Impact of preoperative magnetic resonance imaging on surgery and eligibility for intraoperative radiotherapy in early breast cancer

Chan, Wai Yee and Cheah, Wai Keong and Ramli Hamid, Marlina Tanty and Md Shah, Mohammad Nazri and Fadzli, Farhana and Kaur, Shaleen and See, Mee Hoong and Mohd Taib, Nur Aishah and Rahmat, Kartini (2022) Impact of preoperative magnetic resonance imaging on surgery and eligibility for intraoperative radiotherapy in early breast cancer. PLoS ONE, 17 (10). ISSN 1932-6203, DOI

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We looked at the usefulness of magnetic resonance imaging (MRI) in decision-making and surgical management of patients selected for intraoperative radiotherapy (IORT). We also compared lesion size measurements in different modalities (ultrasound (US), mammogram (MMG), MRI) against pathological size as the gold standard. 63 patients eligible for IORT based on clinical and imaging criteria over a 34-month period were enrolled. All had MMG and US, while 42 had additional preoperative MRI for locoregional preoperative staging. Imaging findings and pathological size concordances were analysed across the three modalities. MRI changed the surgical management of 5 patients (11.9%) whereby breastconserving surgery (BCS) and IORT was cancelled due to detection of satellite lesion, tumor size exceeding 30mm and detection of axillary nodal metastases. Ten of 42 patients (23.8%) who underwent preoperative MRI were subjected to additional external beam radiotherapy (EBRT); 7 due to lymphovascular invasion (LVI), 2 due to involved margins, and 1 due to axillary lymph node metastatic carcinoma detected in the surgical specimen. Five of 21 (23.8%) patients without prior MRI were subjected to additional EBRT post-surgery; 3 had LVI and 2 had involved margins. The rest underwent BCS and IORT as planned. MRI and MMG show better imaging-pathological size correlation. Significant increase in the mean `waiting time' were seen in the MRI group (34.1 days) compared to the conventional imaging group (24.4 days). MRI is a useful adjunct to conventional imaging and impacts decision making in IORT. It is also the best imaging modality to determine the actual tumour size.

Item Type: Article
Funders: University Malaya Research Fund Assistance grant (BKP) (Grant No: BK006-2018), University Malaya Faculty Research Grant (Grant No: GPF009C-2019)
Uncontrolled Keywords: 20-year follow-up; Conserving surgery; Tumor size; Mammography; MRI; Mastectomy; Accuracy; Margins; Women; Ultrasonography
Subjects: R Medicine > RD Surgery
Divisions: Faculty of Medicine > Biomedical Imaging Department
Faculty of Medicine > Surgery Department
Depositing User: Ms. Juhaida Abd Rahim
Date Deposited: 22 Nov 2023 07:05
Last Modified: 22 Nov 2023 07:05

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