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Accuracy of preoperative imaging estimates: Opportunities to de-escalate surgery for early invasive breast cancer

  • Hannah Kapur
    Affiliations
    Department of Surgery, Faculty of Medicine, University of British Columbia, 2775, Laurel Street, Vancouver, BC, V5Z 1M9, Canada
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  • Amy Bazzarelli
    Affiliations
    Providence Breast Centre, Mount Saint Joseph Hospital, 3080, Prince Edward Street, Vancouver, BC, V5T 3N4, Canada

    Department of Surgery, Faculty of Medicine, University of British Columbia, 2775, Laurel Street, Vancouver, BC, V5Z 1M9, Canada
    Search for articles by this author
  • Rebecca Warburton
    Affiliations
    Providence Breast Centre, Mount Saint Joseph Hospital, 3080, Prince Edward Street, Vancouver, BC, V5T 3N4, Canada

    Department of Surgery, Faculty of Medicine, University of British Columbia, 2775, Laurel Street, Vancouver, BC, V5Z 1M9, Canada
    Search for articles by this author
  • Jin-Si Pao
    Affiliations
    Providence Breast Centre, Mount Saint Joseph Hospital, 3080, Prince Edward Street, Vancouver, BC, V5T 3N4, Canada

    Department of Surgery, Faculty of Medicine, University of British Columbia, 2775, Laurel Street, Vancouver, BC, V5Z 1M9, Canada
    Search for articles by this author
  • Carol Dingee
    Affiliations
    Providence Breast Centre, Mount Saint Joseph Hospital, 3080, Prince Edward Street, Vancouver, BC, V5T 3N4, Canada

    Department of Surgery, Faculty of Medicine, University of British Columbia, 2775, Laurel Street, Vancouver, BC, V5Z 1M9, Canada
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  • Leo Chen
    Affiliations
    Department of Surgery, Faculty of Medicine, University of British Columbia, 2775, Laurel Street, Vancouver, BC, V5Z 1M9, Canada
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  • Elaine McKevitt
    Correspondence
    Corresponding author. Providence Breast Centre Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada.
    Affiliations
    Providence Breast Centre, Mount Saint Joseph Hospital, 3080, Prince Edward Street, Vancouver, BC, V5T 3N4, Canada

    Department of Surgery, Faculty of Medicine, University of British Columbia, 2775, Laurel Street, Vancouver, BC, V5Z 1M9, Canada
    Search for articles by this author

      Highlights

      • Ultrasound was more accurate for pathology size than mammogram or MRI.
      • Ultrasound and mammogram underestimated tumors up to 20 mm.
      • Ultrasound, mammogram, and MRI all overestimated tumors over 50 mm.
      • Concordance decreases with increasing size and lobular histology.

      Abstract

      Background

      There is current concern for overtreatment of breast cancer and rising mastectomy rates. This study compared preoperative imaging size (PIS) to postoperative pathology sizes (PPS) with a view to identifying opportunities to de-escalate surgery.

      Methods

      Patients having surgery from 2013 to 2017 for first invasive breast cancers were identified and PIS was compared to PPS looking at correlation and concordance. Associated clinical features were evaluated by regression models stratified by clinical T stage.

      Results

      We identified 1512 tumors among 1502 patients. Ultrasound, mammogram, and MRI correlated to PPS with increasing discordance with increasing PIS. Ultrasound underestimated T1 and T2 tumors, and mammogram underestimated T1 tumors and overestimated T3 tumors. For T1 and T2 tumors ultrasound had the highest concordance with PPS.

      Conclusion

      Patients can be reassured that imaging size can be used dependably by surgeons to plan lumpectomy for clinical T1 tumors. For larger tumors, overestimation by PIS should be considered in surgical planning.

      Keywords

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