The value of dynamic MRI in the evaluation of the breast following conservative surgery and radiotherapy

ObjectiveTo assess the value of dynamic contrast-enhanced magnetic resonance mammography (DCE-MRM) in breast cancer patients treated by conservation breast surgery and radiotherapy.Materials and methodsThis prospective study were performed on 20 consecutive female patients, from January 2008 till January 2010 at Zagazig university hospitals. All cases had undergone breast conservative therapy (BCT) at least 9–12 months since the end of radiation therapy up to 5 years. All cases were suspected for either recurrence or post-operative complications by clinical examination in conjunction with mammography or/and US. DCE-MRM was performed at 1.5 T. The findings were correlated with the histopathology in all cases.ResultsWe found that DCE-MRM accurately revealed the presence or absence, location, and extent of recurrent tumor more accurately than mammography or US. US had high sensitivity and specificity (85.7% and 76.8%) compared to mammography (71.4% and 38.4%, respectively). Seven recurrent cases were found, two of them were multifocal. False-positive contrast enhancement was seen in only one patient pathologically proved as granuloma. MRI showed 95% accuracy, 100% sensitivity, 92.3% specificity with 83% positive predictive value and 100% negative predictive value.ConclusionThe conventional imaging was insufficient to detect the recurrent lesions after BCT, so DCE-MRI should be the imaging modality of choice in detection of the tumoral recurrence, and differentiating it from other complications. One limitation of the DCE-MRM is the persistent false-positive enhancement due to granulation tissue.