A new UK study has reported that preoperative breast MRIs alter the surgical management of approximately 20% of lobular breast cancer patients. An additional 20% will undergo additional imaging and biopsies that do not change disease management. National health guidelines introduced in January 2009 in the UK suggest that patients with lobular breast cancer should be offered breast MRIs.
MRIs should be used to measure the size of the tumor or tumors and exclude multifocal (more than one tumor) and contralateral (in the other breast) disease.
The study included 69 women with lobular breast cancer diagnosed before and after January 2009. Medical records were reviewed and compared with regard to type of surgery, positive margins and changes in patient management as a result of MRIs. The number of additional targeted breast ultrasound scans and biopsies was also documented. A total of 22 of the women had preoperative MRI scans.
No significant difference was found in mastectomy rates or positive surgical margins following lumpectomy.
Of the 22 patients who received MRIs, 11 new findings were reported in the MRI results, including six in the contralateral breast, leading to nine targeted ultrasound scans and eight additional core biopsies. Three of these additional biopsies confirmed malignancy. Two of the MRI scans found multifocal disease and one diagnosed contralateral DCIS. A total of four of the 22 MRI patients’ management was revised due to the MRI result, one of which was due to an increase in estimated tumor size.
However, one case of additional multifocal disease was invisible on all imaging, reflecting lobular breast cancer's reputation for being more difficult to detect than other forms of breast cancer.
Please see our article on diet for lobular breast cancer patients and survivors for more information on how to reduce risk of recurrence.
Selected breast cancer studies
Impact of initial surgical margins and residual cancer upon re-excision on outcome of patients with localized breast cancer
Kouzminova NB, Aggarwal S, Aggarwal A, Allo MD, Lin AY. Impact of initial surgical margins and residual cancer upon re-excision on outcome of patients with localized breast cancer. The American Journal of Surgery. Elsevier BV; 2009; 198:771-780 10.1016/j.amjsurg.2009.05.027
Conservative surgery in patients with multifocal/multicentric breast cancer
Gentilini O, Botteri E, Rotmensz N, Da Lima L, Caliskan M, Garcia-Etienne CA, et al. Conservative surgery in patients with multifocal/multicentric breast cancer. Breast Cancer Research and Treatment. Springer Science and Business Media LLC; 2008; 113:577-583 10.1007/s10549-008-9959-7