RSNA 2010 

Abstract Archives of the RSNA, 2010


SSA01-07

Sonography Compared with MRI in Preoperative Evaluation of Women with Breast Cancer to Determine Extent of Disease

Scientific Formal (Paper) Presentations

Presented on November 28, 2010
Presented as part of SSA01: Breast Imaging (MR Image Interpretation)

Participants

Linda Hovanessian-Larsen MD, Presenter: Research funded, Naviscan, Inc
Sandy C. Lee, Abstract Co-Author: Nothing to Disclose
Pulin Sheth MD, Abstract Co-Author: Nothing to Disclose
Edward G. Grant MD, Abstract Co-Author: Nothing to Disclose

PURPOSE

Compare three imaging arms in women with newly diagnosed breast cancer in terms of accurately measuring tumor size, number and location of tumor foci, contralateral lesions, and impact on surgical treatment:  (Arm 1) standard of care (SOC) includes mammography and targeted ultrasound, (Arm 2) SOC combined with bilateral contrast enhanced magnetic resonance imaging (CE-MRI), and (Arm 3) SOC combined with bilateral whole breast ultrasound (BWBUS).

METHOD AND MATERIALS

300 women with newly diagnosed invasive breast cancer or ductal carcinoma in situ (DCIS) eligible for breast conserving surgery were enrolled from 9/06 to 9/09 at the LAC+USC Medical Center in this single center, prospective, non-randomized, IRB approved protocol. Each participant had a clinical breast examination (CBE), diagnostic mammogram, targeted breast ultrasound, and biopsy of the index cancer (routine care). As part of the study, participants then had a CE-MRI and BWBUS, interpreted independently. All imaging findings were compared to gold standard of surgical pathology.

RESULTS

269 women completed the study (median age 55.4, range 23.4-79.9). Index cancer was 86% invasive ductal carcinoma and 14% DCIS. More lesions were visualized with BWBUS (90%) or CE-MRI (86%) than with Standard of Care (75%). There was no significant difference between mammogram and MRI in regards to tumor size, but mammograms measured sizes smaller (ratio=0.95) and CE-MRI measured sizes larger (ratio=1.05) compared to surgical pathology. All imaging modalities most accurately measured index lesions ranging from 11-20 mm. Biopsy results were concordant with imaging findings in 99% of cases. CE-MRI recommended mastectomy in a greater percentage (~ 2.5 times higher) compared to BWBUS or SOC alone. In lesions that were high-risk or malignant in the contralateral breast, CE-MRI found 13/14, BWBUS found 9/14, and SOC alone found 6/14.  Therefore, CE-MRI is vital for identifying contralateral breast cancer.

CONCLUSION

CE-MRI is more accurate than BWBUS in identifying extent of disease and contralateral lesions in women with newly diagnosed breast cancer.

CLINICAL RELEVANCE/APPLICATION

CE-MRI, not BWBUS, should be used to evaluate the extent of disease and findings in the contralateral breast in women newly diagnosed with breast cancer.

Cite This Abstract

Hovanessian-Larsen, L, Lee, S, Sheth, P, Grant, E, Sonography Compared with MRI in Preoperative Evaluation of Women with Breast Cancer to Determine Extent of Disease.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9004978.html