Amy Suzanne Thurmond MD, Abstract Co-Author: Nothing to Disclose

Charles Kelly Scanlan BS, Presenter: Nothing to Disclose

Judith Richmond MD, Abstract Co-Author: Nothing to Disclose

Our goal was to evaluate the utility of adding MRI and PEM to mammography in the pre-operative evaluation of women with breast cancer. We assume that if surgery is based on accurate delineation of the size and extent of tumor, and if adequate margins are obtained, women will do better and live longer.

Fifty-five women who had mammogram, breast MRI, and PEM within 3 months of lumpectomy or mastectomy for treatment of breast cancer, comprised the study population. Radiologists were given images from one of the studies, and instructed to evaluate the images for cancer, without looking at the history or any other imaging studies on the same patient. Radiologists were asked to score side or sides, quadrant or quadrants, and size in centimeters of any lesion deemed BIRADS category 4 (suspicious), or BIRADS category 5 (malignant).The surgical pathology reports were then reviewed, noting size of tumor or tumors, multifocality (more than one tumor in the same quadrant), multicentricity (tumors in more than one quadrant (for mastectomies)), and whether DCIS was extensive (>25% of the specimen), or not extensive (absent or <25% of the specimen). Pathology findings were correlated with the radiologists’ blinded reports.

Mammography alone would have adequately staged 35 women (64%). Mammography+MRI, or mammography+PEM would have adequately staged 47 women (85%). Mammography+MRI+PEM would have adequately staged 52 women (95%). In women with extensive DCIS mammography overestimated disease in 3 and underestimated in 4, MRI overestimated disease in 7 and underestimated in 0, and PEM overestimated disease in 0 and underestimated in 4. The numbers are small, but suggest that MRI may overestimate and PEM may underestimate DCIS.

Taking into account current societal expectations and medical standards, in women planning treatment for breast cancer, mammography is good but not good enough. Based on our current data and experience, and estimating the cost in time, money, and anxiety to the patient and her surgeon, our preference is to add MRI or PEM to mammography for pre-operative planning, and to add other modalities as needed for confusing situations.

Accurate assessment of the size and extent of breast cancer helps the patient and surgeon select the most appropriate therapy.

Thurmond, A, Scanlan, C, Richmond, J, Comparison of Mammography, MRI, and Positron Emission Mammography (PEM) for Determining Size and Extent of Breast Cancer.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9013388.html