The effectiveness of breast MRI in invasive lobular carcinoma

R.M. Mann

Promotor: C. Boetes and J. O. Barentsz
Radboud University Nijmegen
November 24, 2010

Abstract

The principal goal of this thesis is to increase the quality and level of scientific evidence regarding the use of breast MRI in patients with invasive lobular carcinoma in order to provide a general recommendation for the use of breast MRI in these patients. In Chapter 2 the differences between invasive ductal and invasive lobular cancer are discussed in depth from a radiological point of view. Chapter 3 discusses the evidence to support the use of preoperative MRI in ILC at the start of the present work. It provides a global overview that should be regarded as an introduction to the subject. In the systematic review in Chapter 4, the available evidence for the performance of MRI in patients with ILC is structured and analyzed. We used meta-analytic techniques to increase the scientific value whenever possible and tried to identify the gaps in the currently available evidence. Chapter 5 is a sidestep that explains the use of very rapid imaging and subsequent analysis to obtain quantitative enhancement parameters, that cannot be derived from more conventional imaging with a high spatial resolution and a relative poor temporal resolution. Some of these rapid techniques, as well as conventional imaging and CAD applications are subsequently used in Chapter 6 to evaluate the actual differences between IDC and ILC on MR imaging, since no studies actually compared the two types of cancer directly. In Chapter 7 the correlation between MR measured tumor size and size at histopathology was re-addressed, on one hand because the available data were too sparse and too heterogeneous to allow meta-analysis, on the other hand because we tried to identify a cause for the sometimes observed overestimation of tumor size on breast MRI. These results culminated in Chapter 8 in a study to the only thing that really matters, namely whether the patient actually benefits from preoperative imaging with MRI in case of ILC. For reasons explained above, the rate of re-excisions and the rate of mastectomies were addressed in a retrospective cohort study stratified by the use of preoperative MRI. Chapter 9 provides guidelines for the use of breast MRI. Technical demands are described and indications are discussed. Although partly based on the results of above mentioned studies, the guideline was printed before some of the studies above appeared in press, hence statements on the use of preoperative MRI in patients with ILC are still rather conservative. In the general discussion and conclusions presented in Chapter10, the current evidence for the use of preoperative breast MRI in ILC is revisited, a general advice is formulated and shortcomings are discussed. Chapter 11 provides a Dutch translation of these findings. A short note also addresses the general role of breast MRI in the near future; in Appendix 1 a specific feature of breast MRI in the future is discussed in more detail.

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