Impact of Additional Magnetic Resonance Imaging (MRI)-Guided Biopsies in Management of Breast Cancer Patients Initially Diagnosed by Non-MRI (Ultrasound/Stereotactic) Modalities.
Mamatha Chivukula, Joshua M Lloyd, David Dabbs. UPMC, Pittsburgh, PA
Background: The American Cancer Society (ACS) estimates 54,010 and 207,090 new cases of in-situ and invasive breast carcinoma (IC) in the year 2010 among women, respectively with an estimated 40,230 breast cancer-associated deaths. MRI is a tool that is being utilized with increasing frequency in the evaluation and management of breast cancer. Although the ACS has recommendations regarding the role of MRI in initial breast cancer screening, its appropriate use as an additional modality has not been clearly defined. The aim of this study is to retrospectively determine the impact of additional MRI in surgical management of patients initially diagnosed by non-MRI modalities.
Design: The pathology database was searched for women diagnosed with invasive and/or in-situ breast carcinoma between 2005-2009 by non-MRI modalities (ultrasound/stereotactic) who underwent an additional MRI-guided biopsy. Patients with contralateral MRI-guided biopsies only and patients without follow-up were excluded. 230 patients were retrieved. Patient age, initial diagnostic modality and diagnosis, pre-operative MRI-guided biopsy diagnosis, and definitive surgical procedure (breast conservation therapy (BCT) versus mastectomy) were recorded.
Results: 122 patients were included (mean age=55; range 26-82). The pathology of the initial diagnoses consisted of invasive ductal carcinoma (IDC) (n=83), invasive lobular carcinoma (ILC) (n=15), invasive mixed carcinoma (n=3), and ductal carcinoma in-situ (DCIS) (n=21). Additional MRI biopsy results revealed malignant diagnoses (group 1) in 56/122 patients (46%). Diagnoses consisted of IDC-22, ILC-7, invasive mixed carcinoma-3, DCIS-19, LCIS-4, and carcinoma in-situ-1. 66/122 patients (54%) had a benign diagnosis (group 2). In group 1, 16 (29%) ultimately underwent BCT and 40 (71%) ultimately underwent mastectomy for definitive surgical management. In group 2, 55 (83%) ultimately underwent BCT and 11 (17%) ultimately underwent mastectomy for definitive surgical management.
Conclusions: 1. Additional MRI detected a significant lesion (DCIS/IC) in more than half of the patient cohort. 2. The patients with malignant diagnoses on additional MRI-guided biopsy have a higher rate of mastectomy in comparison to BCT (71% vs. 29%). 3. The patients with a benign diagnosis on additional MRI-guided biopsy have a higher rate of BCT in comparison to mastectomy (83% vs. 17%). 4. Additional MRI-guided biopsies impact the surgical decision to manage patients with mastectomy versus BCT.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 37, Tuesday Morning