Breast MR imaging for the assessment of residual disease following initial surgery for breast cancer with positive margins

• Verfasst von: Krammer, Julia [VerfasserIn]
• Verfasst von: Schönberg, Stefan [VerfasserIn]
• Titel: Breast MR imaging for the assessment of residual disease following initial surgery for breast cancer with positive margins
• Verf.angabe: Julia Krammer, Elissa R. Price, Maxine S. Jochelson, Elizabeth Watson, Melissa P. Murray, Stefan O. Schoenberg, Elizabeth A. Morris
• Jahr: 2017
• Umfang: 7 S.
• Fussnoten: Published online: 31 May 2017 ; Gesehen am 27.06.2018
• Titel Quelle: Enthalten in: European radiology
• Ort Quelle: Berlin : Springer, 1991
• Jahr Quelle: 2017
• Band/Heft Quelle: 27(2017), 11, Seite 4812-4818
• ISSN Quelle: 1432-1084
• ISSN Quelle: 1613-3757
• DOI: doi:10.1007/s00330-017-4823-y
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1576914569

Abstract

ObjectivesTo determine the accuracy of post-operative MR in predicting residual disease in women with positive margins, emphasizing the size thresholds at which residual disease can be confidently identified.MethodsThis IRB-approved HIPAA-compliant retrospective study included 175 patients with MR after positive margins following initial surgery for breast cancer. Two expert readers independently re-evaluated MR images for evidence of residual disease at the surgical cavity and multifocal/multicentric disease. All patients underwent definitive surgery and MR findings were correlated to histopathology.Results139/175 (79.4%) patients had residual disease at surgery. Average overall sensitivity, specificity, PPV and NPV for residual disease at the surgical cavity were 73%, 72%, 91% and 45%, respectively. The readers identified 42/45 (93%, reader 1) and 43/45 (95%, reader 2) patients with residual invasive disease at the cavity of ≥5 mm and 22/22 (100%, both readers) patients with disease ≥10 mm. Average sensitivity, specificity, PPV and NPV for unknown multifocal/multicentric disease were 90%, 96%, 93% and 86%, respectively.ConclusionsPost-operative breast MR can accurately depict ≥5-mm residual disease at the surgical cavity and unsuspected multifocal/multicentric disease. These findings have the potential to lead to more appropriate selection of second surgical procedures in women with positive margins. Key Points • Post-operative breast MRI accurately defines residual disease of ≥5 mm. • Surgical cavity sensitivities were high for both invasive carcinoma and DCIS. • Post-surgical changes and very small residual disease (<5 mm) may overlap. • Post-operative breast MRI may help planning an accurate re-resection.