1. Conventional Breast Image
Did adding breast MRI decrease the surgical margin involved rate than conventional breast image? -A case controlled comparison analysis. Hung-Wen Lai, MD, PhD1, Dar-Ren Chen, MD1, Shou-Tung Chen,MD1, Hwa-Koon Wu, MD3, Chih-Jung Chen, MD, PhD4, Shou-Jen Kuo, MD2 , Hsin-Shun Tseng, MD1, Chia-Loong Wu, MD1 1Comprehesive Breast cancer Center, Changhua Christian Hospital, Changhua, Taiwan, 2 General Surgery, Puli Christian Hospital, Nantou, Taiwan , 3Department of Radiology, 4Department of Surgical Pathology, Changhua Christian Hospital, Changhua, Taiwan
Purpose: Resection of primary tumor with clear margin is the goal of surgical management for primary operable breast cancer. Surgical margin involvement was associated with increased local recurrence, and usually mandated further surgery. The objective of current study is to assess whether combining breast MRI would decrease the rate of margin involvement compared with conventional breast image.
Material and Methods: A retrospective, case controlled comparison study was conducted. Patients with primary operable breast cancer who received surgical management were searched from Changhua Christian Hospital (CCH) breast cancer database. The rate of surgical margin involvement was compared between two groups of patients with conventional breast image (Group A: mammogram and sonogram) or combined with breast MRI (Group B: mammogram, sonogram and MRI). Surgical margin involvement was defined as cancer cells present at surgical margin, or < 1mm. To further evaluate the effect of breast MRI on surgeon’s margin involved rates, the index surgeons, defined as with more than 100 breast cancer operations in both Group A and Group B, were selected and analyzed.
Conclusion: Adding breast MRI to conventional breast image decreased the surgical margin involved rate, with the cost of mild increase the mastectomy rate. This decreasing surgical margin involved rate was not mainly due to increase mastectomy rate, but due to the selection of patients who were not suitable for partial mastectomy to receive total mastectomy.
Flow chart of study design
Total patients
MRI group
736
Breast conserving surgery patient
347
Margin involved 55
Clear margin
292
Total mastectomy patient
389 11
378
Conventional image group
˙741
Breast conserving surgery patient
381 21
360 14
Cleat margin
346
Exclusion criteria :
1 previous breast surgery
2 neoadjuvant chemoradiotheray
3 previous chest wall radiation
4 metasatsic disease
Method:
Parameters include age, gender, hospital stay, recovery to normal diet time, dumping syndrome, bile reflux gastritis or esophagitis, marginal ulcer, anastomosis stricture, cholelithasis, and stump cancers
Results
Conventional Breast Image
Combined Breast MRI
Patient number
741
736
P value
Received Partial mastectomy
51.4% (381/741)
47.1% (347/736)
0.1067
Received Total mastectomy
48.6% (360/741)
52.9% (389/736)
Rate of margin involvement
Overall
8.9% (66/741)
4.8% (35/736)
0.0022
14.4% (55/381)
6.1% (21/347)
0.0004
3.1% (11/360)
3.6% (14/389)
0.8336
Surgeon A
Before MRI
After MRI
P value
Overall margin involvement
7.6%
4.9%
0.2024
Margin involvement in Partial mastectomy
14%
8.1%
0.1511
Margin involvement in Total mastectomy
1.3%
2.2%
0.8066
Surgeon B
9.0%
5.0%
0.1212
12.1%
3.9%
0.0336
6.2%
6.59%
0.7720