Preoperative breast cancer staging with multi-modality imaging and surgical outcomes

Giovanna Mariscotti, Manuela Durando, Alberto Tagliafico, Pier Paolo Campanino, Davide Bosco, Cristina Casella, Riccardo Bussone, Ada Ala, Isabella Castellano, Anna Sapino, Laura Bergamasco, Paolo Fonio, Nehmat Houssami

Research output: Contribution to journalArticle

Abstract

Purpose: To compare the rates of mastectomy and re-operation after breast-conserving surgery (BCS) among patients who had different pre-operative multi-modality imaging, hence identifying significant predictors of mastectomy and re-operations within each group. Method: Retrospective study of consecutive patients with primary breast cancer treated January 2010 – December 2016, divided in 3 groups, undergoing pre-operative local staging respectively with conventional imaging modalities only (2D mammography, ultrasound (US)), conventional imaging and tomosynthesis (DBT) and/or MRI. The primary outcome was identification of significant predictors of surgical outcomes, within each group. Study variables examined in univariate analysis were age, lesion dimension, breast density, multifocality, tumor size, histology, and if associated with outcomes they were included in binary logistic regression analysis. Results: Amongst 1547 patients, patient and tumor characteristics differed across the three groups, as did mastectomy rates which were 18 % (102/562) for 2D + US, 36 % (154/428) for 2D + DBT + US, 45 % (250/557) for 2D+/-DBT + US + MRI(p < 0.001). Variables strongly associated with mastectomy were larger lesions and multifocality (as was multi-modality group). Re-operation rate showed an opposite trend: 12.2 % (56/459) for 2D + US, 8 % (22/272) for 2D + DBT + US, 6.5 % (20/306) for 2D+/-DBT + US + MRI. Re-operation rate for 2D+/-DBT + US + MRI was lower than for 2D + US (p = 0.01) but similar to 2D + DBT + US (p = 0.58). Patients who had 2D + US and re-operations had significantly larger lesions, more underestimation, higher proportion of invasive carcinoma with in-situ component than those who did not require re-operation. Conclusions: Patients who had larger tumors and multifocal disease were more frequently staged by adding DBT and/or MRI to conventional imaging (mammography and US) which was associated with more extensive surgical treatment but lower reoperation rates.

Original languageEnglish
Article number108766
JournalEuropean Journal of Radiology
Volume122
DOIs
Publication statusPublished - Jan 2020

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Neoplasm Staging
Mastectomy
Breast Neoplasms
Ultrasonography
Mammary Ultrasonography
Neoplasms
Segmental Mastectomy
Carcinoma in Situ
Mammography
Reoperation
Histology
Retrospective Studies
Logistic Models
Regression Analysis

Keywords

  • Breast cancer
  • Mastectomy rates
  • Preoperative breast MRI
  • Preoperative multimodality imaging
  • Re-operation rates

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Mariscotti, G., Durando, M., Tagliafico, A., Campanino, P. P., Bosco, D., Casella, C., ... Houssami, N. (2020). Preoperative breast cancer staging with multi-modality imaging and surgical outcomes. European Journal of Radiology, 122, [108766]. https://doi.org/10.1016/j.ejrad.2019.108766

Preoperative breast cancer staging with multi-modality imaging and surgical outcomes. / Mariscotti, Giovanna; Durando, Manuela; Tagliafico, Alberto; Campanino, Pier Paolo; Bosco, Davide; Casella, Cristina; Bussone, Riccardo; Ala, Ada; Castellano, Isabella; Sapino, Anna; Bergamasco, Laura; Fonio, Paolo; Houssami, Nehmat.

In: European Journal of Radiology, Vol. 122, 108766, 01.2020.

Research output: Contribution to journalArticle

Mariscotti, G, Durando, M, Tagliafico, A, Campanino, PP, Bosco, D, Casella, C, Bussone, R, Ala, A, Castellano, I, Sapino, A, Bergamasco, L, Fonio, P & Houssami, N 2020, 'Preoperative breast cancer staging with multi-modality imaging and surgical outcomes', European Journal of Radiology, vol. 122, 108766. https://doi.org/10.1016/j.ejrad.2019.108766
Mariscotti, Giovanna ; Durando, Manuela ; Tagliafico, Alberto ; Campanino, Pier Paolo ; Bosco, Davide ; Casella, Cristina ; Bussone, Riccardo ; Ala, Ada ; Castellano, Isabella ; Sapino, Anna ; Bergamasco, Laura ; Fonio, Paolo ; Houssami, Nehmat. / Preoperative breast cancer staging with multi-modality imaging and surgical outcomes. In: European Journal of Radiology. 2020 ; Vol. 122.
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abstract = "Purpose: To compare the rates of mastectomy and re-operation after breast-conserving surgery (BCS) among patients who had different pre-operative multi-modality imaging, hence identifying significant predictors of mastectomy and re-operations within each group. Method: Retrospective study of consecutive patients with primary breast cancer treated January 2010 – December 2016, divided in 3 groups, undergoing pre-operative local staging respectively with conventional imaging modalities only (2D mammography, ultrasound (US)), conventional imaging and tomosynthesis (DBT) and/or MRI. The primary outcome was identification of significant predictors of surgical outcomes, within each group. Study variables examined in univariate analysis were age, lesion dimension, breast density, multifocality, tumor size, histology, and if associated with outcomes they were included in binary logistic regression analysis. Results: Amongst 1547 patients, patient and tumor characteristics differed across the three groups, as did mastectomy rates which were 18 {\%} (102/562) for 2D + US, 36 {\%} (154/428) for 2D + DBT + US, 45 {\%} (250/557) for 2D+/-DBT + US + MRI(p < 0.001). Variables strongly associated with mastectomy were larger lesions and multifocality (as was multi-modality group). Re-operation rate showed an opposite trend: 12.2 {\%} (56/459) for 2D + US, 8 {\%} (22/272) for 2D + DBT + US, 6.5 {\%} (20/306) for 2D+/-DBT + US + MRI. Re-operation rate for 2D+/-DBT + US + MRI was lower than for 2D + US (p = 0.01) but similar to 2D + DBT + US (p = 0.58). Patients who had 2D + US and re-operations had significantly larger lesions, more underestimation, higher proportion of invasive carcinoma with in-situ component than those who did not require re-operation. Conclusions: Patients who had larger tumors and multifocal disease were more frequently staged by adding DBT and/or MRI to conventional imaging (mammography and US) which was associated with more extensive surgical treatment but lower reoperation rates.",
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AU - Bosco, Davide

AU - Casella, Cristina

AU - Bussone, Riccardo

AU - Ala, Ada

AU - Castellano, Isabella

AU - Sapino, Anna

AU - Bergamasco, Laura

AU - Fonio, Paolo

AU - Houssami, Nehmat

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N2 - Purpose: To compare the rates of mastectomy and re-operation after breast-conserving surgery (BCS) among patients who had different pre-operative multi-modality imaging, hence identifying significant predictors of mastectomy and re-operations within each group. Method: Retrospective study of consecutive patients with primary breast cancer treated January 2010 – December 2016, divided in 3 groups, undergoing pre-operative local staging respectively with conventional imaging modalities only (2D mammography, ultrasound (US)), conventional imaging and tomosynthesis (DBT) and/or MRI. The primary outcome was identification of significant predictors of surgical outcomes, within each group. Study variables examined in univariate analysis were age, lesion dimension, breast density, multifocality, tumor size, histology, and if associated with outcomes they were included in binary logistic regression analysis. Results: Amongst 1547 patients, patient and tumor characteristics differed across the three groups, as did mastectomy rates which were 18 % (102/562) for 2D + US, 36 % (154/428) for 2D + DBT + US, 45 % (250/557) for 2D+/-DBT + US + MRI(p < 0.001). Variables strongly associated with mastectomy were larger lesions and multifocality (as was multi-modality group). Re-operation rate showed an opposite trend: 12.2 % (56/459) for 2D + US, 8 % (22/272) for 2D + DBT + US, 6.5 % (20/306) for 2D+/-DBT + US + MRI. Re-operation rate for 2D+/-DBT + US + MRI was lower than for 2D + US (p = 0.01) but similar to 2D + DBT + US (p = 0.58). Patients who had 2D + US and re-operations had significantly larger lesions, more underestimation, higher proportion of invasive carcinoma with in-situ component than those who did not require re-operation. Conclusions: Patients who had larger tumors and multifocal disease were more frequently staged by adding DBT and/or MRI to conventional imaging (mammography and US) which was associated with more extensive surgical treatment but lower reoperation rates.

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