Search

Objectives To report mastectomy and reoperation rates in women who had breast MRI for screening (S-MRI subgroup) or diagnostic (D-MRI subgroup) purposes, using multivariable analysis for investigating the role of MRI referral/nonreferral and other covariates in driving surgical outcomes. Methods The MIPA observational study enrolled women aged 18–80 years with newly diagnosed breast cancer destined to have surgery as the primary treatment, in 27 centres worldwide. Mastectomy and reoperation rates were compared using non-parametric tests and multivariable analysis. Results A total of 5828 patients entered analysis, 2763 (47.4%) did not undergo MRI (noMRI subgroup) and 3065 underwent MRI (52.6%); of the latter, 2441/3065 (79.7%) underwent MRI with preoperative intent (P-MRI subgroup), 510/3065 (16.6%) D-MRI, and 114/3065 S-MRI (3.7%). The reoperation rate was 10.5% for S-MRI, 8.2% for D-MRI, and 8.5% for P-MRI, while it was 11.7% for noMRI (p ≤ 0.023 for comparisons with D-MRI and P-MRI). The overall mastectomy rate (first-line mastectomy plus conversions from conserving surgery to mastectomy) was 39.5% for S-MRI, 36.2% for P-MRI, 24.1% for D-MRI, and 18.0% for noMRI. At multivariable analysis, using noMRI as reference, the odds ratios for overall mastectomy were 2.4 (p p = 0.957) for D-MRI, and 1.9 (p Conclusions Patients from the D-MRI subgroup had the lowest overall mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). This analysis offers an insight into how the initial indication for MRI affects the subsequent surgical treatment of breast cancer. Key Points • Of 3065 breast MRI examinations, 79.7% were performed with preoperative intent (P-MRI), 16.6% were diagnostic (D-MRI), and 3.7% were screening (S-MRI) examinations. • The D-MRI subgroup had the lowest mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). • The S-MRI subgroup had the highest mastectomy rate (39.5%) which aligns with higher-than-average risk in this subgroup, with a reoperation rate (10.5%) not significantly different to that of all other subgroups.

To compare automated breast volume scanner (ABVS), ultrasound (US) and MRI in measuring breast cancer size, and evaluate the agreement between ABVS and US in assessing lesion location and sonographic features. We retrospectively included 98 women with 100 index cancers who had undergone US and ABVS followed by 1.5T MRI. Images were interpreted by a pool of readers reporting lesion size, location and breast imaging reporting and data system (BI-RADS) features. Bland-Altman analysis (with logarithmic data transformation), intraclass correlation coefficient (ICC) and Cohen’s kappa statistic were used for statistical analysis. MRI showed the best absolute agreement with histology in measuring cancer size (ICC 0.93), with LOA comparable to those of ABVS (0.63–1.99 vs. 0.52–1.73, respectively). Though ABVS and US had highly concordant measurements (ICC 0.95), ABVS showed better agreement with histology (LOA 0.52–1.73 vs. 0.45–1.86, respectively), corresponding to a higher ICC (0.85 vs. 0.75, respectively). Except for posterior features (k=0.39), the agreement between US and ABVS in attributing site and BI-RADS features ranged from substantial to almost perfect (k=0.68–0.85). ABVS performs better than US and approaches MRI in predicting breast cancer size. ABVS performs comparably to US in sonographic assessment of lesions. • ABVS approaches MRI in predicting breast cancer size. • ABVS is equivalent to US in localising and characterising breast cancer. • ABVS is more accurate than US in assessing breast cancer size. • ABVS has the potential to replace US in breast cancer staging.

To evaluate second-look digital breast tomosynthesis (SL-DBT) for additional findings (AFs) at preoperative MRI compared with second-look ultrasound (SL-US). We included 135 patients with breast cancer who underwent digital mammography (DM), DBT, US, and MRI at two centres. MR images were retrospectively evaluated to find AFs, described as focus, mass, or non-mass; ≤10 mm or >10 mm in size; BI-RADS 3, 4, or 5. DM and DBT exams were reviewed looking for MRI AFs; data on SL-US were collected. Reference standard was histopathology or ≥12-month negative follow-up. Fisher exact test and McNemar test were used. Eighty-four AFs were detected in 53/135 patients (39 %, 95 %CI 31–48 %). A correlate was found for 44/84 (52 %, 95 %CI 41–63 %) at SL-US, for 20/84 (24 %, 95 %CI 11–28 %) at SL-DM, for 42/84 (50 %, 95 %CI 39–61 %) at SL-DBT, for 63/84 (75 %, 95 %CI 64–84 %) at SL-DBT, and/or SL-US, the last rate being higher than for SL-US only, overall (p 10 mm, BI-RADS 4 or 5, or malignant lesions (p

The authors report their experience on the use of a biopsy gun for histological sampling in the field of breast lesions. The use of cytological sampling by (FNAB) fine needle aspiration biopsy has been preferred so far, because it has been thoutht to be simpler, less risky and reliable. Nevertheless, the cytological sampling shows a number of drawbacks such as the need for passes to get sufficient cellular material, frequent problems in diagnosing benign lesions and the decisive influence of the operator's skill. By using a biopsy gun for histological sampling these disadvantages are eliminated. In this case, in fact, the validity of the sample is not influenced by the operator's skill; fewer passes are necessary and their validity does not depend on the nature of the lesion. The personal series of cases involves 91 patients subjected to histological sampling for suspected lesions. Two different kinds of needles were used with one an 18 G diameter and a 23-mm extension of the sytlet, as well as a sampling window 17 mm; the other with the same diameter and extension of the stylet, as as a sampling window 8 mm. The first needle was used in all 91 patients, and the second only in 30. The results were not influenced by the employ of the different kinds of needles. A total of 268 samples were made and 110 lesions were discovered, 79 of which were malignant and 31 benign (fibroadenoma, fibrocystic change and epitheliosis). Three carcinomas were not found (3 false-negative) and one specimen was inadequate. The values of sensibility, specificity and diagnostic accuracy of the method were, respectively, 96.2%, 100% and 97.2%, with 3.8% false-negative due to three cases where the lesion was not centred for guidance mistake.