Skip to main content

Advertisement

SpringerLink
Log in

Multiple foci of invasive breast cancer: can breast MRI influence surgical management?

  • Review
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

The use of MRI to assess the extent of breast disease is gaining increasing popularity with the subsequent detection of multiple invasive foci within the breast that had not been identified on previous standard mammography and ultrasonography. What impact this has on subsequent surgical management and ultimately disease-free survival remains a controversial topic. Should histologically confirmed multiple foci of invasive disease within a breast steer the surgical management towards mastectomy, or is there a role in select patients for breast conserving surgery, even if two or more incisions are required? This review considers the evidence for how MRI affects the mastectomy rate and compares this to surgical outcomes for breast conserving surgery in the presence of multiple invasive foci.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347(16):1227–1232. doi:10.1056/NEJMoa020989347/16/1227[pii]

    Article  PubMed  Google Scholar 

  2. Kuhl CK, Schrading S, Leutner CC, Morakkabati-Spitz N, Wardelmann E, Fimmers R, Kuhn W, Schild HH (2005) Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer. J Clin Oncol 23(33):8469–8476. doi:10.1200/jco.2004.00.4960

    Article  PubMed  Google Scholar 

  3. Houssami N, Ciatto S, Macaskill P, Lord SJ, Warren RM, Dixon JM, Irwig L (2008) Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol 26(19):3248–3258. doi:JCO.2007.15.2108[pii]10.1200/JCO.2007.15.2108

    Article  PubMed  Google Scholar 

  4. Holland R, Veling SH, Mravunac M, Hendriks JH (1985) Histologic multifocality of Tis, T1–2 breast carcinomas. Implications for clinical trials of breast-conserving surgery. Cancer 56(5):979–990

    Article  PubMed  CAS  Google Scholar 

  5. Douek M, Vaidya JS, Baum M, Taylor I (1998) Magnetic-resonance imaging and breast cancer multicentricity. Lancet 352(9128):652–653

    Article  PubMed  CAS  Google Scholar 

  6. Turnbull L, Brown S, Harvey I, Olivier C, Drew P, Napp V, Hanby A, Brown J (2010) Comparative effectiveness of MRI in breast cancer (COMICE) trial: a randomised controlled trial. Lancet 375(9714):563–571. doi:S0140-6736(09)62070-5[pii]10.1016/S0140-6736(09)62070-5

    Article  PubMed  Google Scholar 

  7. Lagios MD, Westdahl PR, Rose MR (1981) The concept and implications of multicentricity in breast carcinoma. Pathol Annu 16(Pt 2):83–102

    PubMed  CAS  Google Scholar 

  8. Edge SB, American JointCommittee on Cancer (2010) AJCC cancer staging manual, 7th edn. Springer, London, New York

    Google Scholar 

  9. Sardanelli F, Giuseppetti GM, Panizza P, Bazzocchi M, Fausto A, Simonetti G, Lattanzio V, Del Maschio A (2004) Sensitivity of MRI versus mammography for detecting foci of multifocal, multicentric breast cancer in fatty and dense breasts using the whole-breast pathologic examination as a gold standard. Am J Roentgenol 183(4):1149–1157

    Google Scholar 

  10. Guidelines for Pathology Reporting in Breast Cancer Screening (2005) NHSBSP Publication No 58 edn. NHS Cancer Screening Programmes jointly with The Royal College of Pathologists

  11. Oh JL (2008) Multifocal or multicentric breast cancer: understanding its impact on management and treatment outcomes. In: Hayat MA (ed) Methods of cancer diagnosis, therapy and prognosis, vol 1. Springer Netherlands, Dordrecht, pp 583–587. doi:10.1007/978-1-4020-8369-3_40

  12. Oh JL, Dryden MJ, Woodward WA, Yu TK, Tereffe W, Strom EA, Perkins GH, Middleton L, Hunt KK, Giordano SH, Oswald MJ, Domain D, Buchholz TA (2006) Locoregional control of clinically diagnosed multifocal or multicentric breast cancer after neoadjuvant chemotherapy and locoregional therapy. J Clin Oncol 24(31):4971–4975. doi:24/31/4971[pii]10.1200/JCO.2006.07.6067

    Article  PubMed  Google Scholar 

  13. Leopold KA, Recht A, Schnitt SJ, Connolly JL, Rose MA, Silver B, Harris JR (1989) Results of conservative surgery and radiation therapy for multiple synchronous cancers of one breast. Int J Radiat Oncol Biol Phys 16(1):11–16. doi:0360-3016(89)90004-7[pii]

    Article  PubMed  CAS  Google Scholar 

  14. Kurtz JM, Jacquemier J, Amalric R, Brandone H, Ayme Y, Hans D, Bressac C, Spitalier JM (1990) Breast-conserving therapy for macroscopically multiple cancers. Ann Surg 212(1):38–44

    Article  PubMed  CAS  Google Scholar 

  15. Wilson LD, Beinfield M, McKhann CF, Haffty BG (1993) Conservative surgery and radiation in the treatment of synchronous ipsilateral breast cancers. Cancer 72(1):137–142

    Article  PubMed  CAS  Google Scholar 

  16. Hartsell WF, Recine DC, Griem KL, Cobleigh MA, Witt TR, Murthy AK (1994) Should multicentric disease be an absolute contraindication to the use of breast-conserving therapy? Int J Radiat Oncol Biol Phys 30(1):49–53. doi:0360-3016(94)90518-5[pii]

    PubMed  CAS  Google Scholar 

  17. Nos C, Bourgeois D, Darles C, Asselain B, Campana F, Zafrani B, Durand JC, Clough K (1999) Conservative treatment of multifocal breast cancer: a comparative study. Bull Cancer 86(2):184–188

    PubMed  CAS  Google Scholar 

  18. Cho LC, Senzer N, Peters GN (2002) Conservative surgery and radiation therapy for macroscopically multiple ipsilateral invasive breast cancers. Am J Surg 183(6):650–654. doi:S0002961002008644[pii]

    Article  PubMed  Google Scholar 

  19. Kaplan J, Giron G, Tartter PI, Bleiweiss IJ, Estabrook A, Smith SR (2003) Breast conservation in patients with multiple ipsilateral synchronous cancers. J Am Coll Surg 197(5):726–729. doi:S1072-7515(03)00866-4[pii]10.1016/j.jamcollsurg.2003.06.003

    Article  PubMed  Google Scholar 

  20. Setsuko O, Michihide M, Chikako Y, Sachiko K, Natsuo O, Yasushi N, Masahiro H, Masaki K, Keiichi M, Hiroshi K (2004) Feasibility of breast-conserving therapy for macroscopically multiple ipsilateral breast cancer. Int J Radiat Oncol Biol Phys 59(1):146–151

    Article  Google Scholar 

  21. Gentilini O, Botteri E, Rotmensz N, Da Lima L, Caliskan M, Garcia-Etienne CA, Sosnovskikh I, Intra M, Mazzarol G, Musmeci S, Veronesi P, Galimberti V, Luini A, Viale G, Goldhirsch A, Veronesi U (2009) Conservative surgery in patients with multifocal/multicentric breast cancer. Breast Cancer Res Treat 113(3):577–583. doi:10.1007/s10549-008-9959-7

    Article  PubMed  Google Scholar 

  22. Rakovitch E, Pignol J-P, Hanna W, Narod S, Spayne J, Nofech-Mozes S, Chartier C, Paszat L (2007) Significance of multifocality in ductal carcinoma in situ: outcomes of women treated with breast-conserving therapy. J Clin Oncol 25(35):5591–5596

    Article  PubMed  Google Scholar 

  23. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347(16):1233–1241. doi:10.1056/NEJMoa022152347/16/1233[pii]

    Article  PubMed  Google Scholar 

  24. Clough KB, Lewis JS, Couturaud B, Fitoussi A, Nos C, Falcou MC (2003) Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg 237(1):26–34. doi:10.1097/01.SLA.0000041230.77663.22

    Article  PubMed  Google Scholar 

  25. Patani N, Carpenter R (2010) Oncological and aesthetic considerations of conservational surgery for multifocal/multicentric breast cancer. Breast J 16(3):222–232. doi:10.1111/j.1524-4741.2010.00917.x

    Article  PubMed  Google Scholar 

  26. Bozzini A, Renne G, Meneghetti L, Bandi G, Santos G, Vento AR, Menna S, Andrighetto S, Viale G, Cassano E, Bellomi M (2008) Sensitivity of imaging for multifocal-multicentric breast carcinoma. BMC Cancer 8:275. doi:1471-2407-8-275[pii]10.1186/1471-2407-8-275

    Article  PubMed  Google Scholar 

  27. Wilkinson LS, Given-Wilson R, Hall T, Potts H, Sharma AK, Smith E (2005) Increasing the diagnosis of multifocal primary breast cancer by the use of bilateral whole-breast ultrasound. Clin Radiol 60(5):573–578

    Article  Google Scholar 

  28. Lim HI, Choi JH, Yang JH, Han BK, Lee JE, Lee SK, Kim WW, Kim S, Kim JS, Kim JH, Choe JH, Cho EY, Kang SS, Shin JH, Ko EY, Kim SW, Nam SJ (2010) Does pre-operative breast magnetic resonance imaging in addition to mammography and breast ultrasonography change the operative management of breast carcinoma? Breast Cancer Res Treat 119(1):163–167. doi:10.1007/s10549-009-0525-8

    Article  PubMed  Google Scholar 

  29. Pediconi F, Catalano C, Padula S, Roselli A, Moriconi E, Dominelli V, Pronio AM, Kirchin MA, Passariello R (2007) Contrast-enhanced magnetic resonance mammography: does it affect surgical decision-making in patients with breast cancer? Breast Cancer Res Treat 106(1):65–74

    Article  PubMed  Google Scholar 

  30. Turnbull LW, Brown SR, Olivier C, Harvey I, Brown J, Drew P, Hanby A, Manca A, Napp V, Sculpher M, Walker LG, Walker S (2010) Multicentre randomised controlled trial examining the cost-effectiveness of contrast-enhanced high field magnetic resonance imaging in women with primary breast cancer scheduled for wide local excision (COMICE). Health Technol Assess 14(1):1–182. doi:10.3310/hta14010

    PubMed  CAS  Google Scholar 

  31. Fischer U, Kopka L, Grabbe E (1999) Breast carcinoma: effect of preoperative contrast-enhanced MR imaging on the therapeutic approach. Radiology 213(3):881–888

    PubMed  CAS  Google Scholar 

  32. Solin LJ (2010) Counterview: pre-operative breast MRI (magnetic resonance imaging) is not recommended for all patients with newly diagnosed breast cancer. Breast 19(1):7–9. doi:S0960-9776(09)00164-7[pii]10.1016/j.breast.2009.11.004

    Article  PubMed  Google Scholar 

  33. Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E, Godwin J, Gray R, Hicks C, James S, MacKinnon E, McGale P, McHugh T, Peto R, Taylor C, Wang Y (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366(9503):2087–2106. doi:S0140-6736(05)67887-7[pii]10.1016/S0140-6736(05)67887-7

    PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Research Oncology, Kings College London, 3rd Floor Bermondsey Wing, Guys Hospital, London, SE1 9RT, UK

    L. Johnson, S. Pinder & M. Douek

Authors
  1. L. Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Pinder
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Douek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. Johnson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Johnson, L., Pinder, S. & Douek, M. Multiple foci of invasive breast cancer: can breast MRI influence surgical management?. Breast Cancer Res Treat 128, 1–5 (2011). https://doi.org/10.1007/s10549-011-1491-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-011-1491-5

Keywords

Search

Navigation