Lauren Stein MD, Presenter: Nothing to Disclose

Melanie Chellman-Jeffers MD, Abstract Co-Author: Nothing to Disclose

Alice S. Rim MD, Abstract Co-Author: Nothing to Disclose

Bilateral breast MR imaging of patients with a new diagnosis of Stage I or II breast cancer is being investigated under an IRB approved single institution protocol to determine if MR alters patient management decisions. MR is a sensitive tool for evaluation of disease extent and may detect occult multifocal, multicentric or bilateral breast cancer.

Retrospective review of the medical and imaging records of patients with a new diagnosis of Stage I or II breast cancer who had a pre-operative breast MRI at our institution between 1/2004 and 12/2006. Additional lesions identified on MRI were evaluated by directed ultrasound +/- biopsy. Breast MR imaging was performed using the same 1.0 Tesla Siemens unit, with a dedicated breast coil. MR images were interpreted by 1 of 3 breast imaging radiologists at the Cleveland Clinic.

We identified 937 patients who had a new diagnosis of Stage I or II breast cancer and underwent a pre-operative MRI. Suspicious MR findings were identified in 115 (12.2%), and a directed ultrasound was recommended for these patients. Of these 115 patients, 110 patients had an ultrasound. Biopsy was recommended for suspicious lesions in 51 (5.4%), and 41 (4.4%) were ultimately biopsied. Of the initial 937 patients, a second cancer was found in 21 patients (2.2%). Specifically, 10 patients (1.1%) had multifocal cancer, 6 patients (0.6%) had multicentric cancer, and 4 patients (0.4%) had bilateral cancer. A single patient (0.1%) had both multifocal and bilateral cancer. Six additional patients (0.6%) had high risk lesions for which excision was recommended.

Pre-operative breast MRI can identify mammographically occult multifocal, multicentric and contralateral breast cancer in 2.2% of Stage I and II breast cancer patients at the time of initial diagnosis. Within this subset of patients, there is a greater percentage of women who had multifocal/multicentric breast cancer (1.7%) than contralateral breast cancer (0.4%).

By preemptively identifying patients who may be at risk for recurrence, management can be modified. However, it is unclear whether detection of occult cancer affects patient morbidity and mortality.

Stein, L, Chellman-Jeffers, M, Rim, A, MR Imaging in the Preoperative Evaluation of Stage I and II Breast Cancer: Prevalence of Multifocal, Multicentric, and Bilateral Disease.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5003158.html