Pathologic Correlation with Mammogram and MRI Size for Primary Breast Carcinoma
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Transcript of Pathologic Correlation with Mammogram and MRI Size for Primary Breast Carcinoma
Pathologic Correlation with Mammogram and MRI Size for
Primary Breast CarcinomaRichard D. Lovett, MD Jennifer K. Stedman
Rutland Regional Medical Center, University of Vermont College of Medicine, Fairfield University
Purpose
Current breast cancer screening practice is to employ physical examination, self examination, mammography
Magnetic Resonance Imaging (MRI) with contrast enhancement was demonstrated to be effective in 1989 for breast imaging by Kaiser and Heywang
Purpose
According to Bagley in 2003:– MRI accurately estimated the size of the breast
lesion 91% of the time, an accuracy level believed to be greater than conventional mammograghy
Purpose
To examine all women at RRMC, who underwent MRI preoperatively, to determine whether the Mammogram or the MRI more accurately determined the presence and size of the pathologic lesion. The time frame used was 2001 until May 2006
Materials and Methods
138– 0– 138– 152
– 56– 51– 27– 10– 4– 4
Patients– Male– Female– Lesions
Pathologic Size– 0-1cm– >1-2cm– >2-3cm– >3-4cm– >4-5cm– >5cm
Materials and Methods
Stage T1 (0-2cm) T2 (>2cm-5cm) T3 (>5cm)
107 (70%) 41 (27%) 4 (3%)
Materials and Methods
Women with mammogram and MRI done preoperatively from 2001 to 5/2006
Mammogram done by ACR accredited facility MRI done at RRMC
– Gadolinium enhancement– Dynamic contrast enhancement curves
Analysis of size and lesion by radiologist or radiation oncologist
Materials and Methods
Contrast enhanced MRI with breast cancer in the outer quadrant of the left breast
Images made with the subtracted gradient echo technique rather than the fat saturation technique
Materials and Methods
Dynamic enhancement curves plotted on the breast cancer with data points at 1 minute through 7 minutes after gadolinium injection
Materials and Methods
Patient with multifocal breast cancer in the right breast (the full extent of the breast cancer was not appreciated on the mammogram due to the patients young age (44)
Materials and Methods
Enhancement curves of many of the multifocal sites on this young woman
This patient decided on a mastectomy based on this data
Results
Comparison of Images to Pathologic Size
Table 2 Mammogram (%) MRI (%)
Image Size Equals Path Size (within 5mm)
55.5% 85.5%
Total Images Different
Than Path 44.5% 14.5%
Image Size Greater than 5mm Discordant with
Path
18% 11%
Image Modality Did Not Visualize Lesion
12.5% 3%
Image Modality Did Not Visualize All the Lesions
10% 0%
Could Not Measure the Image
4% .5%
Results
Mammogram vs. MRI
55.5
85.5
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11 12.5
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MM, MRI
% o
f tot
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Mammo correct
% MRI correct
Mammo off >.5cm
MRI off >.5cm
Mammo NED
MRI NED
Mammo not detect alllesions
MRI not detect all lesions
Mammo could not measuresize
MRI could not measure size
Results- Pathologic Stage vs. Discordance Between Image and Pathology
Equal Discordant Not Seen
MammoT1 56% 27% 17%T2 59% 39% 2%T3 0% 100% 0%
MRIT1 87% 9% 4%T2 88% 10% 2%T3 25% 75% 0%
Results
MRI and Mammogram Size versus Pathologic Size
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Pathologic Size (cm)
Imag
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MammogramMRI
Results
MRI and Mammogram Size versus Pathologic Size
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Pathologic Size (cm)
Imag
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r =0.44r =0.64
Conclusions
The accuracy rate of MRI for predicting the size of the lesion is higher than the accuracy rate of mammogram 86% vs. 56% respectively
This finding is maintained for T1 and T2 lesions when staging is stratified
For T3 lesions, MRI is more accurate in predicting the size of the lesion, 25% to 0, however the small number of these lesions in the study precludes conclusions.
Conclusions
Mammography is more likely to image the breast cancer smaller than the true pathologic size
MRI with its contrast enhancement is more likely to image the lesion slightly larger than the pathologic size, presumed to be due to recruitment of perilesional blood vessels
Conclusions
Because the size of a lesion is one of the factors considered in the decision between conservation therapy and mastectomy, the increased accuracy of preoperative MRI scanning may impact on the surgical choice available to a woman with breast cancer.
Acknowledgements
Rutland Regional Medical Center– JC Biebuyck, MD– Allan Eisemann, MD– Daniel Mitchell, MD– Mike Nagar, RTT– James Rademacher, MD– Roshan Siva, MD
Harvard Medical School, Beth Israel Deaconess– Thomas Hill, MD– J. Anthony Parker, MD