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2014, Number 3

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Anales de Radiología México 2014; 13 (3)

Role of magnetic resonance in the surgical treatment decision in patients with recent diagnosis of breast cancer

Avendaño-Ávalos DB, Garza-Montemayor ML

Language: Spanish
References: 48
Page: 277-291
PDF size: 659.49 Kb.


ABSTRACT

Objective: determine the implications, in surgical management of patients with recent diagnosis of breast cancer, of preoperative magnetic resonance studies.
Patients and methods: retrospective, transverse analysis of magnetic resonance breast studies (n = 200) performed by the Hospital San Jose TEC de Monterrey Radiology and Imaging Department, from May 2010 through June 2013. One hundred and one patients with recent diagnosis of breast cancer confirmed histologically and with conventional image studies (mammogram and ultrasound), in addition to magnetic resonance, were included. An observer retrospectively analyzed the image studies (mammogram, ultrasound) to determine unifocal, multifocal, multicentric disease (using the BIRADS system), to evaluate the extent of the disease and to distinguish the therapeutic approach (conservative surgery vs. mastectomy) proposed initially. In the second stage, all magnetic resonance studies (Magnetom 1.5T, Siemens® Medical System) performed on the same patients were analyzed to evaluate the local extent of the cancer and check for additional foci which could change the approach in surgical treatment. The incidence of additional cancerous lesions detected by magnetic resonance and not suspected in conventional image studies was determined; finally, the percentage of change in surgical treatment from the initial proposal was calculated.
Results: In 68/101 patients conservative surgery was considered the appropriate treatment. Following review by magnetic resonance of breasts, a therapeutic change was considered in 43 patients (42.57%); more extensive surgery (quadrantectomy instead of tumorectomy) was recommended in 9 cases (8.9%) due to additional cancerous lesions (multifocal disease); in 30 cases (29.7%) mastectomy instead of conservative surgery (23 cases were due to detection of additional cancerous lesions in relation to multicentric disease, in 7 cases due to greater extension of the primary tumor). In 4 cases (3.9%) tumorectomy was indicated due to detection of synchronous cancer in the contralateral breast.
Conclusion: magnetic resonance of breasts often helps to discover additional malignant lesions not detected by conventional imaging methods; this leads to changes in surgical approach, usually to more extensive surgeries.


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