Giovanna Mariscotti, Abstract Co-Author: Nothing to Disclose

Manuela Durando, Presenter: Nothing to Disclose

Fortunato Di Caterino, Abstract Co-Author: Nothing to Disclose

Pier Paolo Campanino, Abstract Co-Author: Nothing to Disclose

Laura Bergamasco, Abstract Co-Author: Nothing to Disclose

Paolo Fonio, Abstract Co-Author: Nothing to Disclose

Giovanni Gandini MD, Abstract Co-Author: Nothing to Disclose

To evaluate the potential effect of the adjunction of digital breast tomosynthesis (DBT) and MRI to conventional imaging (mammography and ultrasound) on the surgical management of breast cancer. 

Between May 2010 and December 2013, 231 women (mean age: 53.6 years, range 26-79) with newly diagnosed breast cancers (proved by needle biopsy) consecutively underwent surgical treatment in our Institution. Prior to surgery, all women had digital mammography (2D) combined with DBT, breast ultrasound (US) and MRI. After surgery, all radiographic and pathologic results were reviewed to statistically evaluate the beneficial or inappropriate changes in surgical treatment due to the additional DBT and/or MRI findings. Lesions size and characteristics (unifocal, multifocal or multicentric), as well as involvement of nipple-areola complex, skin and pectoral muscle were considered for the indications as concerns the conservative or not conservative surgical approach. 

In 231 women a total of 250 surgical treatments were performed. Pathology showed 186 unifocal, 26 multifocal or multicentric and 19 bilateral cancers, predominately ductal invasive with or without in situ component (52.8%) or lobular invasive (18.6%). By using 2D+US imaging only, inappropriate surgery would occur in 33/250 (13.2%) cases, by adding 3D to 2D+US in 26/250 (10.4%) cases (DBT would correctly change the surgical planning in 7/250 [2.8%]). By adding MR to 2D+US or to 2D combined with DBT+US inappropriate surgery (under/overtreatment) was equally reduced to 10/250 (4.0%) cases (MRI correctly changed 23/250 [9.2%] surgical procedures). By using 2D+US only, instead of 2D+US+MR, the occurrence of inappropriate surgery is significant different (p=0.004) with a relative risk (RR) of 3.3 (CI 95%: 1.7-6.5). Using 2D+DBT+US instead of 2D+US+MR the difference remains significant (p=0.009), but the RR is reduced to 2.6 (CI 95%: 1.3-5.3).  

In our population, MRI is the most effective tool for planning the correct surgical treatment of breast cancer. DBT improves the performances of 2D and US, but is not yet sufficient for significantly reduce the risk of inappropriate surgery.

In our population, MRI is the most effective tool for planning the correct surgical treatment of breast cancer; however Tomosynthesis may improve the performances of 2D and US.

Mariscotti, G, Durando, M, Di Caterino, F, Campanino, P, Bergamasco, L, Fonio, P, Gandini, G, Digital Breast Tomosynthesis and Breast MRI in the Treatment Planning of the Newly Diagnosed Breast Cancers.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14015829.html