Korean J Radiol.  2018 Oct;19(5):897-904. 10.3348/kjr.2018.19.5.897.

Identification of Preoperative Magnetic Resonance Imaging Features Associated with Positive Resection Margins in Breast Cancer: A Retrospective Study

• Kang JH
• Youk JH
• Kim JA
• Gweon HM
• Eun NL
• Ko KH
• Son EJ

• KMID: 2418553
• DOI: http://doi.org/10.3348/kjr.2018.19.5.897

Abstract

OBJECTIVE
To determine which preoperative breast magnetic resonance imaging (MRI) findings and clinicopathologic features are associated with positive resection margins at the time of breast-conserving surgery (BCS) in patients with breast cancer.
MATERIALS AND METHODS
We reviewed preoperative breast MRI and clinicopathologic features of 120 patients (mean age, 53.3 years; age range, 27-79 years) with breast cancer who had undergone BCS in 2015. Tumor size on MRI, multifocality, patterns of enhancing lesions (mass without non-mass enhancement [NME] vs. NME with or without mass), mass characteristics (shape, margin, internal enhancement characteristics), NME (distribution, internal enhancement patterns), and breast parenchymal enhancement (BPE; weak, strong) were analyzed. We also evaluated age, tumor size, histology, lymphovascular invasion, T stage, N stage, and hormonal receptors. Univariate and multivariate logistic regression analyses were used to determine the correlation between clinicopathological features, MRI findings, and positive resection margins.
RESULTS
In univariate analysis, tumor size on MRI, multifocality, NME with or without mass, and segmental distribution of NME were correlated with positive resection margins. Among the clinicopathological factors, tumor size of the invasive breast cancer and in situ components were significantly correlated with a positive resection margin. Multivariate analysis revealed that NME with or without mass was an independent predictor of positive resection margins (odds ratio [OR] = 7.00; p < 0.001). Strong BPE was a weak predictor of positive resection margins (OR = 2.59; p = 0.076).
CONCLUSION
Non-mass enhancement with or without mass is significantly associated with a positive resection margin in patients with breast cancer. In patients with NME, segmental distribution was significantly correlated with positive resection margins.

Keyword

Breast cancer; Breast-conserving surgery; MRI; BI-RADS; Resection margin

MeSH Terms

Breast Neoplasms*
Breast*
Humans
Logistic Models
Magnetic Resonance Imaging*
Mastectomy, Segmental
Multivariate Analysis
Retrospective Studies*

Figure

• 

  Fig. 1 69-year-old woman with invasive solid papillary carcinoma.Preoperative contrast-enhanced T1-weighted subtraction images show segmental clustered ring non-mass enhancement in outer portion of right breast. Patient underwent total mastectomy, which was converted from attempted breast-conserving surgery since positive resection margin was obtained from frozen section analysis. Size of invasive and in situ component of tumor was approximately 3.7 cm. Patient tested positive for estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2.

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