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Feasibility of mapping breast cancer with supine breast MRI in patients scheduled for oncoplastic surgery

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To prospectively determine the feasibility of preoperative supine breast MRI in breast cancer patients scheduled for oncoplastic breast-conserving surgery.

Methods

In addition to a diagnostic prone breast MRI, a supplementary supine MRI was performed with the patient in the surgical position including skin markers. Tumours’ locations were ink-marked on the skin according to findings obtained from supine MRI. Changes in tumours’ largest diameter and locations between prone and supine MRI were measured and compared to histology. Nipple-to-tumour and tumour-to-chest wall distances were also measured. Tumours and suspicious areas were surgically removed according to skin ink-markings. The differences between MRI measurements with reference to histopathology were evaluated with the paired-sample t test.

Results

Fourteen consecutive patients, 15 breasts and 27 lesions were analysed. Compared to histology, prone MRI overestimated tumour size by 47.1% (p = 0.01) and supine MRI by 14.5% (p = 0.259). In supine MRI, lesions’ mean diameters and areas were smaller compared to prone MRI (– 20.9%, p = 0.009 and – 38.3%, p = 0.016, respectively). This difference in diameter was more pronounced in non-mass lesions (– 31.2%, p = 0.031) compared to mass lesions (– 9.2%, p = 0.009). Tumours’ mean distance from chest wall diminished by 69.4% (p < 0.001) and from nipple by 18.2% (p < 0.001). Free microscopic margins were achieved in first operation in all patients.

Conclusions

Supine MRI in the surgical position is feasible and useful in the precise localisation of prone MRI-detected lesions and provides a helpful tool to implement in surgery. Supine MRI more accurately determines tumours’ size and location and might have an important role to diminish overestimations.

Key Points

• Breath-hold supine breast MRI is feasible using commercially available coils and sequences.

• Size and area of lesions on MRI were consistently smaller when measured from the supine position as compared to the prone position.

• Supine breast MRI is useful in the precise preoperative localisation of prone MRI-detected lesions.

•

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Abbreviations

BCS:

Breast-conserving surgery

DCIS:

Ductal carcinoma in situ

IDC:

Invasive ductal carcinoma

OBCS:

Oncoplastic breast-conserving surgery

VIBE:

Volumetric interpolated breath-hold examination

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Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. S. Joukainen and A. Masarwah contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, Division of Plastic Surgery, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland

    S. Joukainen

  2. Department of Clinical Radiology, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland

    A. Masarwah, M. Könönen, M. Husso, A. Sutela, R. Vanninen & M. Sudah

  3. Department of Pathology, Diagnostic Imaging Centre, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland

    V. Kärjä

  4. Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Yliopistonranta 1, 70210, Kuopio, Finland

    R. Vanninen

  5. Cancer Center of Eastern Finland, University of Eastern Finland, Yliopistonranta 1, 70210, Kuopio, Finland

    R. Vanninen

Authors
  1. S. Joukainen
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  2. A. Masarwah
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  3. M. Könönen
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  4. M. Husso
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  5. A. Sutela
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  8. M. Sudah
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Corresponding author

Correspondence to S. Joukainen.

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Guarantor

The scientific guarantor of this publication is Dr Mazen Sudah MD, PhD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Institutional review board approval was obtained.

Methodology

• prospective

• case-control, diagnostic study

• performed at one institution

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Joukainen, S., Masarwah, A., Könönen, M. et al. Feasibility of mapping breast cancer with supine breast MRI in patients scheduled for oncoplastic surgery. Eur Radiol 29, 1435–1443 (2019). https://doi.org/10.1007/s00330-018-5681-y

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  • DOI: https://doi.org/10.1007/s00330-018-5681-y

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