IntroductionThe purpose of the study is to assess the role of preoperative magnetic resonance (MR) imaging on the surgical management of invasive lobular carcinoma (ILC) and to evaluate whether breast density and background parenchymal enhancement (BPE) influence surgical treatment.MethodsThis retrospective study was conducted on 56 patients who were diagnosed with ILC between 2014 and 2020. All patients had mammogram and ultrasound. Preoperative MRI was available in 34 patients. Age, menopausal status, breast density, BPE, multifocality/multicentricity and surgical treatment were collected.ResultsMean pathological tumour size was 36.4 mm (range 5–140 mm). Dense breasts had larger tumours compared to non‐dense breasts (P = 0.072). Of the 34 patients with MRI, 6 opted for mastectomy. Of the remaining 28 cases, MRI findings upgraded surgery to mastectomy in 54% (15/28) because mammogram/ultrasound underestimated tumour extent in 25% (7/28), or multifocal/multicentric disease was identified in 29% (8/28). Tumour size was underestimated by MRI in 7% (2/28). In the non‐MRI subgroup, 64% (14/22) of patients underwent breast‐conserving surgery, but 29% of them (4/14) required a second‐stage mastectomy due to extensive margin involvement. There was no difference in mastectomy rate between patients with MRI (62%) and without MRI (55%) (P = 0.061). Tumour size correlation between MRI and histopathology demonstrated an excellent intraclass correlation coefficient (P < 0.001). Surgical treatment recommendation was not significantly impacted by breast density or BPE.ConclusionBreast MRI improves surgical management of patients with ILC in providing additional diagnostic information often missed with standard imaging modalities, and without increasing mastectomy rate. Surgical treatment is not impacted by breast density or BPE.

中文翻译：

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术前乳腺 MR 成像影响浸润性小叶癌患者的手术管理


引言该研究的目的是评估术前磁共振 （MR） 成像对浸润性小叶癌 （ILC） 手术治疗的作用，并评估乳腺密度和背景实质增强 （BPE） 是否影响手术治疗。方法本回顾性研究对 2014 年至 2020 年间诊断为 ILC 的 56 例患者进行。所有患者均进行乳腺 X 线摄影和超声检查。34 例患者术前 MRI 可用。收集年龄、绝经状态、乳腺密度、BPE、多焦点/多中心和手术治疗。结果平均病理肿瘤大小为 36.4 毫米 （范围 5-140 毫米）。与非致密乳房相比，致密乳房的肿瘤更大 （P = 0.072）。在 34 例 MRI 患者中，6 例选择了乳房切除术。在其余 28 例病例中，54% （15/28） 的 MRI 结果将手术升级为乳房切除术，因为 25% （7/28） 的乳房 X 光检查/超声低估了肿瘤范围，或 29% （8/28） 发现了多灶性/多中心疾病。7% （2/28） 的 MRI 低估了肿瘤大小。在非 MRI 亚组中，64% （14/22） 的患者接受了保乳手术，但其中 29% （4/14） 的患者由于广泛的切缘受累而需要第二期乳房切除术。MRI 患者 （62%） 和无 MRI 患者 （55%） 的乳房切除术率没有差异 （P = 0.061）。MRI 和组织病理学之间的肿瘤大小相关性表明极好的类内相关系数 （P < 0.001）。手术治疗推荐不受乳房密度或 BPE 的显著影响。结论乳腺 MRI 改善了 ILC 患者的手术管理，提供了标准影像学检查经常遗漏的额外诊断信息，并且不会增加乳房切除术率。 手术治疗不受乳房密度或 BPE 的影响。