Simone Schrading MD, Abstract Co-Author: Nothing to Disclose

Nuschin Morakkabati-Spitz MD, Abstract Co-Author: Nothing to Disclose

Claudia C Leutner MD, Abstract Co-Author: Nothing to Disclose

Hans Heinz Schild MD, Abstract Co-Author: Nothing to Disclose

Christiane Katharina Kuhl MD, Presenter: Nothing to Disclose

To investigate the accuracy of mammography, ultrasound (US) and MRI for the local staging of breast cancers in women at high genetic risk for breast cancer (proven suspected carriers of a breast cancer susceptibility gene).

Prospective study on a total 43 women with known or suspected (BI-RADS 5) familial or hereditary breast cancer (mean age: 39 years) who underwent pre-operative staging with mammography, ultrasound and MRI. In all cases, 2-view mammography (plus further views where appropriate), high-resolution (7.5 - 13 MHz) physician-performed breast ultrasound and dynamic contrast enhanced breast MRI was available. Studies were read independently to avoid bias. We investigated the accuracy with which multifocal or multicentric tumor growth was identified.

A total 20/43 patients (44%) had more than one (multifocal or multicentric) invasive or intraductal tumor foci. Mammography detected the index tumor in 9/43 patients and multifocal or multicentric disease in 3 of 9 (overall 3 of a total 20 patients with proven multifocal or multicentric disease, i.e. 15%); US detected the index tumor in 13/43 patients, and multifocal or multicentric disease in 4 of the 13 (overall 4/20, 20%); if mammography and US were combined, the index tumor was identified in 14/43 patients, and multifocality / multicentricity in 5 of the 14 (overall 5/20, 25%). MRI detected 39/43 index cancers and multifocality / multicentricity in 20 of the 39 (20/20, 100%). Treatment options were available for 39/43 women; of those, 13 (33%) underwent primary mastectomy, and 26 (66%) breast conservation.

The high rate (44%) of multifocality or multicentricity in this cohort of young women with FBC is striking. This observation is in line with the known biologic aggressiveness of these tumors and underscores the importance of accurate staging before breast conservation is considered in these women. Staging with mammography and breast US may underestimate the actual disease extent in a high number of cases. MRI offered the highest accuracy. If breast MRI is not offered for screening anyway, it should at least be considered mandatory if breast conservation is a consideration in a young patient with FBC.

Schrading, S, Morakkabati-Spitz, N, Leutner, C, Schild, H, Kuhl, C, Mammography, Ultrasound, and MRI for Preoperative Staging of Women with Familial (Hereditary) Breast Cancer.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4418191.html