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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Article info
Publication history
Published online: March 30, 2022
Accepted:
March 28,
2022
Received in revised form:
February 25,
2022
Received:
November 13,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
