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Preoperative breast magnetic resonance imaging in early breast cancer: implications for partial breast irradiation.
Cancer. 2009 Apr 15; 115(8):1621-30.C

Abstract

BACKGROUND

Accelerated partial breast irradiation (APBI) of patients with early breast cancer is being investigated on a multi-institutional protocol National Surgical Adjuvant Breast and Bowel Project (NSABP) B-39/RTOG 0413. Breast magnetic resonance imaging (MRI) is more sensitive than mammography (MG) and may aid in selection of patients appropriate for PBI.

METHODS

Patients with newly diagnosed breast cancer or ductal carcinoma in situ (DCIS) routinely undergo contrast-enhanced, bilateral breast MRI at the Cleveland Clinic. We retrospectively reviewed the medical records of all early-stage breast cancer patients who had a breast MRI, MG, and surgical pathology data at our institution between June of 2005 and December of 2006. Any suspicious lesions identified on MRI were further evaluated by targeted ultrasound +/- biopsy.

RESULTS

A total of 260 patients met eligibility criteria for NSABP B-39/RTOG 0413 by MG, physical exam, and surgical pathology. The median age was 57 years. DCIS was present in 63 patients, and invasive breast cancer was found in 197 patients. MRI identified suspicious lesions in 35 ipsilateral breasts (13%) and in 16 contralateral breasts (6%). Mammographically occult, synchronous ipsilateral foci were found by MRI in 11 patients (4.2%), and in the contralateral breast in 4 patients (1.5%). By univariate analysis, lobular histology (infiltrating lobular carcinoma [ILC]), pathologic T2, and American Joint Committee on Cancer stage II were significantly associated with additional ipsilateral disease. Of patients with ILC histology, 18% had ipsilateral secondary cancers or DCIS, compared with 3% in the remainder of histologic subtypes (P = .004). No patient older than 70 years had synchronous cancers or DCIS detected by MRI.

CONCLUSIONS

Breast MRI identified synchronous mammographically occult foci in 5.8% of early breast cancer patients who would otherwise be candidates for APBI.

Authors+Show Affiliations

Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA. tendulr@ccf.orgNo 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

19224552

Citation

Tendulkar, Rahul D., et al. "Preoperative Breast Magnetic Resonance Imaging in Early Breast Cancer: Implications for Partial Breast Irradiation." Cancer, vol. 115, no. 8, 2009, pp. 1621-30.
Tendulkar RD, Chellman-Jeffers M, Rybicki LA, et al. Preoperative breast magnetic resonance imaging in early breast cancer: implications for partial breast irradiation. Cancer. 2009;115(8):1621-30.
Tendulkar, R. D., Chellman-Jeffers, M., Rybicki, L. A., Rim, A., Kotwal, A., Macklis, R., & Obi, B. B. (2009). Preoperative breast magnetic resonance imaging in early breast cancer: implications for partial breast irradiation. Cancer, 115(8), 1621-30. https://doi.org/10.1002/cncr.24172
Tendulkar RD, et al. Preoperative Breast Magnetic Resonance Imaging in Early Breast Cancer: Implications for Partial Breast Irradiation. Cancer. 2009 Apr 15;115(8):1621-30. PubMed PMID: 19224552.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preoperative breast magnetic resonance imaging in early breast cancer: implications for partial breast irradiation. AU - Tendulkar,Rahul D, AU - Chellman-Jeffers,Melanie, AU - Rybicki,Lisa A, AU - Rim,Alice, AU - Kotwal,Ashwin, AU - Macklis,Roger, AU - Obi,Betty B, PY - 2009/2/19/entrez PY - 2009/2/19/pubmed PY - 2009/6/10/medline SP - 1621 EP - 30 JF - Cancer JO - Cancer VL - 115 IS - 8 N2 - BACKGROUND: Accelerated partial breast irradiation (APBI) of patients with early breast cancer is being investigated on a multi-institutional protocol National Surgical Adjuvant Breast and Bowel Project (NSABP) B-39/RTOG 0413. Breast magnetic resonance imaging (MRI) is more sensitive than mammography (MG) and may aid in selection of patients appropriate for PBI. METHODS: Patients with newly diagnosed breast cancer or ductal carcinoma in situ (DCIS) routinely undergo contrast-enhanced, bilateral breast MRI at the Cleveland Clinic. We retrospectively reviewed the medical records of all early-stage breast cancer patients who had a breast MRI, MG, and surgical pathology data at our institution between June of 2005 and December of 2006. Any suspicious lesions identified on MRI were further evaluated by targeted ultrasound +/- biopsy. RESULTS: A total of 260 patients met eligibility criteria for NSABP B-39/RTOG 0413 by MG, physical exam, and surgical pathology. The median age was 57 years. DCIS was present in 63 patients, and invasive breast cancer was found in 197 patients. MRI identified suspicious lesions in 35 ipsilateral breasts (13%) and in 16 contralateral breasts (6%). Mammographically occult, synchronous ipsilateral foci were found by MRI in 11 patients (4.2%), and in the contralateral breast in 4 patients (1.5%). By univariate analysis, lobular histology (infiltrating lobular carcinoma [ILC]), pathologic T2, and American Joint Committee on Cancer stage II were significantly associated with additional ipsilateral disease. Of patients with ILC histology, 18% had ipsilateral secondary cancers or DCIS, compared with 3% in the remainder of histologic subtypes (P = .004). No patient older than 70 years had synchronous cancers or DCIS detected by MRI. CONCLUSIONS: Breast MRI identified synchronous mammographically occult foci in 5.8% of early breast cancer patients who would otherwise be candidates for APBI. SN - 0008-543X UR - https://www.unboundmedicine.com/medline/citation/19224552/Preoperative_breast_magnetic_resonance_imaging_in_early_breast_cancer:_implications_for_partial_breast_irradiation_ L2 - https://doi.org/10.1002/cncr.24172 DB - PRIME DP - Unbound Medicine ER -