STAGING OF SYMPTOMATIC PRIMARY BREAST-CANCER WITH MR-IMAGING

OBJECTIVE. This study was designed to investigate the accuracy of cont rast-enhanced MR imaging in the locoregional staging of symptomatic pr imary breast cancer and to determine the impact of contrast-enhanced M R imaging in planning surgical management. MATERIALS AND METHODS. Nine ty patients with primary breast cancer (including two bilateral cancer s) diagnosed and treated on the basis of conventional triple assessmen t (clinical, cytologic, and mammographic examination) underwent MR ima ging at 1.0 T using a three-dimensional fast low-angle shot T1-weighte d pulse sequence before and after contrast enhancement. A short invers ion time inversion recovery sequence was also obtained to evaluate the axilla of each patient. After resection, tumors were histopathologica lly mapped in detail and correlated with the extent of contrast enhanc ement on MR imaging. RESULTS. On the basis of triple assessment, 53 ca ncers were treated by wide local excision, of which 17 (32%) had posit ive margins at excision. Residual disease at reexcision was detected i n eight of these 17 patients, a finding that correlated accurately wit h the extent of contrast enhancement on MR imaging. MR imaging was mor e accurate than mammography in determining invasive tumor size (r(2) = .93 versus r(2) = .59), in depicting multifocality and extensive intr aductal component (sensitivity, 81% versus 62%), and in assessing nipp le-retroareolar complex. MR imaging-histopathologic correlation was po ssible in 75 axillae. Sensitivity and specificity for axillary node me tastases were 90% and 82%, respectively. CONCLUSION. MR imaging of the breast has value in the preoperative locoregional staging of symptoma tic primary breast cancer and is useful in planning a single definitiv e surgical resection in patients with breast cancer.