Title: Comparison of the Accuracy of MRI, Sonography and Mammography in Predicting the Pre Operative Breast Tumor Size Measurements

Authors: Dr Mohammed Ameer Ali Khan Afrose, Dr Yuefan Gu, Dr Junkang Shen, Dr Uzma Jabeen

 DOI:  http://dx.doi.org/10.18535/jmscr/v4i9.35

Abstract

Background: 70 patients with primary breast cancer who presented preoperatively in the New Life Hospital, Hyderabad from Jan 2016 to June 2016 were retrospectively analyzed. Accurate preoperative assessment of maximum tumor size was a significant step of clinical cancer staging that assisted in planning further patient managements. The commonly used radiological modalities to measure tumor size are mammography, Ultra Sonography (US), and MRI. To prospectively estimate the accuracy of mammography, Ultrasonography and Magnetic Resonance Imaging in preoperative assessment of local extent of breast cancer, we did a study which illustrated the purpose. Bilateral whole-breast Ultrasonography was performed with prior information about clinical and mammographic findings either prior to MR imaging or afterward.

Methods: Data from 70 patients with primary breast cancer were analysed in a retrospective study. The results were divided into the groups “ductal carcinoma in situ (DCIS)”, invasive ductal carcinoma (IDC) + ductal carcinoma in situ (DCIS)”, “invasive ductal carcinoma (IDC)”, “invasive lobular carcinoma (ILC)” and “other tumours” (tubular, medullary, mucinous and papillary breast cancer). The largest tumour diameter was chosen as the sizing reference in each case. Data from the study was diagrammatically illustrated and study data was incorporated in table form to accurately differentiate between the modalities so as to come to conclusions.

Result: Our study found that ultrasound produced significant underestimation of tumor size, particularly so when size of tumor is larger. Mammography also under estimates the size of the tumor as compared to histology. MRI gives most accurate size estimation. However, overall mean difference between mammography, Ultrasonography and MRI was not statistically significant.

Conclusion: We state that all 3 modalities of imaging has a role in pre operative estimation of breast tumor. As depicted in our study, MRI has shown most accurate results.

Abbreviations: DCIS: Ductal Carcinoma in Situ, IDC: Invasive Ductal carcinoma, ILC: Invasive Lobular  carcinoma

Keywords: Breast tumour, BI RADS classification, Ultra sonography, mammography, MRI.

References

1.      Kaufmann M, von Minckwitz G, Smith R, Valero V, Gianni L, Eiermann W, et al. International expert panel on the use of primary (preoperative) systemic treatment of operable breast cancer: review and recommendations. J Clin Oncol 2003; 21:2600–8

2.      Buchberger W, DeKoekkoeK Doll P, Springer P, Obrist P, Dunser M. Incidental findings on sonography of the breast: clinical significance and diagnostic workup.  AJR Am J Roentgenol.  1999; 173:921–927.

3.      Kolb TM, Lichy J, Newhouse JH. Occult cancer in women with dense breasts: detection with screening US – diagnostic yield and tumor characteristics.  Radiology. 1998;207:191–199. 

4.      Schulz KD, Albert US. Stufe-3-Leitlinie Brustkrebs- Früherkennung in Deutschl-and.  München: Zuckschwerdt; 2003. 

5.      Kolb TM, Lichy J, Newhouse JH. Comparison of the performance of screen-ing mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patients evaluations.  Radiology.  2002; 225:165–175. 

6.      Boyd NF, Guo H, Martin LJ, Sun L, Stone J, Fishell E, Jong RA, Hislop G, Chiarelli A, Minkin S, Yaffe MJ. Mammographic density and the risk and detection of breast cancer. N Engl J Med. 2007;356:227–336.

7.      Skaane P, Engedal K. Analysis of sonographic features in the differentiation of fibroadenomas and invasive ductal carcinoma. AJR Am J Roentgenol.  1998; 170:109–114

8.      Peintinger F, Kuerer H, Anderson K, Boughey J, Meric-Bernstam F, Singletary S, et al. Accuracy of the combination of mammography and sonography in predict-ting tumour response in breast cancer patients after neoadjuvant chemotherapy.  Ann Surg Oncol 2006; 13:1443–9 

9.      Rhabar G, Sie AC, Hansen GC, Prince JS, Melany ML, Reynolds HW, Jackson VP, Syre JW, Bassett LW. Benign versus malignant solid breast masses: US differ-entiation.  Radiology.  1999; 213:889–894.

10.  Booser D, Hortobagyi G. Treatment of locally advanced breast cancer. Semin Oncol 1992;19:278–85

11.  Mendelson EB, Baum JK, Berg WA, Merritt CRB, Rubin E. Breast Imaging Reporting and Data System, BI-RADS: Ultrasound. Reston: American College of Radiology; 2003.

12.  Landis JR, Koch GG. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers.  Biometrics  1977; 33:363–74

13.  Baez E, Strathmann K, Vetter M, Madjar H, Hackelöer BJ. Likelihood of malign-ancy in breast lesions characterized by ultrasound with a combined diagnostic score. Ultrasound Med Biol. 2005;31:179–184.

14.  Elmore JG, Armstrong K, Lehmann CD, et al. Screening for breast cancer.  JAMA.  2005;293:1245–1256. 

15.  Madjar H, Ohlinger R, Mundinger A, Watermann D, Frenz JP, Bader W, Schulz-Wendtland R, Degenhardt F. BI-RADS-analogue DEGUM criteria for findings in breast ultrasound – consensus of the DEG-UM Committee on Breast Ultrasound.  Ultraschall Med. 2006;27:374–379. 

16.  Chen JH, Mehta RS, Nalcioglu O, Su MY. Inflammatory breast cancer after neoadjuvant chemotherapy: can magnetic resonance imaging precisely diagnose the final pathological response? Ann Surg Oncol2008;15:3609–13

17.  Moss HA, Britton PD, Flower CD, et al. How reliable is modern breast imaging in differentiating benign from malignant breast lesions in the symptomatic populat-ion? Clin Radiol. 1999;54:676–682. 

18.  Shoma A, Moutamed A, Ameen M, Abdelwahab A: Ultrasound for accurate measurement of invasive breast cancer tumor size. Breast J. 2006, 12: 252-256

19.  Wasif N, Garreau J, Terando A, Kirsch D, Mund DF, Giuliano AE: MRI versus ultrasonography and mammography for preoperative assessment of breast cancer. Am Surg. 2009, 75: 970-975.

20.  Skaane P, Skjorten F: Ultrasonographic evaluation of invasive lobular carcinoma. Act Radiol. 1999, 40: 369-375.

21.  Stomper PC, Margolin FR: Ductal carcinoma in situ: the mammographer’s perspective. AJR Am J Roentgenol. 1994, 162: 585-591.

22.  Sardanelli F, Giuseppetti GM, Panizza P, Bazzocchi M, Fausto A, Simonetti G, Lattanzio V, Del Maschio A: Sensitivity of MRI versus mammography for detecting foci of multifocal, multicentric breast cancer in fatty and dense breasts using the whole breast pathologic examination as a gold standard. AJR Am J Roentgenol. 2004, 183: 1149-1157. 

23.  Lenz S: Breast ultrasound in office gynecology--ten years of experience. Ultrasc-hall Med. 2011, 32 (Suppl 1): 3-7.

24.  Landis JR, Koch GG. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers.  Biometrics.  1977;33 (2):363–374.

25.  Buchholz TA, Tucker SL, Masullo L, et al. Predictors of local-regional recurrence after neoadjuvant chemotherapy and mastectomy without radiation. J Clin Oncol. 2002;20(1):17–23.

26.  Golshan M, Fung BB, Wiley E, et al. Prediction of breast cancer size by ultrasound, mammography and core biopsy. The Breast. 2004;13(4):265–271

27.  Fornage B, Toubas O, Morel M. Clinical, mammographic, and sonographic determination of preoperative breast cancer size. Cancer. 1987;60:765–771. 

Corresponding Author

Dr Mohammed Ameer Ali Khan Afrose

MBBS (MD Radiology)

Second affiliated hospital of Soochow University