Annemarie Caroline Schmitz MD, Presenter: Nothing to Disclose

Kenneth Pengel, Abstract Co-Author: Nothing to Disclose

Maurice A. Van Den Bosch MD, PhD, Abstract Co-Author: Nothing to Disclose

Claudette Elisabeth Loo MD, Abstract Co-Author: Nothing to Disclose

Johannes Peterse, Abstract Co-Author: Nothing to Disclose

Maria Gertenbach, Abstract Co-Author: Nothing to Disclose

Emiel Rutgers, Abstract Co-Author: Nothing to Disclose

Kenneth G.A. Gilhuijs PhD, Abstract Co-Author: Nothing to Disclose

00030490-DMT et al, Abstract Co-Author: Nothing to Disclose

To discriminate between invasive breast cancers with extensive subclinical disease around the MRI visible lesion and those without surrounding subclinical disease.

Sixty-two breast-cancer patients (64 breasts) eligible for breast-conserving therapy on the basis of conventional imaging and MRI were included. The wide-local excision (WLE) specimens were processed using complete embedding, reconstruction and correlation with MRI. Tumors were stratified by presence (extensive breast cancer) or absence (limited breast cancer) of subclinical disease beyond 10 mm from the edge of the MRI-visible lesion in the WLE specimen. Imaging features at mammography, ultrasonography, contrast-enhanced MRI as well as at core histology were evaluated for their ability to discriminate between the extensive and limited breast cancers. Interpretation of MRI was focused on morphological and kinetic properties of contrast uptake. Assessment of core histology included tumor grade and molecular subtype; basal-type (estrogen-receptor negative), luminal-type (estrogen-receptor positive), and Her2+ (positive).

Of the 64 tumors, 57 were visible at mammography, 59 at ultrasonography and 61 at MRI. Thirty-five (57%) tumors were limited breast cancers. Significantly associated with extensive breast cancer were late enhancement kinetics at MRI (presence vs. absence of washout) (p= 0.036, PPV 96%, NPV 24%), basal-type (present vs. absent) (p=0.029, PPV=26%, NPV=95%), and quantity of DCIS in the tumor (moderate/extensive vs. none vs. minimal) (p<0.001, PPV=26%, NPV=95%).

MRI contrast-uptake kinetics, molecular subtype and presence of DCIS in the index tumor are associated with increased risk of extensive breast cancer around the MRI-visible lesion. These tumors may be less suitable for more localized therapies such as partial breast irradiation or MRI-guided high-intensity focused ultrasound.  

Identifying tumors with extensive subclinical disease around the MRI-visible lesion may be relevant to optimize selection of more localized therapies, such as partial breast irradiation.

Schmitz, A, Pengel, K, Van Den Bosch, M, Loo, C, Peterse, J, Gertenbach, M, Rutgers, E, Gilhuijs, K, et al, 0, Pre-operative MRI and Factors Associated with Breast Cancers of Limited Extent in Wide-Local Excision Specimens.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8014736.html