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Screening for Recurrences in Patients Treated with Breast-Conserving Surgery: Is there a Role for MRI?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Although it has been shown that magnetic resonance imaging (MRI) is more sensitive than mammography in the detection of breast cancer in high-risk populations, there is little data on the use of MRI as a screening tool to detect recurrence after breast-conserving surgery. Our objective was to determine the potential role of MRI in the screening of breast cancer patients treated with breast-conserving surgery.

Methods

Retrospective chart review of all patients undergoing margin-negative lumpectomy and adjuvant radiation therapy for infiltrating breast carcinoma between 1st January 1993 and 1st January 2004. Patients were followed for recurrence in the ipsilateral or contralateral breast by physical exam and mammography.

Results

Four hundred and seventy-six primary tumor excisions were performed. Patients were followed for a median of 5.4 years. Ipsilateral breast recurrences developed in eight patients (1.7%) with a mean diameter of 1.6 cm. All of these women are alive and free of metastases. Contralateral cancers developed in 11 patients (2.3%) with a mean diameter of 1.5 cm. Ten of these 11 women are alive and free of disease.

Conclusions

In a contemporary patient population the risk of local recurrence after lumpectomy and radiation therapy is very low. If screening MRI had been a part of annual follow-up, a total of 2570 MRIs would have been performed. Given the small tumor size at detection and the excellent survival of those who recurred, annual screening MRI would have incurred significant cost and would have been unlikely to improve overall survival.

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References

  1. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: Breast Cancer V.2.2007. Accessed September 1, 2007. http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf

  2. Kriege M, Brekelmans CT, Boetes C, et al. Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med 2004; 351:427–37

    Article  PubMed  CAS  Google Scholar 

  3. Leach MO, Boggis CR, Dixon AK, et al. Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS). Lancet 2005; 365:1769–78

    Article  PubMed  CAS  Google Scholar 

  4. Warner E, Plewes DB, Hill KA, et al. Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination. JAMA 2004; 292:1317–25

    Article  PubMed  CAS  Google Scholar 

  5. Early Breast Cancer Trialists’ Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15–year survival: an overview of the randomised trials. Lancet 2005; 365:1687–717

    Article  CAS  Google Scholar 

  6. Anscher MS, Jones P, Prosnitz LR, et al. Local failure and margin status in early-stage breast carcinoma treated with conservation surgery and radiation therapy. Ann Surg 1993; 218:22–8

    Article  PubMed  CAS  Google Scholar 

  7. Burke M, Allison R, Tipcony L. Conservative therapy of breast cancer in Queensland. Int J Radiat Oncol Biol Phys 1995:31:295–303

    PubMed  CAS  Google Scholar 

  8. Heimann R, Powers C, Halpern HJ, et al. Breast preservation in stage I and II carcinoma of the breast. The University of Chicago experience. Cancer 1996:78:1722–30

    Article  PubMed  CAS  Google Scholar 

  9. Pierce LJ, Stawderman MH, Douglas KR, et al. Conservative surgery and radiotherapy for early-stage breast cancer using a lung density correction: The University of Michigan experience. Int J Radiat Oncol Biol Phys 1997; 39:921–8

    PubMed  CAS  Google Scholar 

  10. Freedman G, Fowble B, Hanlon A, et al. Patients with early stage invasive cancer with close or positive margins treated with conservative surgery and radiation have an increased risk of breast recurrence that is delayed by adjuvant systemic therapy. Int J Radiat Oncol Biol Phys 1999; 44:1005–15

    PubMed  CAS  Google Scholar 

  11. Fyles AW, McCready DR, Manchul LA, et al. Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer. N Engl J Med 2004; 351:963–70

    Article  PubMed  CAS  Google Scholar 

  12. Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002; 347:1227–32

    Article  PubMed  Google Scholar 

  13. Fisher B, Anderson S, Bryant J, et al. 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 2002; 347:1233–41

    Article  PubMed  Google Scholar 

  14. Clarke M, Collins R, Darby S, et al. 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 2005; 366:2087–106

    PubMed  CAS  Google Scholar 

  15. Punglia RS, Morrow M, Winer EP, et al. Local therapy and survival in breast cancer. N Engl J Med 2007; 356:2399–405

    Article  PubMed  CAS  Google Scholar 

  16. Morris EA, Liberman L, Ballon D, et al. MRI of occult breast carcinoma in a high risk population. AJR 2003; 181:619–26

    PubMed  Google Scholar 

  17. Barth RJ, Gibson GR, Carney PA, et al. Detection of breast cancer on screening mammography allows patients to be treated with less-toxic therapy. AJR 2005; 184:324–9

    PubMed  Google Scholar 

  18. Fowble B, Hanlon A, Freedman G, et al. Second cancers after conservative surgery and radiation for stages I–II breast cancer: identifying a subset of women at increased risk. Int J Radiat Oncol Biol Phys 2001; 51:679–90

    PubMed  CAS  Google Scholar 

  19. Pierce L, Levin A, Rebbeck T, et al. Ten year multi-institutional results of breast conserving surgery and radiotherapy in BRCA1/2 associated stage I/ II breast cancer. J Clin Oncol 2006; 24:2437–43

    Article  PubMed  Google Scholar 

  20. Robson M. Clinical considerations in the management of individuals at risk for hereditary breast and ovarian cancer. Cancer Control 2002; 9:457–65

    PubMed  Google Scholar 

  21. Liberman L, Morris EA, Dershaw DD, et al. MR imaging of the ipsilateral breast in women with percutaneously proven breast cancer. AJR 2003; 180:901–10

    PubMed  Google Scholar 

  22. Tillman GF, Orel SG, Schnall MD, et al. Effect of breast magnetic resonance imaging on the clinical management of women with early-stage breast carcinoma. J Clin Oncol 2002; 20:3413–23

    Article  PubMed  Google Scholar 

  23. Saslow D, Boetes C, Burke W, et al. American Cancer Society Guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin 2007; 57:75–89

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Dartmouth-Hitchcock Medical Center and Norris Cotton Cancer Center, Lebanon, NH, 03756, USA

    John W. Gorechlad MD, Elizabeth B. McCabe MS, ARNP, John H. Higgins MS, Donald S. Likosky PhD, Kari M. Rosenkranz MD & Richard J. Barth Jr MD

  2. Department of Radiology, Dartmouth-Hitchcock Medical Center and Norris Cotton Cancer Center, Lebanon, NH, 03756, USA

    Petra J. Lewis MB, BS

Authors
  1. John W. Gorechlad MD
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  2. Elizabeth B. McCabe MS, ARNP
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  3. John H. Higgins MS
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  4. Donald S. Likosky PhD
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  5. Petra J. Lewis MB, BS
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  6. Kari M. Rosenkranz MD
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  7. Richard J. Barth Jr MD
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Corresponding author

Correspondence to Richard J. Barth Jr MD.

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Gorechlad, J.W., McCabe, E.B., Higgins, J.H. et al. Screening for Recurrences in Patients Treated with Breast-Conserving Surgery: Is there a Role for MRI?. Ann Surg Oncol 15, 1703–1709 (2008). https://doi.org/10.1245/s10434-008-9832-2

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  • DOI: https://doi.org/10.1245/s10434-008-9832-2

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