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Magnetic resonance imaging identifies multifocal and multicentric disease in breast cancer patients who are eligible for partial breast irradiation.
Cancer. 2008 Nov 01; 113(9):2408-14.C

Abstract

BACKGROUND

In this retrospective study, the authors hypothesized that magnetic resonance imaging (MRI) would alter partial breast irradiation (PBI) eligibility by identifying cancers outside the PBI volume compared with mammography alone.

METHODS

Since 2002, MRI was used nonselectively at the authors' institution for the staging of patients with nonmetastatic breast cancer. Of 450 consecutive patients with invasive breast cancer, 110 patients who were eligible for PBI were identified by using criteria outlined by National Surgical Adjuvant Breast and Bowel Project B-39/Radiation Oncology Group trial 0413 based on mammography, ultrasonography, and initial pathology. In that trial, patients were randomized (stage I/II invasive cancers that measured <or=3 cm and <or=3 positive lymph nodes) to receive either whole-breast radiotherapy or PBI. MRI reports were reviewed to determine whether MRI identified secondary lesions 1) within the same quadrant (multifocal), 2) in a different quadrant (multicentric), or 3) in the contralateral breast. These lesions were pathologically proven carcinoma and would have rendered the patient ineligible for PBI.

RESULTS

MRI identified secondary lesions in 10% of patients (95% confidence interval [CI], 4.4%-15.6%). Multifocal disease was identified in 3.6% (95% CI, 1.4%-9%), multicentric disease was identified in 4.5% (95% CI, 2%-10.2%), and contralateral disease was identified in 1.8% (95% CI, 0.5%-6.4%). The proportion of patients with false-positive MRI findings was 4.5% (95% CI, 2%-10.2%). The positive predictive value of MRI was 72.2% (95% CI, 46.4%-89.3%).

CONCLUSIONS

MRI identified frequent secondary cancers that would not be removed routinely by surgery or targeted in the radiation field if treated with PBI. The current data suggest that MRI should be considered to assess PBI eligibility to minimize potential local failures.

Authors+Show Affiliations

Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois 60637, USA. hal-hallaq@radonc.uchicago.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18823018

Citation

Al-Hallaq, Hania A., et al. "Magnetic Resonance Imaging Identifies Multifocal and Multicentric Disease in Breast Cancer Patients Who Are Eligible for Partial Breast Irradiation." Cancer, vol. 113, no. 9, 2008, pp. 2408-14.
Al-Hallaq HA, Mell LK, Bradley JA, et al. Magnetic resonance imaging identifies multifocal and multicentric disease in breast cancer patients who are eligible for partial breast irradiation. Cancer. 2008;113(9):2408-14.
Al-Hallaq, H. A., Mell, L. K., Bradley, J. A., Chen, L. F., Ali, A. N., Weichselbaum, R. R., Newstead, G. M., & Chmura, S. J. (2008). Magnetic resonance imaging identifies multifocal and multicentric disease in breast cancer patients who are eligible for partial breast irradiation. Cancer, 113(9), 2408-14. https://doi.org/10.1002/cncr.23872
Al-Hallaq HA, et al. Magnetic Resonance Imaging Identifies Multifocal and Multicentric Disease in Breast Cancer Patients Who Are Eligible for Partial Breast Irradiation. Cancer. 2008 Nov 1;113(9):2408-14. PubMed PMID: 18823018.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Magnetic resonance imaging identifies multifocal and multicentric disease in breast cancer patients who are eligible for partial breast irradiation. AU - Al-Hallaq,Hania A, AU - Mell,Loren K, AU - Bradley,Julie A, AU - Chen,Lucy F, AU - Ali,Arif N, AU - Weichselbaum,Ralph R, AU - Newstead,Gillian M, AU - Chmura,Steven J, PY - 2008/10/1/pubmed PY - 2008/12/17/medline PY - 2008/10/1/entrez SP - 2408 EP - 14 JF - Cancer JO - Cancer VL - 113 IS - 9 N2 - BACKGROUND: In this retrospective study, the authors hypothesized that magnetic resonance imaging (MRI) would alter partial breast irradiation (PBI) eligibility by identifying cancers outside the PBI volume compared with mammography alone. METHODS: Since 2002, MRI was used nonselectively at the authors' institution for the staging of patients with nonmetastatic breast cancer. Of 450 consecutive patients with invasive breast cancer, 110 patients who were eligible for PBI were identified by using criteria outlined by National Surgical Adjuvant Breast and Bowel Project B-39/Radiation Oncology Group trial 0413 based on mammography, ultrasonography, and initial pathology. In that trial, patients were randomized (stage I/II invasive cancers that measured <or=3 cm and <or=3 positive lymph nodes) to receive either whole-breast radiotherapy or PBI. MRI reports were reviewed to determine whether MRI identified secondary lesions 1) within the same quadrant (multifocal), 2) in a different quadrant (multicentric), or 3) in the contralateral breast. These lesions were pathologically proven carcinoma and would have rendered the patient ineligible for PBI. RESULTS: MRI identified secondary lesions in 10% of patients (95% confidence interval [CI], 4.4%-15.6%). Multifocal disease was identified in 3.6% (95% CI, 1.4%-9%), multicentric disease was identified in 4.5% (95% CI, 2%-10.2%), and contralateral disease was identified in 1.8% (95% CI, 0.5%-6.4%). The proportion of patients with false-positive MRI findings was 4.5% (95% CI, 2%-10.2%). The positive predictive value of MRI was 72.2% (95% CI, 46.4%-89.3%). CONCLUSIONS: MRI identified frequent secondary cancers that would not be removed routinely by surgery or targeted in the radiation field if treated with PBI. The current data suggest that MRI should be considered to assess PBI eligibility to minimize potential local failures. SN - 0008-543X UR - https://www.unboundmedicine.com/medline/citation/18823018/Magnetic_resonance_imaging_identifies_multifocal_and_multicentric_disease_in_breast_cancer_patients_who_are_eligible_for_partial_breast_irradiation_ L2 - https://doi.org/10.1002/cncr.23872 DB - PRIME DP - Unbound Medicine ER -