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. 2021 Oct 8;28(5):4016-4030.
doi: 10.3390/curroncol28050341.

Multifocality and Multicentrality in Breast Cancer: Comparison of the Efficiency of Mammography, Contrast-Enhanced Spectral Mammography, and Magnetic Resonance Imaging in a Group of Patients with Primarily Operable Breast Cancer

Katarzyna Steinhof-Radwańska  1 , Andrzej Lorek  2 , Michał Holecki  3 , Anna Barczyk-Gutkowska  1 , Anna Grażyńska  4 , Joanna Szczudło-Chraścina  5 , Oskar Bożek  1 , Justyna Habas  6 , Karol Szyluk  7   8 , Paweł Niemiec  9 , Iwona Gisterek  10
Affiliations

Multifocality and Multicentrality in Breast Cancer: Comparison of the Efficiency of Mammography, Contrast-Enhanced Spectral Mammography, and Magnetic Resonance Imaging in a Group of Patients with Primarily Operable Breast Cancer

Katarzyna Steinhof-Radwańska et al. Curr Oncol. .

Abstract

Background: The multifocality and multicentrality of breast cancer (MFMCC) are the significant aspects that determine a specialist's choice between applying breast-conserving therapy (BCT) or performing a mastectomy. This study aimed to assess the usefulness of mammography (MG), contrast-enhanced spectral mammography (CESM), and magnetic resonance imaging (MRI) in women diagnosed with breast cancer before qualifying for surgical intervention to visualize other (additional) cancer foci.

Methods: The study included 60 breast cancer cases out of 630 patients initially who underwent surgery due to breast cancer from January 2015 to April 2019. MG, CESM, and MRI were compared with each other in terms of the presence of MFMCC and assessed for compliance with the postoperative histopathological examination (HP).

Results: Histopathological examination confirmed the presence of MFMCC in 33/60 (55%) patients. The sensitivity of MG in detecting MFMCC was 50%, and its specificity was 95.83%. For CESM, the sensitivity was 85.29%, and the specificity was 96.15%. For MRI, all the above-mentioned parameters were higher as follows: sensitivity-91.18%; specificity-92.31%.

Conclusions: In patients with MFMCC, both CESM and MRI are highly sensitive in the detection of additional cancer foci. Both CESM and MRI change the extent of surgical intervention in every fourth patient.

Keywords: breast cancer; comparative studies; contrast-enhanced spectral mammography; mammography; multifocal and multicentral breast cancers; pathology; surgery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the study.
Figure 2
Figure 2
Mammography (MG): (A) craniocaudal (CC) and (B) mediolateral oblique (MLO) views—pathological mass in the left breast in the superior-outer quadrant (orange arrows), invasive lobular carcinoma GII, BI-RADS 6; (C) craniocaudal (CC) and (D) mediolateral oblique (MLO) views—pathological mass in the left breast in the superior-inner quadrant (orange arrows), infiltrating duct carcinoma, BI-RADS 6. BI-RADS: Breast Imaging-Reporting and Data System.
Figure 3
Figure 3
Contrast-enhanced spectral mammography (CESM)subtraction images: (A) craniocaudal (CC) and (B) mediolateral oblique (MLO) views—irregular mass with heterogeneous enhancement and long spiculated mass BI-RADS 6. Numerous enhanced small foci are noted in left breast BI-RADS 4 (orange arrows); (C) craniocaudal (CC) and (D) mediolateral oblique (MLO) views—irregular mass with heterogeneous enhancement and long spiculated mass BI-RADS 6. Additional enhanced small foci are noted in the left breast in superior-outer quadrant BI-RADS 4 (orange arrows).
Figure 4
Figure 4
Magnetic resonance imaging (MRI) subtraction image (A,B) 2 min after contrast injection irregular mass with heterogeneous enhancement BI-RADS 6 with numerous foci of contrast uptake showing multicentric cancer BI-RADS 4 (orange arrows); (C,D) MRI subtraction image 2 min after contrast injection irregular mass with heterogeneous enhancement BI-RADS 6 with additional foci of contrast uptake showing multicentric cancer BI-RADS 4 (orange arrows).
Figure 5
Figure 5
Receiver operating characteristic (ROC) curves based on the tested diagnostic methods (directional coefficient = 1.00, suggested cut-off point = 1.00): (A) for the mammography (MG) method, the value of the area under the curve (AUC) field was 0.729 with a standard error of 0.066, p < 0.05; (B) for the contrast-enhanced spectral mammography (CESM) method, the value of the AUC field was 0.907 with a standard error of 0.042, p < 0.05; (C) for the magnetic resonance imaging(MRI) method, the value of the AUC field was 0.917, with a standard error of 0.042, p < 0.05.
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