Magnetic Resonance Mammography in the Evaluation of Recurrence
Introduction: The aim was to assess the value of magnetic resonance mammography (MRM) in the detection of recurrent breast cancer on the prior lumpectomy site in patients with previous conservative surgery and radiotherapy.
Methods: Between April 1999 and July 2003, 93 consecutive patients with breast cancer treated with conservative surgery and radiotherapy underwent MRM, when a malignant lesion on the site of lumpectomy was suspected by ultrasound and/or mammography. MRM scans were evaluated by morphological and dynamic characteristics. MRM diagnosis was compared with histology or with a 36-month imaging follow-up. Enhancing areas independent of the prior lumpectomy site, incidentally detected during the MRM, were also evaluated.
Results: MRM findings were compared with histology in 29 patients and with a 36-month follow-up in 64 patients. MRM showed 90% sensitivity, 91.6% specificity, 56.3% positive predictive value and 98.7% negative predictive value for detection of recurrence on the surgical scar. MRM detected 13 lesions remote from the scar. The overall sensitivity, specificity, positive predictive value and negative predictive value of MRM for detection of breast malignancy were 93.8%, 90%, 62.5% and 98.8%, respectively.
Conclusion: MRM is a sensitive method to differentiate recurrence from post-treatment changes at the prior lumpectomy site after conservative surgery and radiation therapy. The high negative predictive value of this technique can avoid unnecessary biopsies or surgical treatments.
Recurrence of breast cancer lesions on the surgical scar after conservative surgery and radiation therapy have been reported to occur in at least 1–2% of cases per year. The proper follow-up of these patients usually includes periodic clinical examination, mammography and ultrasonography. Detection of recurrence on the prior lumpectomy site still represents a challenge because of changes in breast tissue after treatment. Clinical examination, mammography or ultrasonography can raise a suspicion but an additional evaluation is frequently mandatory to avoid unnecessary biopsy or surgery.
Several recent studies have shown the important role of breast magnetic resonance imaging (MRI) imaging for detection of recurrent lesions in patients treated with conservative surgery (quadrantectomy) and radiation therapy. Magnetic resonance mammography (MRM) has high sensitivity, high specificity and high accuracy in differentiating physiologic changes of the scar from tumoral tissue. MRM multifactorial evaluation, based on both morphological features and time–signal intensity curves of enhancing lesions, is related to significantly higher sensitivity and higher specificity than evaluation protocols based only on one morphological or enhancing feature.
To the best of our knowledge, no specific data are available on the accuracy of MRM to differentiate recurrent lesions from normal changes of the surgical scar at the site of prior lumpectomy when a multifactorial MRM evaluation protocol is used to classify enhancing lesions.
This study was designed to determine whether MRM, performed with a multifactorial evaluation of enhancing lesions, improves the accuracy of diagnosis of recurrence on the surgical scar in patients who underwent quadrantectomy and local radiation therapy. Furthermore, the overall accuracy of contrast-enhanced MRM for the detection of suspicious enhancing lesions, even when not closely related to the surgical scar, has also been assessed in the series reported.
Introduction: The aim was to assess the value of magnetic resonance mammography (MRM) in the detection of recurrent breast cancer on the prior lumpectomy site in patients with previous conservative surgery and radiotherapy.
Methods: Between April 1999 and July 2003, 93 consecutive patients with breast cancer treated with conservative surgery and radiotherapy underwent MRM, when a malignant lesion on the site of lumpectomy was suspected by ultrasound and/or mammography. MRM scans were evaluated by morphological and dynamic characteristics. MRM diagnosis was compared with histology or with a 36-month imaging follow-up. Enhancing areas independent of the prior lumpectomy site, incidentally detected during the MRM, were also evaluated.
Results: MRM findings were compared with histology in 29 patients and with a 36-month follow-up in 64 patients. MRM showed 90% sensitivity, 91.6% specificity, 56.3% positive predictive value and 98.7% negative predictive value for detection of recurrence on the surgical scar. MRM detected 13 lesions remote from the scar. The overall sensitivity, specificity, positive predictive value and negative predictive value of MRM for detection of breast malignancy were 93.8%, 90%, 62.5% and 98.8%, respectively.
Conclusion: MRM is a sensitive method to differentiate recurrence from post-treatment changes at the prior lumpectomy site after conservative surgery and radiation therapy. The high negative predictive value of this technique can avoid unnecessary biopsies or surgical treatments.
Recurrence of breast cancer lesions on the surgical scar after conservative surgery and radiation therapy have been reported to occur in at least 1–2% of cases per year. The proper follow-up of these patients usually includes periodic clinical examination, mammography and ultrasonography. Detection of recurrence on the prior lumpectomy site still represents a challenge because of changes in breast tissue after treatment. Clinical examination, mammography or ultrasonography can raise a suspicion but an additional evaluation is frequently mandatory to avoid unnecessary biopsy or surgery.
Several recent studies have shown the important role of breast magnetic resonance imaging (MRI) imaging for detection of recurrent lesions in patients treated with conservative surgery (quadrantectomy) and radiation therapy. Magnetic resonance mammography (MRM) has high sensitivity, high specificity and high accuracy in differentiating physiologic changes of the scar from tumoral tissue. MRM multifactorial evaluation, based on both morphological features and time–signal intensity curves of enhancing lesions, is related to significantly higher sensitivity and higher specificity than evaluation protocols based only on one morphological or enhancing feature.
To the best of our knowledge, no specific data are available on the accuracy of MRM to differentiate recurrent lesions from normal changes of the surgical scar at the site of prior lumpectomy when a multifactorial MRM evaluation protocol is used to classify enhancing lesions.
This study was designed to determine whether MRM, performed with a multifactorial evaluation of enhancing lesions, improves the accuracy of diagnosis of recurrence on the surgical scar in patients who underwent quadrantectomy and local radiation therapy. Furthermore, the overall accuracy of contrast-enhanced MRM for the detection of suspicious enhancing lesions, even when not closely related to the surgical scar, has also been assessed in the series reported.
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