Impact of Preoperative Bilateral Whole Breast Sonography in Patients with Invasive Lobular Carcinoma: Results from Two Medical Centers

Abstract

Purpose: The purpose of this study was to evaluate the sensitivity of bilateral whole breast sonography (BWBS) combined with mammography for the detection of additional lesions, as well as index lesions, in patients with invasive lobular carcinoma (ILC) and to evaluate the impact of BWBS on surgical treatment and cancer staging strategies.

Materials and Methods: We retrospectively reviewed mammographic and sonographic records of 97 patients with proven ILCs between November 2002 and November 2009. We evaluated the sensitivity of mammography and BWBS for the detection of additional and index lesions. We compared the impact of BWBS on surgical treatment and breast cancer staging between cases with single index lesions and with BWBS-detected additional lesions and index lesions. We compared the differences in sensitivity, surgical treatment procedures and breast cancer staging between BWBS and MRI confined to the patients underwent MRI.

Results: The overall sensitivity was 74.4 % (93/125 lesions) for mammography and 96.0 % (120/125 lesions) for BWBS (p < 0.001). The group with additional lesions detected using US alone exhibited more frequent mastectomy (p = 0.003) and higher N staging (p = 0.051) than did the group with single index lesions. Comparing the BWBS and MRI cases, there were no significant differences in lesion staging, the sensitivity of malignant foci detection (p = 0.074).

Conclusion: BWBS has a higher sensitivity than does mammography for the detection of index and additional ILC. Detection of additional malignancies using BWBS could affect which strategy is chosen for surgical treatment.

Zusammenfassung

Ziel: Ziel dieser Untersuchung ist die Evaluierung des Stellenwertes der umfassenden Sonografie beider Mammae („bilater whole breast sonografie, BWBS) zusammen mit einer Mammografie zur Detektion zusätzlicher maligner Läsionen bei Patienten mit invasivem lobulärem Karzinom (ILC). Dieses Vorgehen soll bezüglich der Auswirkung auf das Tumorstaging und das therapeutische Management untersucht werden.

Material und Methoden: Die Befunde von Mammografie und beidseitiger Mammasonografie von 97 Patienten mit nachgewiesenen ILCs zwischen November 2002 und November 2009 wurde retrospektiv ausgewertet. Anschließend haben wir die Sensitivität der Mammografie und der BWBS zur Feststellung von zusätzlichen Läsionen und Indexläsionen evaluiert. Die Auswirkungen der BWBS auf das chirurgische Vorgehen und die Stadieneinteilung des Mammakarrzinoms wurden für Fälle mit unilokulärem ILC und Fälle mit BWBS-entdeckten zusätzlichen Läsionen verglichen. Ferner haben wir den Stellenwert der BWSB auf das chirurgischen Vorgehen und die Stadieneinteilung des ILC bei einer Subgruppe von Patienten mit der MR-Mammografie verglichen, bei denen die MR-Mammografie auch durchgeführt worden war.

Ergebnisse: Die Sensitivität für zusätzliche Tumorläsionen betrug 74,4 % (93/125 Läsionen) für die Mammografie und 96,0 % (120/125 Läsionen) für die BWBS (p < 0,001). Die Gruppe mit alleine durch US zusätzlich entdeckte Läsionen war durch häufigere Brustamputationen (p = 0,003) und ein höheres N-Staging (p = 0,051) gekennzeichnet als die Gruppe mit singulären Läsionen eines ILC. Ein Vergleich der BWBS- und MRI-Fälle zeigte keinen signifikanten Unterschied in der Stadieneinteilung des ILC und der Sensitivität zur Detektion zusätzlicher maligner Läsionen (p = 0,074) zwischen den Methoden.

Schlussfolgerung: US (BWBS) hat eine höhere Sensitivität als die Mammografie zur Feststellung zusätzlicher maligner Läsionen bei ILC. Das hat eine Auswirkung auf das therapeutische Management dieser Patientinnen.

Key words

breast - ultrasound - mammography

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