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Efficacy of 3D-MR mammography for breast conserving surgery after neoadjuvant chemotherapy
Seigo Nakamura1, Hironori Kenjo, Takeki Nishio
1Department of Surgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan.
Background:
One of the main roles of neoadjuvant chemotherapy for breast cancer is to shrink large tumors to increase patient eligibility for breast conserving surgery. Three dimensional MR Mammography (3D-MRM) can detect tumor extension more accurately compared with mammography and Ultrasonography (US). Therefore, the shrinkage pattern observed on 3D-MRM was analyzed with regard to several pathological factors.
Methods:
A total of 27 breast cancer cases were examined by 3D-MRM before and after neoadjuvant chemotherapy. The volume reduction and shrinkage patterns were assessed and compared with the pathological diagnosis.
Results:
There were two shrinkage patterns. Twelve of 25 evaluable breast cancers (48%) showed a concentric shrinkage pattern while 13 cases (52%) showed a dendritic shrinkage pattern. The cases with concentric shrinkage were good candidates for breast conserving surgery, But tumors showing dendritic shrinkage often had positive margins necessitating mastectomy. Pathologically, tumors with a papillotubular pattern, Estrogen receptor (ER) positivity, low nuclear grade and c-erbB 2 negativity tended to show dendritic shrinkage.
Conclusions:
3D-MRM is a useful modality for evaluating whether breast conserving surgery can be safely done in the neoadjuvant setting.