IMPACT OF MAGNETIC-RESONANCE-IMAGING IN DETERMINING SURGICAL-MANAGEMENT IN BREAST-CANCER

While conventional triple assessment (clinical, needle biopsy and mamm ography) has a high sensitivity in the diagnosis of symptomatic breast cancer, it has limitations in defining the extent of disease within t he breast and the axilla. The purpose of this study was to evaluate th e clinical settings in which pre-operative magnetic resonance imaging (MRT) may be of additional value to triple assessment. Eighty-six pati ents with breast cancer (including one bilateral cancer) diagnosed at triple assessment underwent preoperative contrast enhanced MRI. Based on clinical and mammographic findings and patient's choice of treatmen t (but not MR findings), 49 cancers were treated by wide local excisio n, of whom 16 (33%) had resection margin involvement. Residual disease at re-excision was detected in 8 of these 16 patients. The extent of residual disease in the re-excision specimen correlated accurately wit h the extent of contrast enhancement on MRI in all cases. There was go od size correlation between histological and MRI measurement of invasi ve tumour (r(2)=0.93) size compared with mammographic measurement of t umour size (r(2)=0.59). MRT was also more accurate than mammography in depicting multifocal/multicentric tumours (86% Versus 50%), intraduct extension associated with invasive tumours and assessment of the nipp le-retro-areolar complex. In conclusion, MRI may be of value in planni ng definitive surgical resection of breast cancer. Its incorporation i nto clinical use may have an impact on local recurrence rates and on t he number of patients considered suitable for breast conservation.