J Korean Soc Magn Reson Med.  2014 Jun;18(2):133-143. 10.13104/jksmrm.2014.18.2.133.

Magnetic Resonance Imaging Factors Predicting Re-excision in Breast Cancer Patients Having Undergone Conserving Therapy

• Jang M
• Kim SM
• Yun BL
• Kim SW
• Kang EY
• Park SY
• Kim JH
• Kim Y
• Ahn HS

• KMID: 2099889
• DOI: http://doi.org/10.13104/jksmrm.2014.18.2.133

Abstract

PURPOSE
The aim of this study was to determine the magnetic resonance imaging (MRI) features associated with re-excision due to the presence of a positive margin after breast conserving therapy (BCT) in breast cancer patients.
MATERIALS AND METHODS
We reviewed the records of 286 consecutive breast cancer patients who received BCT between January 2006 and December 2007. Among 246 patients who had undergone BCT, 38 (15.4%) underwent immediate further surgery due to positive margin status. We analyzed the MRI findings using chi2 test, Fisher's exact test and t tests. Multivariate logistic regression was conducted for prediction of re-excision.
RESULTS
Tumor size (p < 0.001), lesion multiplicity (p = 0.003), and non-mass-like enhancement (NMLE) type on MRI (p < 0.001) were associated with margin involvement in BCT. On preoperative MRI, larger size (> or = 5 cm) (odds ratio = 2.96), NMLE (odds ratio = 3.81), and multifocal lesions (odds ratio = 2.54) were positively associated with re-excision. In cases involving NMLE, segmental distribution was associated with a greater likelihood of immediate re-excision.
CONCLUSION
Larger size, multiplicity, and NMLE on MRI are significantly associated with re-excision after BCT in breast cancer patients. For NMLE lesions, the segmental distribution pattern was predictive of re-excision.

Keyword

Breast; Breast neoplasm; Conservation therapy; Diagnosis, Magnetic resonance imaging (MRI)

MeSH Terms

Breast
Breast Neoplasms*
Humans
Logistic Models
Magnetic Resonance Imaging*

Figure

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  Fig. 1 Preoperative MR imaging showing a mass that was treated with single BCT. Images are of the left breast of a 34-year-old woman with confirmed invasive ductal carcinoma. Sagittal, contrast enhanced, fat-suppressed, 2D gradient (a) T1-weighted, (b) subtraction, and (c) MIP images of the left breast show a 2.1-cm-sized oval, not circumscribed, homogenous enhancing mass (arrows).

• 

  Fig. 2 Preoperative MRI showing NMLE; the patient underwent immediate re-excision after single BCT. Images are of the right breast of a 43-year-old woman with confirmed DCIS. Sagittal, contrast enhanced, fat-suppressed, 2D gradient (a) T1-weighted, (b) subtraction, and (c) MIP images of the right breast show a segmental clumped NMLE (arrows) extending 6 cm. This patient had received a lumpectomy and then underwent immediate re-excision due to positive superficial and deep margin.

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  Fig. 3 Preoperative MRI showing multifocal NMLEs and masses which were treated with immediate re-excision after single BCT. Images are of the left breast of a 52-year-old woman with confirmed DCIS. Sagittal, contrast enhanced, fat-suppressed, 2D gradient (a, b) T1-weighted, (c) subtraction, and (d) (MIP) images of the left breast show a segmental clumped NMLE (arrowheads) extending 3 cm, and other multifocal 1-cm-sized irregularly shaped enhancing masses (arrows) in the same quadrant. This patient had undergone a lumpectomy, after which re-excision was immediately performed due to positive inferior and medial margin. The surgical specimen of this NMLE confirmed that it was a 0.3-cm-sized invasive ductal carcinoma with a 4.5-cm area of DCIS (pT1a).

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