Carlo De Felice MD, Presenter: Nothing to Disclose

Giuseppe Borgoni, Abstract Co-Author: Nothing to Disclose

Alessandra Marini MD, Abstract Co-Author: Nothing to Disclose

Valentina Cipolla, Abstract Co-Author: Nothing to Disclose

Mario Marini MD, Abstract Co-Author: Nothing to Disclose

Andrea Stagnitti MD, Abstract Co-Author: Nothing to Disclose

Emanuela Pasqualitto, Abstract Co-Author: Nothing to Disclose

Aim of the study was to evaluate the influence of pre-surgical MRI in local staging of early breast cancer on the operative management of selected patients with high mammographic density, candidates for breast conservative treatment (BCT).

A total of 123 patients underwent pre-surgical MRI. All patients had early stage breast cancer diagnosed by conventional imaging techniques (mammography and ultrasound) for which wider local excision had been planned; all presented breast density BI-RADS 3-4. BI-RADS system was also employed to classify MRI additional findings. In case of additional foci classified as BI-RADS 3-4, a US targeted second look was performed. If second look confirmed additional foci, a needle biopsy was performed. Possible changes in therapeutic planning resulting from the findings of preoperative MRI was decided by a multidisciplinary team. Correlation between MRI findings and final pathology was evaluated in order to determine if a change in breast cancer management due to pre-surgical MRI was appropriate.  

Additional foci were detected in 41.6% and a greater local extension of the index lesion in 6.4% whereas in 52% MRI confirmed local staging established by conventional imaging. In 13.8% additional foci were not confirmed at second look and needle biopsy. In total 34.1% underwent therapeutic changes and 29.2% were judged appropriate after histological verification with an overtreatment rate of 4.9%. Pre-surgical breast MRI resulted in confirmation of previously planned surgery in 65.8%, whereas 29.2% were judged appropriate after histological verification resulting in a re-resection rate of 11.4%. Overall operative management established after breast MRI was judged appropriate in 83.7%.  

This analysis shows MRI utility in pre-surgical workup of selected breast cancer patients with high mammographic density. In this subgroup of patients MRI improved local staging allowing safer conservative breast surgery. This might reduce the risk of local recurrence after BCT.

This study suggests that pre-surgical MRI can reduce under-treatment risk in subgroups of patients with high mammographic density in whom mammography sensitivity is reduced.

De Felice, C, Borgoni, G, Marini, A, Cipolla, V, Marini, M, Stagnitti, A, Pasqualitto, E, Preoperative MRI in Patients with Early Breast Cancer and High Mammographic Density.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034584.html