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MR Imaging of the Breast in Patients with Positive Margins After Lumpectomy

Influence of the Time Interval Between Lumpectomy and MR Imaging

Kathrin A. Frei1, Karen Kinkel2, Harald M. Bonel3, Ying Lu3, Laura J. Esserman3 and Nola M. Hylton3

1 Department of Obstetrics and Gynecology, Kantonales Frauenspital Fontana, Lürlibadstr. 118, 7000 Chur, Switzerland.
2 Department of Radiology, Hopiteaux Universitaires de Genève, Hopital Cantonal, Rue Micheli/du Crest, Ch-1211 Genève 14, Switzerland.
3 Department of Radiology, University of California, Magnetic Resonance Science Center, Box 1290, 1 Irving St., San Francisco, CA 94143-1290.



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  		Fig. 1. —Diagram shows relationship between diagnostic performance of MR imaging of breast for residual breast cancer as function of time interval between lumpectomy and MR imaging. Time interval between lumpectomy and MR imaging of breast most strongly influenced specificity and negative predictive value (NPV) of MR imaging. Such influence increased progressively over time. Note plateau of 75% specificity and NPV that was reached at 28 days after surgery. Whereas sensitivity and positive predictive value (PPV) showed smaller variations over time, peak values of 95% and 92% were obtained at 35 and 28 days after surgery, respectively. Sensitivity = {diamondsuit}, specificity = {blacksquare}, PPV = {blacktriangleup}, NPV = X.

 


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  		Fig. 2A. —True-positive MR imaging findings in 51-year-old woman 36 days after excisional biopsy showing positive margins. Unenhanced three-dimensional (3D) sagittal fat-suppressed T1-weighted fast gradient-recalled echo (FGRE) MR image shows biopsy cavity (arrowhead).

 


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  		Fig. 2B. —True-positive MR imaging findings in 51-year-old woman 36 days after excisional biopsy showing positive margins. Enhanced 3D sagittal fat-suppressed T1-weighted FGRE MR image at same level as A but ontained 2 min 30 sec later shows clumped regional enhancement (arrow) at lower edge of biopsy cavity with 1-cm enhancing irregular nodular rim.

 


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  		Fig. 2C. —True-positive MR imaging findings in 51-year-old woman 36 days after excisional biopsy showing positive margins. Enhanced 3D sagittal fat-suppressed T1-weighted FGRE MR image at same level as A but obtained 7 min 30 sec later shows washout enhancement pattern (asterisk) in area of clumped regional enhancement. Clumped regional enhancement corresponded to residual invasive lobular cancer at histopathology.

 


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  		Fig. 3A. —True-negative MR imaging findings in 61-year-old woman 79 days after excisional biopsy showing positive margins. Unenhanced three-dimensional (3D) sagittal fat-suppressed T1-weighted fast gradient-recalled echo (FGRE) MR image shows biopsy cavity (arrowhead).

 


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  		Fig. 3B. —True-negative MR imaging findings in 61-year-old woman 79 days after excisional biopsy showing positive margins. Enhanced 3D sagittal fat-suppressed T1-weighted FGRE MR image at same level as A but obtained 2 min 30 sec later shows biopsy cavity has small enhancing rim (arrows). There is no additional enhancing lesion in area of surgical site.

 


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  		Fig. 3C. —True-negative MR imaging findings in 61-year-old woman 79 days after excisional biopsy showing positive margins. Enhanced 3D sagittal fat-suppressed T1-weighted FGRE MR image at same level as A but obtained 7 min 30 sec later shows no changes. Findings at histopathology were consistent with healing biopsy cavity.

 


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  		Fig. 4A. —False-positive imaging findings in 39-year-old woman 14 days after excisional biopsy with positive margins. Unenhanced three-dimensional (3D) sagittal fat-suppressed T1-weighted fast gradient-recalled echo (FGRE) MR image shows biopsy cavity (arrowhead).

 


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  		Fig. 4B. —False-positive imaging findings in 39-year-old woman 14 days after excisional biopsy with positive margins. Enhanced 3D sagittal fat-suppressed T1-weighted FGRE MR image at same level as A but obtained 2 min 30 sec later shows biopsy cavity with 0.8-mm irregular enhancing rim and spiculated focal mass (arrow) adjacent to cavity.

 


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  		Fig. 4C. —False-positive imaging findings in 39-year-old woman 14 days after excisional biopsy with positive margins. Enhanced 3D sagittal fat-suppressed T1-weighted FGRE MR image at same level as A but obtained 7 min 30 sec later shows spiculated focal mass with washout enhancement pattern (asterisk). Corresponding histopathologic findings were foreign body reaction and fat necrosis.

 


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  		Fig. 5A. —False-positive MR imaging findings in 49-year-old woman 50 days after excisional biopsy showing positive margins. Unenhanced three-dimensional (3D) sagittal fat-suppressed T1-weighted fast gradient-recalled echo (FGRE) MR image shows small scar (arrow).

 


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  		Fig. 5B. —False-positive MR imaging findings in 49-year-old woman 50 days after excisional biopsy showing positive margins. Enhanced 3D sagittal fat-suppressed T1-weighted FGRE MR image at same level as A but obtained 2 min 30 sec later shows segmental enhancement adjacent to scar (asterisk).

 


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  		Fig. 5C. —False-positive MR imaging findings in 49-year-old woman 50 days after excisional biopsy showing positive margins. Enhanced 3D sagittal fat-suppressed T1-weighted FGRE MR image at same level as A but obtained 7 min 30 sec later shows segmental enhancement with peripheral washout enhancement pattern (arrow), histopathologically corresponding to fibrocystic changes.

 

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