Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group.

The aim of breast MRI is to obtain a reliable evaluation of any lesion within the breast. It is currently always used as an adjunct to the standard diagnostic procedures of the breast, i.e., clinical examination, mammography and ultrasound. Whereas the sensitivity of breast MRI is usually very high, specificity—as in all breast imaging modalities—depends on many factors such as reader expertise, use of adequate techniques and composition of the patient cohorts. Since breast MRI will always yield MR-only visible questionable lesions that require an MR-guided intervention for clarification, MRI should only be offered by institutions that can also offer a MRI-guided breast biopsy or that are in close contact with a site that can perform this type of biopsy for them. Radiologists involved in breast imaging should ensure that they have a thorough knowledge of the MRI techniques that are necessary for breast imaging, that they know how to evaluate a breast MRI using the ACR BI-RADS MRI lexicon, and most important, when to perform breast MRI. This manuscript provides guidelines on the current best practice for the use of breast MRI, and the methods to be used, from the European Society of Breast Imaging (EUSOBI).

/pdf/breast-mri-guidelines-from-the-european-society-of-breast-25bwn1furs.pdf

Breast MRI: guidelines from the European Society of Breast Imaging

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(11)61350-0.pdf

MRI for breast cancer screening, diagnosis, and treatment

Background It has been proposed that magnetic resonance imaging (MRI) be used to guide breast cancer surgery by dif ferentiating residual tumor from pathologic complete response (pCR) after neoadjuvant chemotherapy. This metaanalysis examines MRI accuracy in detecting residual tumor, investigates variables potentially affecting MRI performance, and compares MRI with other tests. Methods A systematic literature searc h was undertaken. Hierarchical summary receiver operating characteristic (HSROC) models were used to estimate (relative) diagnostic odds ratios ([R]DORs). Summary sensitivity (correct identification of residual tumor), specificity (correct identification of pCR), and areas under the SROC curves (AUCs) were derived. All statistical tests were two-sided. Results F orty-four studies (2050 patients) were included. The overall AUC of MRI was 0.88. Accuracy was lower for “standard” pCR definitions (referent category) than “less clearly described” (RDOR = 2.41, 95% confidence interval [CI] = 1.11 to 5.23) or “near-pCR” definitions (RDOR = 2.60, 95% CI = 0.73 to 9.24; P = .03.) Corresponding AUCs were 0.83, 0.90, and 0.91. Specificity was higher when negative MRI was defined as contrast enhancement less than or equal to normal tissue (0.83, 95% CI = 0.64 to 0.93) vs no enhancement (0.54, 95% CI = 0.39 to 0.69; P = .02), with comparable sensitivity (0.83, 95% CI = 0.69 to 0.91; vs 0.87, 95% CI = 0.80 to 0.92; P = .45). MRI had higher accuracy than mammography (P = .02); there was only weak evidence that MRI had higher accuracy than clinical examination (P = .10). No difference in MRI and ultrasound accuracy was found (P = .15). Conclusions MRI accurately detects residual tumor af ter neoadjuvant chemotherapy. Accuracy was lower when pCR was more rigorously defined, and specificity was lower when test negativity thresholds were more stringent; these definitions require standardization. MRI is more accurate than mammography; however, studies comparing MRI and ultrasound are required.

Meta-Analysis of Magnetic Resonance Imaging in Detecting Residual Breast Cancer After Neoadjuvant Therapy

Our results show that in patients with breast cancer, the pretreatment apparent diffusion coefficients of patients who responded to neoadjuvant chemotherapy are significantly lower than those of patients who did not respond to neoadjuvant chemotherapy.

Diffusion-weighted MR imaging: pretreatment prediction of response to neoadjuvant chemotherapy in patients with breast cancer.

Purpose. To compare the value of conventional imaging modalities and MRI for determination of response to neoadjuvant chemotherapy for breast cancer. 
Material and methods. Sixty tumors (53 ductal carcinomas, seven invasive lobular carcinomas) in 51 patients were evaluated by physical examination, mammography, ultrasound, and MRI at baseline before therapy, after three courses of chemotherapy, and after six courses prior to surgery. Data from physical examination and imaging studies were compared to histopathological findings. 
Results. (i) MRI was the most reliable technique for evaluation of residual tumor size; this parameter was correctly estimated in 63% of cases by MRI versus, respectively 52, 38, and 43% by physical examination, mammography, and ultrasound, (ii) MRI correctly identified the response to chemotherapy in all cases of complete response (five cases), and in 45/55 cases of partial response (43 cases) or no response (12 cases), and (iii) among the 32 patients who underwent a mastectomy, MRI correctly revealed the multifocal nature of the disease for 12/15 multifocal lesions found at histological examination; both mammography and sonography were accurate in only six of the 15 cases. 
Conclusion. MRI appears to be a valuable technique for assessment of response to chemotherapy and identification of multifocal disease prior to surgery.

Imaging in evaluation of response to neoadjuvant breast cancer treatment benefits of MRI.

Ultrasonography of invasive lobular carcinoma of the breast: sonographic patterns and diagnostic value: report of 102 cases.

Les performances de l'echographie permettent d'augmenter la specificite de la mammographie aussi bien en depistage qu'en presence d'une anomalie palpable. En depistage de masse c'est essentiellement dans la caracterisation d'une opacite ACR 2 ou 3 que l'echographie est indiquee, permettant de differencier les kystes simples des kystes complexes et parmi les masses tissulaires d'orienter, par un certain nombre de criteres dont le plus puissant est l'irregularite des contours vers la surveillance ou la verification histologique. L'echographie par sa VPN est utile dans les asymetries de densite et les distorsions architecturales classees ACR 3 et 4 et pour les microcalcifications a la recherche d'un syndrome tissulaire associe. Devant une anomalie palpable, la VPN de l'echographie est tres elevee lorsque la mammographie est normale, en revanche, si l'image radiologique est classee ACR 3 l'histologie est recommandee. Dans les seins denses en presence de facteurs de risques, l'echographie augmente le nombre de cancers depistes par l'imagerie diminuant le taux de cancers d'intervalle qui sont les plus deleteres sur la survie.

Place de l'échographie dans le dépistage du cancer du sein

But : Les resultats des 158 premieres procedures de macrobiopsies mammaires par aspiration sur table dediee, effectuees de Janvier a Novembre 2001, au CRLCC Antoine-Lacassagne (Nice) sont presentes. Materiels et methodes: 139 examens (88 %) ont ete realises pour des microcalcifications, 19 (12 %) pour des opacites isolees. Il y avait 99 ACR 4 (62,4 %), 8 ACR 5 (5 %), 49 ACR 3 (31 %) et 2 ACR 2. Resultats : 124 lesions sont benignes dont 17 hyperplasies epitheliales atypiques (HEA). 34 lesions sont malignes dont 20 avec une composante invasive. 7 des HEA et toutes les lesions malignes ont eu une reprise chirurgicale. La sous-evaluation des HEA est de 28,57 % ; celle des carcinomes canalaires in situ de 35,7 %. La VPP des ACR 4 pour le diagnostic de malignite est de 22,2 % (22 cas /99). Celle des ACR 3 est de 10 % (5/49 cas). Parmi les 124 lesions benignes, 77 etaient classees ACR 4 et 1 ACR 5 (autant de procedures qui ont evite un acte chirurgical). Conclusion : Nous etudions les avantages, inconvenients et les limites de la technique et discutons des indications, en particulier dans la categorie ACR 3.

Macrobiopsies mammaires assistées par aspiration: Expérience du centre Antoine-Lacassagne (Nice)

Macrobiopsies mammaires assistées par aspiration

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