Impact of preoperative staging with contrast-enhanced mammography for localized breast cancer management
Fanny Montrognon, Florian Clatot, Anca Berghian, F. Douvrin, Farzaneh Quieffin, Diana Defta, Anaïs Buquet, Martine Ferret, Justine Lequesne, Marianne Leheurteur, Maxime Fontanilles, D. Georgescu, Françoise Callonnec
Abstract
OBJECTIVE: A precise evaluation of the disease extent is mandatory before surgery for early breast cancer (EBC). Contrast-enhanced mammography (CEDM) is a recent technique that may help define adequate surgery. METHODS: This retrospective study included consecutive patients referred to a cancer center between November 2016 and July 2017 for biopsy-confirmed invasive EBC management. The primary objective was to evaluate the rate of surgical changes after incorporating the results of the preoperative staging examination, including CEDM. RESULTS: A total of 231 patients were screened for inclusion, and 132 patients were included, corresponding to 134 lesions. The first surgical plan was modified for 33 patients (25%), which represented 34 lesions. For 8 patients (6%), the surgery was cancelled in preference for neoadjuvant chemotherapy; for 16 patients (12.1%), the primary tumor procedure was enlarged; and for 23 patients (17.4%) the lymph node management was modified. Surgery was changed only due to the CEDM results for 24 patients (18.5%) and consisted of a more invasive procedure due to a more extended, multifocal or multicentric lesion than seen on the standard imaging. Anatomopathological surgery piece findings were well correlated with contrast-enhanced mammography results. Overall, there was no increase in the delay between the planned date of surgery and the effective surgical procedure (median 0 days). CONCLUSION: CEDM added to preoperative staging helped define better surgical management without increasing delay in the surgical procedure. ADVANCES IN KNOWLEDGE: CEDM is a reliable technique that should be considered as part of preoperative staging for EBC.