BACKGROUND:
Breast cancer has become a major threat to female health in Iraq, with a cancer-related mortality rate of (23%). Despite advances in early diagnosis, treatment, and biomarker identification of breast cancer, it carries a high risk of recurrence, about 20-30% and substantially worse overall survival.
AIM:
To evaluate the role of dynamic contrast enhanced magnetic resonance imaging in differentiation between benign postoperative changes and recurrent malignant tumors in postoperative patient with breast cancer.
PATIENTS AND METHODS:
Cross-sectional prospective study was performed at MRI unit of Al-Imamein Al-Kadhimein Medical city in Baghdad/ Iraq within the period from January 2019 to January 2020. The study included 29 female patients with 42 detected lesions suspected as local recurrent.All women were recruited for dynamic contrast enhanced (DCE-MRI).
RESULTS:
The mean age of 29 patients were 50.58±10.01 years (range 21-66 years). of the 42 detected lesions 22 proved histopathologically as local recurrence (17 were invasive ductal carcinoma, 2 were ductal carcinoma insitu and 3 were invasive lobular carcinoma), the remaining 20 were benign postoperative lesions (8 were fibrosis, 5 were granulation tissue, 5 were fat necrosis, 2 were seroma and 1 was diffuse skin thickening and edema). DCE-MRI study show to have a sensitivity of 95.5%, a specificity of 90%, Positive Predictive Value of 91.3% Negative Predictive Value of 94.7% and an accuracy of 92.86% in differentiation between benign postoperative changes and recurrent malignant tumors.
CONCLUSION:
DCE-MRI is a valuable tool in evaluation of postoperative breast as it has high sensitivity and specificity in differentiation between benign postoperative changes and recurrent malignant tumor.
|
- Catalano O, Nunziata A, Siani A. The breast, in fundamentals in oncologic ultrasound. Sonographic imaging and intervention. 1st ed. Italia: Springer-Verlag; 2009, p. 145–17.
- Nada A.S. Alwan. Breast Cancer among Iraqi Women: Preliminary Findings from a Regional Comparative Breast Cancer Research Project. J Glob Oncol. 2016; 2: 255–58.
- Morris E, Liberman L. Breast MRI. New York: Springer; 2004.
- Lowery AJ, Kell MR, Glynn RW, et al. Locoregional recurrence after breast cancer surgery: a systematic review by receptor phenotype. Breast Cancer Res Treat 2012; 133:831–41.
- Senkus E, Kyriakides S, Penault-Llorca F, et al. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013; 24:vi7–vi23.
- Grainger RG, Allison DJ, Dixon AK, et al. Grainger & Allisons diagnostic radiology: a textbook of medical imaging. Edinburgh: Churchill livingstone/Elsevier; 2015: 1669.
- Sharma U, Sah RG, Agarwal K, et al. Potential of Diffusion-Weighted Imaging in the Characterization of Malignant, Benign, and Healthy Breast Tissues and Molecular Subtypes of Breast Cancer. Frontiers in Oncology. 2016; 6.
- Yin J, Yang J, Han L, Guo Q, Zhang W: Quantitative discrimination between invasive ductal carcinomas and benign lesions based on semi-automatic analysis of time intensity curves from breast dynamic contrast enhanced MRI. J Exp Clin Cancer Res 2015;34: 24.
- Saleh OI, Attia M S.A., Ahmed H A., The role of magnetic resonance imaging in early detection of recurrent breast cancer. Egypt J Radiol Nucl Med. March 2017; 48: 293-301.
- Li CI, Uribe DJ, Daling JR. Clinical characteristics of different histological types of breast cancer. Br J Cancer. 2005;93:1046–52.
- Hyunkyung Y, Shin HJ, Baek S, et al. Diagnostic performance of apparent diffusion coefficient and quantitative kinetic parameters for predicting additional malignancy in patients with newly diagnosed breast cancer. Magn Reson Imag 2014; 32:867–74.
- Drukteinis JS, Gombos EC, Raza S, et al. MR imaging assessment of the breast after breast conservation therapy: distinguishing benign from malignant lesions. Radiographics 2012; 32:219–34.
- Dershaw DD, Li J, Lee CH, et al. Breast MRI after conservation therapy: usual findings in routine follow-up examinations. AJR Am J Roentgenol 2010; 195:799–807.
- Brennan S, Liberman L, Dershaw DD, et al. Breast MRI screening of women with a personal history of breast cancer ,AJR Am J Roentgenol 2010;195:510–16.
- EL-Adalany M A , Hamed E E-D , Role of dynamic contrast enhanced MRI in evaluation of post-operative breast lesions, _ 2016 The Egyptian Journal of Radiology and Nuclear Medicine 2016; 47:631–40.
- Fournier HO, Olson LK, Rochelle M, et al. Accelerated partial breast irradiation and posttreatment imaging evaluation. RadioGraphics 2011; 31:1701–16.
- Devon RK, Rosen MA, Mies C, et al. Breast reconstruction with a transverse rectus abdominis myocutaneous flap: spectrum of normal and abnormal MR imaging findings. Radiographics 2004; 24:1287–99.
- Kinoshita T, Yashiro N, Yoshigi J, et al. Fat necrosis of the breast: a potential pitfall in breast MRI. Clin Imag 2002; 26:250–53.
- Mansour SM, Behairy N. Residual breast cancer or postoperative changes: can diffusion magnetic resonance imaging solve the case? Egyp J Radilo Nucl Med 2015; 46:234–55.
- Tan S, Rahmat K, Rozalli F, Mohd-Shah M, Aziz Y, Yip C et al. Differentiation between benign and malignant breast lesions using quantitative diffusion-weighted sequence on 3 T MRI. 2014; 54:67-73.
- Whipp E, Beresford M, Sawyer E, Halliwell M. True local recurrence rate in the conserved breast after magnetic resonance imaging-targeted radiotherapy. J Radiat Oncol Biol Phys 2010; 76:984–90.
- Oh SD, Lee JS. A comparison of residual tumor accuracy prior to re-excision between breast magnetic resonance imaging and ultrasonography. J Breast Dis, 2014; 2:8–15.
|
