J Breast Cancer.  2019 Sep;22(3):453-463. 10.4048/jbc.2019.22.e36.

Measuring Tumor Extent Based on Subtypes Using Magnetic Resonance Imaging: Radiologic-Pathologic Discordance and High Positive Margin Rates in Breast Cancer

• Bae SJ
• Ahn SG
• Yoon CI
• Yang BS
• Lee HW
• Son EJ
• Jeong J

• KMID: 2458865
• DOI: http://doi.org/10.4048/jbc.2019.22.e36

Abstract

PURPOSE
We evaluated the clinical value of breast magnetic resonance imaging (MRI) in patients who underwent breast-conserving surgery (BCS). The degree of correlation between pathology size and MRI or ultrasonography (US) size was compared based on breast cancer subtypes. In addition, we investigated the positive margin rates.
METHODS
Patients with invasive breast cancer who underwent preoperative breast MRI and US between 2011 and 2016 were included in the study. Lin's concordance correlation coefficient was used to measure the correlation between MRI or US andpathologic tumor extent. Tumor extent was defined as pathologic tumor size, including in situ carcinoma. Margin positivity was assessed based on frozen-section examination.
RESULTS
A total of 516 patients with a single tumor who underwent BCS were included in the study. The correlation between pathologic size and MRI was significantly higher than that of US (r = 0.6975 vs. 0.6211, p = 0.001). The superiority of MRI over US in measuring the pathologic extent was only observed in triple-negative breast cancer (TNBC; r = 0.8089 vs. 0.6014, p < 0.001). The agreement between MRI or US and tumor extent was low for the human epidermal growth factor receptor 2 (HER2)-positive subtype (MRI: 0.5243, US: 0.4898). Moreover, the positive margin rate was higher in the HER2-positive subtype than in the others (luminal/HER2-negative: 11.6%, HER2-positive: 23.2%, TNBC: 17.8%, p = 0.019). The post hoc analysis showed that the HER2-positive subtype was more likely to show positive margins than the luminal/HER2-negative subtype (p = 0.007).
CONCLUSION
Breast MRI was superior to US in the preoperative assessment of the pathologic extent of tumor size; this was most evident in TNBC. For HER2-positive tumors, imaging-pathologic discordance resulted in higher positive margin rates than that with other subtypes.

Keyword

Breast neoplasms; Magnetic resonance imaging; Margins of excision; Receptor, ErbB-2; Ultrasonography

MeSH Terms

Breast Neoplasms*
Breast*
Humans
Magnetic Resonance Imaging*
Mastectomy, Segmental
Pathology
Receptor, Epidermal Growth Factor
Receptor, ErbB-2
Triple Negative Breast Neoplasms
Ultrasonography
Receptor, Epidermal Growth Factor
Receptor, ErbB-2

Figure

• 

  Figure 1 Correlation between pathologic size and US or MRI. All patients: (A) US, (B) MRI; luminal/HER2-negative: (C) US, (D) MRI; HER2-positive: (E) US, (F) MRI; TNBC: (G) US, (H) MRI. US = ultrasonography; MRI = magnetic resonance imaging; HER2 = human epidermal growth factor receptor 2.

• 

  Figure 2 Positive margin and re-excision rates according to subtypes. (A) Positive margin rates and (B) re-excision rates based on subtypes (luminal/HER2-negative, HER2-positive, and TNBC), (C) positive margin rates and (D) re-excision rates based on HER2 expression. HER2 = human epidermal growth factor receptor 2; TNBC = triple-negative breast cancer.

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