Dynamic contrast enhanced Magnetic Resonance Imaging of the breast is superior to triple assessment for the pre-operative detection of multifocal breast cancer

Background: Inadequately treated multifocal and multicentric disease result s in increased local recurrence following breast-conserving surgery. The ac curate preoperative diagnosis of multifocal/ centric breast cancer would fa cilitate the planning of appropriate surgery and prevent reoperation for re sidual disease. While triple assessment remains the established diagnostic technique, its sensitivity for the diagnosis of multifocal disease remains poor. Dynamic contrast enhanced Magnetic Resonance Imaging (DCE-MRI) of the breast represents an alternative emerging diagnostic modality that has bee n shown to be highly sensitive for the delineation of primary breast cancer . The aim of this; study was to prospectively compare the diagnostic accura cy of DCE-MRI of the breast with conventional triple assessment for the pre operative diagnosis of multifocal/centric breast cancer. Methods: Patients were recruited from the symptomatic breast clinics. All p atients underwent standard triple assessment and DCE-MRI. The MRI scans wer e reported by a single radiologist blinded to the results of the triple ass essment, Surgery was then planned accordingly to all available scan results and the specimens examined by a single pathologist. All patients who did n ot undergo surgery have been followed up for a minimum of 18 months. Results: A total of 334 women were recruited. There were 178 (52%) cancers that were histologically confirmed and multifocal/centric breast cancer was diagnosed provisionally by the preoperative investigations in 68 (38%); mu ltifocal n = 33, multicentric n = 35, of these patients. In this group, sub sequent histology confirmed multifocal/centric disease in 50 (73.5%): multi focal n = 15, multicentric n = 35. Unifocal cancer was found in 15 (22%) an d benign disease in 3 (4.4%). The resultant sensitivity, specificity, posit ive, and negative predictive values were 18%, 100%, 100%, and 76% for tripl e assessment and 100%, 86%, 73%, and 100% for DCE-MRI. Conclusion: DCE-MRI identified a subgroup of breast cancer patients with mu ltifocal/centric disease not evident on standard triple assessment. MRI of the breast should be considered for the preoperative planning of surgery fo r primary breast cancer.