Aims and objectives
In patients with invasive breast cancer,
current guidelines define clear or adequate surgical resection margins as no tumour on ink in order to ensure complete surgical excision[1,2].
In those patients with positive surgical resection margins,
surgical treatment options range from re-excision of the surgical cavity to mastectomy.
While breast MRI can prove useful in the pre-operative setting to determine extent of tumour,
there is limited evidence for the use of post-operative MRI to detect residual tumour in patients with positive margins.
Krammer et al determined...
Methods and materials
A review of all breast MRIs performed in the Cambridge Breast Unit from August 2015 to August 2017 was performed to identify those MRIs performed post-operatively.
Patients were referred for MRI following multidisciplinary review of conventional imaging and histology.
Only those patients who had their postoperative MRI performed within 4 months of original surgery were included.
MRI images were reported by at least 2 breast radiologists as per our departmental protocol with evaluation of breast morphology,
post contrast enhancement patterns with associated kinetics determined using...
Results
Of the 858 MRIs performed in 788 patients over the 2-year period,
23 were performed post-operatively,
within 4 months of the original surgery.
Complete data was available in 22 patients.
On review of the postoperative MRI cases,
none of these patients had pre-operative MRI imaging.
The average age of the patients was 59,
with 12 screening and 10 symptomatic cases.
In 5 cases (21%),
abnormal enhancement was identified in the ipsilateral breast,
distant from the surgical cavity. 4 biopsies were performed following MRI,
3 US...
Conclusion
Post-operative MRI is difficult to interpret due to the presence of postsurgical change,
making evaluation of the residual disease adjacent to the surgical cavity difficult.
However it can prove useful in assessing for distant disease in the ipsilateral breast and direct appropriate further surgery.
Although our numbers are small,
postoperative MRI detected distant abnormal enhancement in 5 cases (21%).
Of these 4 required further biopsy with 3 ultimately requiring a mastectomy. Conversely 10 patients (43%) had no adverse MRI findings distant to the surgical site...
References
1.
Housammi N et al.
Meta-analysis of the impact of surgical margins on local recurrence in women with early stage invasive breast cancer treated with breast conserving therapy.
2010.
Eur J Cancer 46:3219-3232
2.
Moran MS,
et al.
Society of Surgical Oncology-American Society for Radiation Oncology Consensus guideline on margins for breast-conserving surgery with whole breast irradiation in stages I and II invasive breast cancer.
2014.
J Radiat Oncol Biol Phys.
88: 553-564
3.
Krammer J et al.
Breast MRI imaging for the assessment of...