To evaluate the role of magnetic resonance imaging (MRI) in the detection of residual disease for patients after excisional biopsy of breast carcinoma, before re-excision.
We performed a retrospective review of 97 patients who underwent MRI soon after excisional biopsy of breast carcinoma with undeterminable margin status before further surgical intervention to determine the value of MRI in detecting residual disease.
The positive predictive value was 50.0%. The negative predictive value was 78.9%. The MRI detected 54.5% of the residual disease for invasive ductal carcinoma and 100% for ductal carcinoma in situ. Positive predictive value and sensitivity for MRI conducted within 14 days of the original surgery were lower than those for MRI conducted after 14 days of the original surgery, being 31.6% and 46.2% versus 66.7% and 73.4%, respectively. The difference between the positive predictive value within 14 days versus after 14 days was statistically significant.
Magnetic resonance imaging in detecting residual disease soon after excisional biopsy for breast carcinoma had a low positive predictive value and moderately high negative predictive value. Magnetic resonance imaging was more sensitive in detecting residual ductal carcinoma in situ than invasive ductal carcinoma. Magnetic resonance imaging conducted more than 14 days after the original biopsy had a significantly higher positive predictive value than MRI done within 14 days.
[Show abstract][Hide abstract] ABSTRACT: We performed a retrospective review to determine the need for reexcision after excisional biopsy in patients with breast cancer who were treated with breast-conserving therapy.
Eighty-seven patients with infiltrating ductal carcinoma of the breast underwent excisional biopsy followed by reexcision of the tumor site. Reexcision specimens were evaluated for residual disease and correlated with initial mammographic and pathologic findings.
Tumors with an extensive intraductal component (EIC) were more likely to have residual disease at reexcision than those without an EIC (65% versus 6%, p < .01). Initially positive margins did not predict residual disease at reexcision significantly better than did initially negative margins (29% versus 13%, p = .08). Suspicious mammographic calcifications, absence of a discernible mass detected mammographically, or both were associated with a significantly increased risk of residual disease at reexcision. By combining all features (EIC, margin status, and mammography), we found that subsets of patients had significantly different risks of residual disease, which ranged from 6% to 83% (p < .01).
Mammographic and pathologic findings are useful in predicting the adequacy of breast resection before radiation therapy in patients treated with breast-conserving therapy. An EIC is the most useful predictor of residual disease at reexcision. When combined, EIC, margin status, and mammographic findings form a powerful tool to judge the need for reexcision before radiation therapy.
American Journal of Roentgenology 12/1996; 167(6):1409-14. DOI:10.2214/ajr.167.6.8956568 · 2.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Mammograms, including microfocus spot magnification views, were obtained before reexcision of the tumor-ectomy site in 43 women with breast carcinoma. These studies were prospectively evaluated by radiologists experienced in breast imaging. All women had mammographically evident microcalcifications associated with their original tumors. In all, tumor was at or near the margin of resection or the status of margins was unknown, necessitating reexcision of the tumorectomy site. Of 29 women with residual microcalifications, 20 had residual tumor. The positive predictive value of residual microcalcifications was 0.69. The positive predictive value was greatest (0.90) in women with ductal carcinoma in situ, when more than five microcalifications were present. Residual microcalifications not due to carcinoma were secondary to sclerosing adenosis, fat necrosis, and foreign body granuloma. Of the 13 cases in which no residual calcifications were left after tumorectomy, residual tumor was found in four. The negative predictive value of the absence of calcifications for total excision of tumor was 0.64 for all tumor types and was 1.0 for the noncomedo subtype of ductal carcinoma in situ.
[Show abstract][Hide abstract] ABSTRACT: As breast cancers are diagnosed at increasingly early stages, and there is little biological rationale for mastectomy in most patients, breast conservation is likely to be practised with increased frequency in the future. Newer breast imaging techniques, particularly magnetic resonance imaging (MRI), should contribute to improved pretherapy planning, both aiding in the selection of patients for conservation approaches, and estimating the residual tumour burden following minimally invasive surgical interventions. Image-guided tumour mapping may permit local treatment to be individualised, most importantly allowing definition of subgroups not requiring treatment directed at the whole breast. Moreover, interventional radiology opens new possibilities for focalised treatments, which may come to be employed in the management of small lesions. The increasing use of primary chemo- or chemoendocrine therapy will also tend to favour the option of breast conservation. Functional imaging techniques, including MRI, may prove valuable in the assessment of response to medical therapy, allowing more individualised use of radiotherapy and surgery. Technical progress and the development of biological response modifiers may further improve the therapeutic ratio associated with radiation treatment.
European Journal of Cancer 11/2000; 36(15):1919-24. DOI:10.1016/S0959-8049(00)00172-6 · 5.42 Impact Factor
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