Scripties UMCG - Rijksuniversiteit Groningen
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Clinical relevance of MRI-detected additional breast lesions in patients with breast cancer at the onset of neoadjuvant systemic therapy

(2019) Hern√°ndez, G.S. (Genevieve)

Background: Breast cancer requires a multidisciplinary treatment existing of surgery, radiotherapy and systemic therapy. Systemic therapy includes (a combination of) chemotherapy, immunotherapy and hormonal therapy. Neoadjuvant systemic therapy (NST) is an important treatment strategy that starts with systemic therapy followed by surgery and radiotherapy in order to downsize the tumor and facilitate breast conserving surgery (BCS). Before onset of NST magnetic resonance imaging (MRI) of the breast is performed. MRI may detect additional breast lesions that require further analysis and may cause changes in treatment strategy. The aim of this study is to determine the clinical relevance of MRI-detected additional breast lesions in patients starting with NST.
Material and method: Patients with breast cancer who started with NST in the period of 2010-2014 and underwent MRI pre-NST were included. All MRI-detected additional lesions found in pre-NST setting were analyzed. Additional lesions were classified according to their localization from the index tumor, as multifocal, multicentric or contralateral. All additional lesions were classified based on radiologic patterns according to the BI-RADS classification and finally according to pathology analysis as benign, malignant or as unidentified breast object (UBO).
Results: MRI detected 280 additional lesions in 252 included patients. Most of the additional lesions were multicentric (n=160), 34 lesions were multifocal and 86 lesions were localized contralateral from the index tumor. According to radiologic patterns 136 lesions (49%) were suspected benign and 144 lesions (51%) were suspected malignant. Pathology analysis classified 81 lesions (29%) as true benign and 116 lesions (41%) as true malignant. From 83 lesions (30%) no pathology analysis was obtained. They were classified as UBO. MRI classification alone correctly suspected 55 lesions (40%) benign and 72 lesions (50%) malignant. All malignant lesions were surgically removed.
Conclusion: In about 40% of the patients at the onset of NST MRI-detected additional lesions were found, of which 41% were malignant. This study highlights the complexity of MRI-detected additional lesions and emphasizes the need for more consensuses on management and treatment of these lesions.

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