The Role of Magnetic Resonance Imaging in the Identification of Multicentric Lesions in Breast Cancer

Purpose: To study the effectiveness of magnetic resonance imaging of the mammary glands in detecting multicentric lesions in breast cancer.

Matreial and Methods: From 2022 to 2023, a prospective study was conducted, including 57 breast cancer patients, who underwent magnetic resonance imaging of the mammary glands for the purpose of clarifying the diagnosis of the process, followed by surgical treatment in the Department of Oncology and reconstructive Plastic Surgery of the breast and skin of the P.A. Herzen Moscow State Medical Institute. In the postoperative period, the data of magnetic resonance imaging of the mammary glands and the results of a pathomorphological examination of the surgical material were compared.

Results: Multicentricity was confirmed in 21 (38.9 й) patients out of 54 patients with breast cancer with multicentric lesion (sTm) according to magnetic resonance imaging of the mammary glands during a planned pathomorphological examination of the surgical material. In 3 patients (5.3 й), a multicentric lesion was revealed by the results of a pathomorphological examination, whereas magnetic resonance imaging determined one pathological focus. Surgical treatment in the volume of mastectomy, including subcutaneous /skin-preserving mastectomy with a reconstructive plastic component was performed in 44 (77.2 й), in 13 (22.8 й) cases organ-preserving surgery.

Conclusion: Thus, in most cases, multicentricity according to instrumental examination (magnetic resonance imaging) was not confirmed during the pathomorphological examination of the surgical material, which led to the performance of a larger volume of surgical intervention, namely mastectomies or mastectomies with reconstruction. A more careful selection of patients who are shown magnetic resonance imaging in the diagnostic search is needed.

1. The state of cancer care for the population of Russia in 2022. Edited by AD Kaprin, VV Starinsky, AO Shakhzadova; Moscow, 2022. (In Russ.)

2. Britton P, Warwick J, Wallis MG, et al. Measuring the accuracy of diagnostic imaging in symptomatic breast patients: team and individual performance. Br J Radiol. 2012;85:415-22.

3. Mann RM, Kuhl CK, Moy L. Contrast-enhanced MRI for breast cancer screening. J Magn Reson Imaging. 2019;50(2):377-90. https://doi.org/10.1002/jmri.26654. Epub 2019 Jan 18. PMID: 30659696; PMCID: PMC6767440.

4. Mann RM, Cho N, Moy L. Breast MRI: State of the Art. Radiology. 2019;292:520-36.

5. Mann RM, Hoogeveen YL, Blickman JG, Boetes C. MRI compared to conventional diagnostic work-up in the detection and evaluation of invasive lobular carcinoma of the breast: a review of existing literature. Breast Cancer Res Treat. 2008;107:1-14.

6. Mann RM, Cho N, Moy L. Breast MRI: State of the Art. Radiology. 2019;292(3):520-36. https://doi.org/10.1148/radiol.2019182947.

7. Song SE, Park EK, Cho KR, Seo BK, Woo OH, Jung SP, Cho SB. Additional value of diffusion-weighted imaging to evaluate multifocal and multicentric breast cancer detected using preoperative breast MRI. Eur Radiol. 2017;27(11):4819-27. https://doi.org/10.1007/s00330-017-4898-5.

8. Waugh SA, Purdie CA, Jordan LB et al. Magnetic resonance imaging texture analysis classification of primary breast cancer. Eur Radio. 2016;l26:322-30.

9. Pinker K, Moy L, Sutton EJ, et al. Diffusion-Weighted Imaging With Apparent Diffusion Coefficient Mapping for Breast Cancer Detection as a Stand-Alone Parameter: Comparison With Dynamic Contrast-Enhanced and Multiparametric Magnetic Resonance Imaging. Invest Radiol. 2018;53(10):587-95. https://doi.org/10.1097/RLI.0000000000000465.

10. Lee SH, Shin HJ, Moon WK. Diffusion-Weighted Magnetic Resonance Imaging of the Breast: Standardization of Image Acquisition and Interpretation. Korean J Radiol. 2021;22(1):9-22. https://doi.org/10.3348/kjr.2020.0093.

11. Schnall M: MR imaging evaluation of cancer extent: Is there clinical relevance? Magn Reson Imaging Clin N Am. 2006;14:379-81.

12. Liberman L. Breast MR imaging in assessing extent of disease. Magn Reson Imaging Clin N Am. 2006;14:339-49.

13. Houssami N, Ciatto S, Macaskill P, et al. Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol. 2008;26(19):3248-58. https://doi.org/10.1200/JCO.2007.15.2108.

14. Mota BS, Reis YN, de Barros N, et al. Effects of preoperative magnetic resonance image on survival rates and surgical planning in breast cancer conservative surgery: randomized controlled trial (BREAST-MRI trial). Breast Cancer Res Treat. 2023;198(3):447-61. https://doi.org/10.1007/s10549-023-06884-5.

15. Lobbes MB, Vriens IJ, van Bommel AC, et al. Breast MRI increases the number of mastectomies for ductal cancers, but decreases them for lobular cancers. Breast Cancer Res Treat. 2017;162(2):353-64. https://doi.org/10.1007/s10549-017-4117-8.

16. Houssami N, Turner R, Morrow M. Preoperative magnetic resonance imaging in breast cancer: meta-analysis of surgical outcomes. Ann Surg. 2013;257(2):249-55. https://doi.org/10.1097/SLA.0b013e31827a8d17.

17. Turnbull L, Brown S, Harvey I, et al. Comparative effectiveness of MRI in breast cancer (COMICE) trial: a randomised controlled trial. Lancet. 2010;13;375(9714):563-71. https://doi.org/10.1016/S0140-6736(09)62070-5.

18. Gonzalez V, Sandelin K, Karlsson A, et al. Preoperative MRI of the breast (POMB) inŇuences primary treatment in breast cancer: a prospective, randomized, multicenter study. World J Surg. 2014;38(7):1685-93. https://doi.org/10.1007/s00268-014-2605-0.

19.