Preoperative breast MR imaging influences surgical management in patients with invasive lobular carcinoma

Author:

Aroney Stephanie1ORCID,Lloyd Thomas1ORCID,Birch Simone2,Godwin Belinda1,Walters Kylie1,Khoo Jeremy3,Geere Simone3,Shen Linda2,Vujovic Petar3,Bennett Ian3,Santamaría Gorane1ORCID

Affiliation:

1. Department of Radiology Princess Alexandra Hospital Brisbane Queensland Australia

2. Department of Pathology Princess Alexandra Hospital Brisbane Queensland Australia

3. Department of Breast and Endocrine Surgery Princess Alexandra Hospital Brisbane Queensland Australia

Abstract

AbstractIntroductionThe purpose of the study is to assess the role of preoperative magnetic resonance (MR) imaging on the surgical management of invasive lobular carcinoma (ILC) and to evaluate whether breast density and background parenchymal enhancement (BPE) influence surgical treatment.MethodsThis retrospective study was conducted on 56 patients who were diagnosed with ILC between 2014 and 2020. All patients had mammogram and ultrasound. Preoperative MRI was available in 34 patients. Age, menopausal status, breast density, BPE, multifocality/multicentricity and surgical treatment were collected.ResultsMean pathological tumour size was 36.4 mm (range 5–140 mm). Dense breasts had larger tumours compared to non‐dense breasts (P = 0.072). Of the 34 patients with MRI, 6 opted for mastectomy. Of the remaining 28 cases, MRI findings upgraded surgery to mastectomy in 54% (15/28) because mammogram/ultrasound underestimated tumour extent in 25% (7/28), or multifocal/multicentric disease was identified in 29% (8/28). Tumour size was underestimated by MRI in 7% (2/28). In the non‐MRI subgroup, 64% (14/22) of patients underwent breast‐conserving surgery, but 29% of them (4/14) required a second‐stage mastectomy due to extensive margin involvement. There was no difference in mastectomy rate between patients with MRI (62%) and without MRI (55%) (P = 0.061). Tumour size correlation between MRI and histopathology demonstrated an excellent intraclass correlation coefficient (P < 0.001). Surgical treatment recommendation was not significantly impacted by breast density or BPE.ConclusionBreast MRI improves surgical management of patients with ILC in providing additional diagnostic information often missed with standard imaging modalities, and without increasing mastectomy rate. Surgical treatment is not impacted by breast density or BPE.

Publisher

Wiley

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