Agreement between MRI and pathologic analyses for determination of tumor size and correlation with immunohistochemical factors of invasive breast carcinoma

Abstract

Background

There may be discordance between tumor size determined by magnetic resonance imaging (MRI) and that observed during pathologic analyses.

Purpose

To evaluate MRI-pathology concordance of tumor size in patients with invasive breast carcinoma.

Material and Methods

Data from 307 invasive breast carcinomas were analyzed retrospectively. Preoperative breast MRI was reviewed for size, lesion type, morphology, and dynamic contrast-enhanced tumor kinetics. MRI tumor size was compared with tumor size measurements from the pathologic analysis. Concordance was defined as a difference in diameter of ≤ 0.5 cm. MRI-pathology concordance was compared according to clinical and histopathologic features.

Results

The mean tumor size on MRI was 2.48 ± 1.41 cm. Tumor measurements determined by MRI were not significantly different from those recorded in the pathologic reports (2.56 ± 1.61 cm, P = 0.199). MRI-pathology concordance was found in 229/307 (74.6%) cases; the size was overestimated in 36 (11.7%) tumors and underestimated in 42 (13.7%). On univariate analysis, MRI-pathology discordance was associated with larger tumor size (P < 0.001), estrogen receptor (ER) negativity (P = 0.006), and lymphovascular invasion (P = 0.003). Human epidermal growth factor receptor 2 positive molecular subtype showed worse correlation between the tumor size measured by MRI and pathology compared with luminal A and luminal B subtypes (P = 0.008 and 0.007). On multivariate analysis, tumor size and ER status significantly influenced MRI-pathology concordance (P < 0.05).

Conclusion

ER negativity and larger tumor size were strongly associated with MRI-pathology discordance in invasive breast carcinomas. Awareness of these factors might improve surgical planning.

Keywords

Breast neoplasm tumor burden pathology immunohistochemistry magnetic resonance imaging (MRI)

Get full access to this article

View all access options for this article.

References

Surgical guidelines for the management of breast cancer. Eur J Surg Oncol 2009;35(Suppl. 1):1–22.

Mennella

Garlaschi

Paparo

et al.

Magnetic resonance imaging of breast cancer: factors affecting the accuracy of preoperative lesion sizing. Acta Radiol 2015; 56: 260–268.

Grimsby

Gray

Dueck

et al.

Is there concordance of invasive breast cancer pathologic tumor size with magnetic resonance imaging?

Am J Surg 2009; 198: 500–504.

Goldhirsch

Winer

Coates

et al.

Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013. Ann Oncol 2013; 24: 2206–2223.

Chang

Chen

Chang

et al.

Quantification of breast tumor heterogeneity for ER status, HER2 status, and TN molecular subtype evaluation on DCE-MRI. Magn Reson Imaging 2016; 34: 809–819.

Chang

Kwon

Choi

et al.

Magnetic resonance imaging of breast cancer and correlation with prognostic factors. Acta Radiol 2009; 50: 990–998.

Rominger

Berg

Frauenfelder

et al.

Which factors influence MRI-pathology concordance of tumour size measurements in breast cancer?

Eur Radiol 2016; 26: 1457–1465.

Sloane

Amendoeira

Apostolikas

et al.

Consistency achieved by 23 European pathologists from 12 countries in diagnosing breast disease and reporting prognostic features of carcinomas. European Commission Working Group on Breast Screening Pathology. Virchows Arch 1999; 434: 3–10.

Mai

Yazdi

Burns

et al.

Pattern of distribution of intraductal and infiltrating ductal carcinoma: a three-dimensional study using serial coronal giant sections of the breast. Hum Pathol 2000; 31: 464–474.

10.

Choi

Han

Choe

et al.

Three-phase dynamic breast magnetic resonance imaging with two-way subtraction. J Comput Assist Tomogr 2005; 29: 834–841.

11.

Behjatnia

Sim

Bassett

et al.

Does size matter? Comparison study between MRI, gross, and microscopic tumor sizes in breast cancer in lumpectomy specimens. Int J Clin Exp Pathol 2010; 22: 303–309.

12.

Onesti

Mangus

Helmer

et al.

Breast cancer tumor size: correlation between magnetic resonance imaging and pathology measurements. Am J Surg 2008; 196: 844–848.

13.

McGhan

Wasif

Gray

et al.

Use of preoperative magnetic resonance imaging for invasive lobular cancer:good, better, but maybe not the best?

Ann Surg Oncol 2010; 17: 266–262.

14.

Ahn

Kim

et al.

The value of chest CT for prediction of breast tumor size:comparison with pathology measurement. World J Surg Oncol 2013; 11: 130–130.

15.

Boetes

Veltman

van Die

et al.

The role of MRI in invasive lobular carcinoma. Breast Cancer Res Treat 2004; 86: 31–37.

16.

Berg

Gutierrez

NessAiver

et al.

Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology 2004; 233: 830–849.

17.

American College of Radiology. BI-RADS atlas: breast imaging reporting and data system atlas, 5th edn. Reston, VA: American College of Radiology, 2013.

18.

Jin

Mango

et al.

Breast cancer molecular subtype as a predictor of the utility of preoperative MRI. Am J Roentgenol 2015; 204: 1354–1360.

19.

Leddy

Irshad

Metcalfe

et al.

Comparative accuracy of preoperative tumor size assessment on mammography, sonography, and MRI: Is the accuracy affected by breast density or cancer subtype?

J Clin Ultrasound 2016; 44: 17–25.

20.

Gruber

Rueckert

Kagan

et al.

Measurement of tumour size with mammography, sonography and magnetic resonance imaging as compared to histological tumour size in primary breast cancer. BMC cancer 2013; 13: 328–328.

21.

Mann

Bult

van Laarhoven

et al.

Breast cancer size estimation with MRI in BRCA mutation carriers and other high risk patients. Eur J Radiol 2013; 82: 1416–1422.

22.

Tot

. The diffuse type of invasive lobular carcinoma of the breast: morphology and prognosis. Virchows Arch 2003; 443: 718–724.

23.

Rastelli

Crispino

. Factors predictive of response to hormone therapy in breast cancer. Tumori 2008; 94: 370–383.

24.

Kyndi

Sorensen

Knudsen

et al.

Estrogen receptor, progesterone receptor, HER-2, and response to postmastectomy radiotherapy in high-risk breast cancer: the Danish Breast Cancer Cooperative Group. J Clin Oncol 2008; 26: 1419–1426.

25.

Fernandez-Morales

Segui

Andreu

et al.

Analysis of the pathologic response to primary chemotherapy in patients with locally advanced breast cancer grouped according to estrogen receptor, progesterone receptor, and HER2 status. Clin Breast Cancer 2007; 7: 559–564.

26.

Jones

Salter

A’Hern

et al.

Relationship between oestrogen receptor status and proliferation in predicting response and long-term outcome to neoadjuvant chemotherapy for breast cancer. Breast Cancer Res Treat 2010; 119: 315–323.

27.

Koukourakis

Manolas

Minopoulos

et al.

Angiogenesis relates to estrogen receptor negativity, c-erbB-2 overexpression and early relapse in node-negative ductal carcinoma of the breast. Int J Surg Pathol 2003; 11: 29–34.

28.

Putti

El-Rehim

Rakha

et al.

Estrogen receptor-negative breast carcinomas: a review of morphology and immunophenotypical analysis. Mod Pathol 2005; 18: 26–35.

29.

Chen

Baek

Nalcioglu

et al.

Estrogen receptor and breast MR imaging features: a correlation study. J Magn Reson Imaging 2008; 27: 825–833.

30.

Taneja

Evans

Rakha

et al.

The mammographic correlations of a new immunohistochemical classification of invasive breast cancer. Clin Radiol 2008; 63: 1228–1235.