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Preoperative MRI for evaluation of extent of disease in IDC compared to ILC

  • Author Footnotes
    ⁎ Authors share equal contribution as first author
    Einat Carmon
    Footnotes
    ⁎ Authors share equal contribution as first author
    Affiliations
    Dept of Surgery, Samson Assuta Ashdod University Hospital, Ashdod, Israel

    Affiliated with the Ben Gurion University Medical School, Beer Sheva, Israel
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  • Author Footnotes
    ⁎ Authors share equal contribution as first author
    Talia Alster
    Footnotes
    ⁎ Authors share equal contribution as first author
    Affiliations
    Dept of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel

    Affiliated with the Hebrew University Medical School, Jerusalem, Israel
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  • Bella Maly
    Affiliations
    Dept of Pathology, Hadassah Hebrew University Hospital, Jerusalem, Israel

    Affiliated with the Hebrew University Medical School, Jerusalem, Israel
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  • Luna Kadouri
    Affiliations
    Dept of Oncology, Hadassah Hebrew University Hospital, Jerusalem, Israel

    Affiliated with the Hebrew University Medical School, Jerusalem, Israel
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  • Tal Arazi Kleinman
    Affiliations
    Dept of Radiology, Shamir Medical Center, Be'er Ya'akov, Israel

    Affiliated with the Sackler School of Medicine, Tel Aviv University
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  • Tamar Sella
    Correspondence
    Corresponding author: Pob 12000 Ein Kerem, Jerusalem, Israel 91120
    Affiliations
    Dept of Radiology, Hadassah Hebrew University Hospital, Jerusalem, Israel

    Affiliated with the Hebrew University Medical School, Jerusalem, Israel
    Search for articles by this author
  • Author Footnotes
    ⁎ Authors share equal contribution as first author

      Key Points

      • The added benefit of MRI for evaluation of extent of disease is greater in ILC than IDC.
      • In ILC, MRI shows 80-90% concordance with pathology in defining extent of disease.
      • When discordance with pathology occurred, mammography and US more commonly underestimated and MRI more commonly overestimated extent of disease.
      • Pre-operative MRI should be considered for patients with ILC
      • Pre-operative MRI may decrease underestimation of disease extent and potentially contribute to a reduction in post-operative residual disease in IDC patients.

      Abstract

      Objectives

      The purpose of this study was to assess the incremental value of preoperative breast MRI over mammography and US in depicting the accurate extent of disease in invasive duct carcinoma (IDC) compared to invasive lobular carcinoma (ILC).

      Patients and Methods

      Retrospective analysis of pre-operative mammography, US and MRI was performed in 239 patients with either IDC (n=193) or ILC (n=46). Images were evaluated for solitary, multifocal or multicentric disease and compared for concordance with postsurgical pathology. Discordance was documented as either overestimation or underestimation. Two tailed paired T and Fischer's exact tests were used for analysis.

      Results

      Multifocality was present on pathology in 35% and 61% of patients with IDC and ILC (p<0.05) and multicentricity in 23% and 41% respectively (p=0.84). In ILC, MRI demonstrated better concordance with pathology compared to mammography and US (89%, 44%, 49% for multifocality (p<0.05) and 80.5%, 63%, 71% for multicentricity (p=0.3)). For IDC, concordance with pathology for all modalities was similar (65-76%). Among discordant cases, underestimation was significantly more common for mammography and US, while MRI more frequently overestimated disease extent. MRI very rarely overestimated multifocal disease in ILC (2%).

      Conclusion

      MRI demonstrates an 80-90% concordance rate with pathology for ILC, superior to mammography and US. The addition of MRI in IDC patients may decrease underestimation of disease extent and potentially contribute to a reduction in post-operative residual disease.

      Keywords

      Abbreviations:

      IDC (invasive duct carcinoma), ILC (invasive lobular carcinoma), DCIS (ductal carcinoma in-situ), US (ultrasound), MRI (magnetic resonance imaging), MIP (maximal intensity projection)
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