Breast MR imaging for the assessment of residual disease following initial surgery for breast cancer with positive margins Journal Article


Authors: Krammer, J.; Price, E. R.; Jochelson, M. S.; Watson, E.; Murray, M. P.; Schoenberg, S. O.; Morris, E. A.
Article Title: Breast MR imaging for the assessment of residual disease following initial surgery for breast cancer with positive margins
Abstract: Objectives: To determine the accuracy of post-operative MR in predicting residual disease in women with positive margins, emphasizing the size thresholds at which residual disease can be confidently identified. Methods: This IRB-approved HIPAA-compliant retrospective study included 175 patients with MR after positive margins following initial surgery for breast cancer. Two expert readers independently re-evaluated MR images for evidence of residual disease at the surgical cavity and multifocal/multicentric disease. All patients underwent definitive surgery and MR findings were correlated to histopathology. Results: 139/175 (79.4%) patients had residual disease at surgery. Average overall sensitivity, specificity, PPV and NPV for residual disease at the surgical cavity were 73%, 72%, 91% and 45%, respectively. The readers identified 42/45 (93%, reader 1) and 43/45 (95%, reader 2) patients with residual invasive disease at the cavity of ≥5 mm and 22/22 (100%, both readers) patients with disease ≥10 mm. Average sensitivity, specificity, PPV and NPV for unknown multifocal/multicentric disease were 90%, 96%, 93% and 86%, respectively. Conclusions: Post-operative breast MR can accurately depict ≥5-mm residual disease at the surgical cavity and unsuspected multifocal/multicentric disease. These findings have the potential to lead to more appropriate selection of second surgical procedures in women with positive margins. Key Points: • Post-operative breast MRI accurately defines residual disease of ≥5 mm. • Surgical cavity sensitivities were high for both invasive carcinoma and DCIS. • Post-surgical changes and very small residual disease (<5 mm) may overlap. • Post-operative breast MRI may help planning an accurate re-resection. © 2017, European Society of Radiology.
Keywords: magnetic resonance imaging; breast cancer; residual disease; breast-conserving therapy; positive margins
Journal Title: European Radiology
Volume: 27
Issue: 11
ISSN: 0938-7994
Publisher: Springer  
Date Published: 2017-11-01
Start Page: 4812
End Page: 4818
Language: English
DOI: 10.1007/s00330-017-4823-y
PROVIDER: scopus
PUBMED: 28567547
DOI/URL:
Notes: Article -- Export Date: 1 November 2017 -- Source: Scopus
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MSK Authors
  1. Melissa P Murray
    114 Murray
  2. Elizabeth A Morris
    295 Morris
  3. Elizabeth   Watson
    4 Watson