidelines were not confirmed by clinical evidence.     

磁共振成像在乳腺癌保乳手术中的应用价值

目的 探讨磁共振成像在乳腺癌保乳手术中的应用价值.方法 对2004年5月至2007年12月通过常规影像学检查符合保乳手术指征的52例乳腺癌患者术前进行乳腺磁共振检查,以检出多中心性乳腺癌病例,同时在增强扫描联合脂肪抑制成像中对肿瘤大小以及周围浸润范围进行准确测定,以确定手术切除的最小范围.结果 根据52例乳腺癌患者的磁共振诊断,多中心性乳腺癌3例,单发乳腺癌49例,并且发现单发乳腺癌中有3例存在较广泛的乳管内浸润.本组行保乳手术47例,首次切缘阴性率为93.6%(44/47).结论 磁共振成像对多中心性乳腺癌的检出及乳腺癌乳管内浸润的判断具有明显优势,对于明确乳腺癌保乳适应证以及准确把握保乳手术的切除范围具有较高的临床应用价值.     

MRI对浸润性乳腺癌新辅助化疗疗效的评估价值

目的:探讨MRI在评价新辅助化疗治疗浸润性乳腺癌方面的价值。方法:回顾性分析20例行术前新辅助化疗,并行化疗前、后MRI检查的浸润性乳腺癌病人。将其病理学反应分为5级;4级和5级为组织学显著反应(majorhistological response,MHR),并以此作为参考标准,以图像表现作为对照。所有影像资料由两位医师通过诊断工作站共同阅片,判断是否属MHR;意见不一致时,咨询另一位资深医师。用Kappa分析对MRI判读结果与参考标准间进行一致性检验。结果:MRI对化疗后浸润癌残余的诊断与参考标准间的一致性较好,Kappa值为0.6。新辅助化疗后乳腺癌病灶明显缩小(P<0.05)。结论:MRI在乳腺癌新辅助化疗疗效的无创性评价方面具有较大价值。     

Value of magnetic resonance imaging in prostate cancer diagnosis

MRI has shown its potential in prostate cancer (PCa) imaging. MRI is able to demonstrate zonal anatomy with excellent contrast resolution. Furthermore it can detect PCa dependent not only on tumor-size, histological grading, PSA levels, but also on technical equipment and reader’s experience. Non-palpable PCas in the inner and outer gland can be detected by this technique. Another potential is that MRI is helpful for tumor staging and treatment planning as well as response evaluation. Besides the morphological information, MRI can give functional information based on metabolic evaluation with proton magnetic resonance spectroscopy and of tumor angiogenesis based on dynamic contrast-material enhanced MRI and diffusion-weighted imaging. In addition MRI can be used for targeted prostate biopsies; however, the clinical practicability is questionable. Furthermore many data about the value of MRI for PCa diagnosis are based on transrectal ultrasound (TRUS) biopsy findings. Since there is lack of accuracy in fusing MRI images with TRUS images these limit the results of MRI for cancer diagnosis. However, in the future MRI may play an additional role in planning and monitoring minimally invasive PCa therapies. Although, MRI of the prostate seems to be useful, nevertheless this method remains expensive and lacks availability regarding the oncoming requirements.     

磁共振成像技术对直肠癌术前分期应用的评价

目的探讨MRI直肠成像技术对直肠癌术前分期的价值。方法2004年12月至2006年6月，156例经肠镜和病理确诊为直肠癌的患者在我院行直肠MRI扫描，将影像诊断结果与手术病理结果进行对照。结果156例患者中72例表现为腔内局限性软组织肿块；84例表现为肠壁不规则增厚．肠腔环形狭窄环绕肠腔1周或部分：16例合并直肠息肉，2例合并卵巢囊肿；骶前转移13例．股骨转移2例。MRI对直肠T1-2、T3和L分期的敏感性分别为25.0％（8／32）、93.3％（84／90）、94．1％（32／34），特异性分别为100％（124／124）、57．6％（38／66）、96．7％（118／122）。MRI对肠旁转移淋巴结诊断（直径超过5mm，边界不规则或呈混合信号定为转移）的敏感性85．1％（80／94）．特异性45．2％（28／62）。结论MRI对直肠癌的术前分期诊断有较高的准确性，有助于判断肿瘤直肠浆膜外浸润及区域淋巴结转移。     

Nodal positivity in breast cancer correlated with the number of lesions detected by magnetic resonance imaging versus mammogram

Background

Magnetic resonance imaging (MRI) in breast cancer can detect more than 15% additional lesions than mammography. We investigated lymph node metastases rates in patients with multifocal or multicentric disease detected by MRI compared with patients with a single lesion detected by mammography and magnetic resonance imaging.

Methods

A retrospective analysis of breast cancer patients undergoing MRI and mammography was performed. The objective was to compare lymph node metastases rates in patients with additional lesions detected by MRI versus a single lesion detected by mammography or MRI.

Results

Of 413 patients, 318 were included for the study. The overall nodal metastases rate was 24.8%. MRI detected multiple lesions in 83 (26.1%) patients; 67 (21.1%) patient MRI findings were not detected by mammography. The lymph node metastases rate was 37.3% when ≥2 lesions were detected compared with 20.2% when a single malignant lesion was detected (P = .01). The evaluation of the 67 patients with additional lesions detected by MRI revealed 32 patients with invasive lesions, 29 with benign lesions, and 6 with in situ disease. Comparing patients with single malignant lesions with patients with additional malignant lesions detected by MRI, the lymph node metastases rate increased from 20.2% to 50% (P = .002).

Conclusions

Our study shows a significant increase in the lymph node metastases rate in patients with additional malignant lesions detected by MRI. This finding suggests that MRI-detected malignant lesions are biologically significant and may predict more aggressive disease.     

Correlation of magnetic resonance imaging and pathologic size of infiltrating lobular carcinoma of the breast

BACKGROUND: Determining the extent of infiltrating lobular carcinoma (ILCA) in the breast is difficult. This study was designed to determine if the size of ILCA on magnetic resonance imaging (MRI) correlated with final pathology. METHODS: Retrospective study of patients between 1998 and 2004, who were evaluated for extent of ILCA prior to definitive treatment, was conducted. Demographic data and radiology and pathology results were obtained. Spearman correlation coefficient was used. RESULTS: Twenty-nine patients (median age 62 years) had MRI of breast. Fourteen patients (48%) had contralateral MRIs; 13 (45%) normal; 1 (8%) prompted core biopsy; 6 of 13 patients underwent contralateral mastectomies, which were benign. The distribution of tumor size was: T1 = 15 (52%); T2 = 7 (24%); T3 = 5 (17%); T4 = 2 (7%). Spearman correlation coefficient between tumor size on ultrasound and MRI with pathology was .19 (P = .5) and .88 (P < .001), respectively. CONCLUSION: MRI provided superior correlation between tumor size and pathology.     

Combining steady-state constructive interference and diffusion-weighted magnetic resonance imaging in the surgical treatment of epidermoid tumors

We describe the usefulness of three-dimen-sional Fourier transformation-constructive interference in steady-state (CISS) imaging and diffusion-weighted imaging (DWI) in the pre- and postoperative magnetic resonance imaging evaluation of intracranial epidermoid tumors. Two surgically proven epidermoid tumors in the cerebellopontine (CP) angle were not identified in conventional T1- and T2-weighted images because of a signal intensity similar to that of cerebrospinal fluid (CSF). CISS images clearly demonstrated displacement of the cranial nerves and a shift caused by a lesion in the cistern, but the signal intensity of the tumor by CISS was not sufficiently different from that of CSF to demonstrate the tumor directly. Using DWI, the tumor in the cistern was shown clearly by its increased signal intensity. Together, CISS and DWI compensated for each other's disadvantages, and this combination was useful in guiding surgical treatment of epidermoid tumors in the CP cistern. Received: 8 October 1998 / Accepted: 15 December 1998     

术中磁共振成像和多模态功能神经导航在胶质母细胞瘤手术中的应用

目的 评价术中磁共振成像(iMRI)和多模态功能神经导航在胶质母细胞瘤手术中的应用价值.方法 2009年2月至2010年7月,76例胶质母细胞瘤患者接受iMRI和多模态功能神经导航引导下肿瘤切除术.其中男性43例,女性33例;年龄14～79岁,平均49岁.分别于首次和末次iMRI扫描时计算胶质母细胞瘤全切除率和切除程度,采用x2检验比较全切除率.结果 所有患者均成功实施iMRI和多模态功能神经导航.首次iMRI扫描时,术者对24例肿瘤切除程度判断不准确,误判率31.6％.iMRI使得本组胶质母细胞瘤的全切除率从52.6％提高至78.9％(x2=11.692,P=0.001),20例(26.3％)肿瘤全切除得益于iMRI扫描和多模态功能神经导航.在28例首次iMRI扫描后继续手术切除肿瘤的患者中,肿瘤平均切除程度由81.5％提高到98.1％.所有患者的平均切除程度从92.3％提高到98.4％.术后3个月随访时,3例(3.9％)患者术后神经功能障碍程度较术前加重.术后随访时间3.0 ～45.0个月,平均15.6个月,术后24个月累积生存率为19.7％.60例肿瘤全切除患者中位无进展生存期12个月(95％ CI:10.1 ～ 13.9个月),中位总生存期16个月(95％CI:13.7 ～ 18.3个月);16例未全切除(次全、部分切除)患者中位无进展生存期9个月(95％ CI:7.9～10.1个月),中位总生存期12个月(95％CI:9.7 ～14.3个月),两组比较差异有统计学意义(无进展生存时间:x2=4.756,P=0.029;总生存时间:x2=7.885,P=0.005).结论 iMRI和多模态功能神经导航能够在提高胶质母细胞瘤切除程度的同时,保护患者的神经功能.     

The effect of magnetic resonance imaging in the workup of breast cancer

Background

Breast magnetic resonance imaging (MRI) is becoming an often-utilized examination in the preoperative planning for breast cancer. However, it is not yet accepted as a routine examination for all breast cancer patients due to the lack of data regarding whether breast MRI has any effect on recurrence or survival.

Methods

The charts of 76 patients referred by their surgeons for breast MRI during breast cancer workup were reviewed to determine if the breast MRI changed the preoperative clinical staging, the operative plan, or prompted additional testing.

Results

Thirty-eight of 76 patients (50%) received follow-up imaging and 22/76 (29%) received additional biopsies. The breast MRI upstaged the cancer in 14/76 patients (18%). There was a change in the surgical plan in 19 of 76 (25%) patients, all of whom received more extensive surgery than previously planned.

Conclusion

Breast MRI contributed significantly to the workup and management of breast cancer at our institution, suggesting a higher stage in 18% of the patients and changing the surgical plan in 25% of the patients.     

聚丙烯酰胺水凝胶注射隆乳术后MRI诊断价值

目的　探讨聚丙烯酰胺水凝胶注射隆乳术后不良反应的MRI表现及其临床价值。方法　 16例聚丙烯酰胺水凝胶注射隆乳者行乳腺MRI平扫 ,MR表现与临床症状对照。结果　MRI显示 16例中 :① 2例 (4只 )注入物所形成的“假体”基本正常 ;② 1例于哺乳期发生一侧乳房巨大积乳囊肿 ;③ 3例 (6只 )双侧乳房不对称 ,双侧注射部位不一致 ;④ 10例 (2 0只 )注入物所形成的“假体”不完整。 16例MRI表现与临床表现相符 ,6例行手术取出注射物 ,手术所见与MRI相符。结论　乳腺MRI对聚丙烯酰胺水凝胶隆乳术后并发症有较大的诊断价值。     

分子分型及动态增强磁共振成像对乳腺癌新辅助治疗疗效的预测和评价

目的 前瞻性研究分子分型及动态增强MRI对乳腺癌新辅助治疗疗效的预测和评价价值.方法 选择2010年1月至2011年12月实施新辅助治疗并完成R0切除手术的79例乳腺癌患者,均为女性,年龄28 ～67岁,中位年龄48岁;其中Luminal A型6例,Luminal B型42例,HER-2阳性型14例,三阴型17例.研究入组患者动态增强MRI评价与病理疗效评价间的关系,分析分子分型及动态增强MRI对新辅助治疗疗效的预测和评价作用.结果 新辅助治疗临床有效率为83.5％(66/79),病理有效率为79.7％(63/79).79例患者中27例获得病理完全缓解(34.2％),其中Luminal B型12例(28.6％,12/42),HER-2阳性型5例(5/14),三阴型10例(10/17).分子分型与病理完全缓解具有统计学相关性(P =0.039).动态增强MRI临床疗效评价与病理疗效评价间有统计学相关性(r =0.432,P=0.000).结论 分子分型对乳腺癌新辅助治疗疗效具有预测价值,动态增强MRI检查与新辅助治疗后组织病理疗效评价具有相关性,有助于新辅助治疗疗效评价.