Targeted oncoplastic breast surgery based on breast imaging

Preoperative staging of breast cancer based on breast imaging is mandatory. Breast imaging is a general term that encompasses mammography, breast sonography, and breast magnetic resonance tomography (MR-mammography, MRM). It is known that earlier diagnosis of breast cancer is more likely to result in a favourable oncological outcome. Use, limitations, and influences on surgical procedures of MR-mammography in diagnosis and staging of breast cancer have to be discussed. Different interventional procedures have been developed. The histological results of interventional procedures guided by ultrasound, stereotactic mammography or magnetic resonance have to be integrated in planning surgical resection margins in oncoplastic breast-conserving surgery. Image-guided wire markings are an important tool for planning these surgical margins. This review gives an overview regarding the influences of breast imaging, interventional procedures, and wire markings on breast-conserving therapy of breast cancer. Breast imaging and interventional procedures are the basis for a concept of targeted oncoplastic breast surgery.

Breast cancer; Breast imaging; Mammography; Breast ultrasound; Magnetic resonance mammography; Oncoplastic surgery; Interventional breast diagnostics.

[1] Balleyguier C., Ayadi S., Van Nguyen K., Banel D., Dromain C., Sigal R.: “BIRADS classification in mammography”. Eur. J. Radiol., 2007, 61, 192.

[2] Levy L., Suissa M., Chiche J.F., Teman G., Martin B.: “BIRADS ultrasonography”. Eur. J. Radiol., 2007, 61, 202.

[3] Tardivon A.A., Athansiou A., Thibault F., El Khoury C.: “Breast imgaging and reporting data system (BIRADS): magnetic resonance imaging”. Eur. J. Radiol., 2007, 61, 212.

[4] Fasching P.A., Heusinger K., Loehberg C.R., Wenkel E., Lux M.P., Schrauder M., et al.: “Influence of mammographic density on the diagnostic accuracy of tumor size – assessment and association with breast cancer tumor characteristics”. Eur. J. Radiol., 2006, 60, 398.

[5] Kopans D.B.: “The positive predictive value of mammography”. Am. J. Roentgenol., 1992, 158, 521.

[6] Kopans D.B.: “The accuracy of mammographic interpretation”. N. Engl. J. Med., 1994, 331, 1521.

[7] Schulz-Wendtland R., Hermann K.P., Bautz W.: “Clinical results of digital mammography”. Radiologe, 2005, 45, 255.

[8] James J.J.: “The current status of digital mammography”. Clin. Radiol., 2004, 59, 1.

[9] Säbel M., Aichinger U., Schulz-Wendtland R., Bautz W.: “Digital full field mammography”. Röntgenpraxis, 1999, 52, 171.

[10] Lewin J.M., D`Orsi C.J., Hendrick R.E.: “Clinical comparison of full-field digital mammography with screen-film mammography for detection of breast cancer”. Am. J. Roentgenol., 2002, 179, 671.

[11] Schulz-Wendtland R., Lell M., Wenkel E., Aichinger U., Imhoff K., Bautz W.: “Experimental investigations at the new digital mammographic system”. Röfo, 2003, 175, 1564.

[12] Schulz-Wendtland R., Aichinger U., Krämer S.: “Interventionelle mammographisch gestützte Techniken”. In: Duda V., Schulz-Wendtland R. (eds). Mammadiagnostik – Komplementärer Einsatz aller Verfahren. Berlin: Springer Verlag, 2004

[13] Stavros A.T., Thickman D., Rapp C.L.: “Solid breast nodules: use of sonography to distinguish between benign and malignant lesions”. Radiology, 1995, 196, 123.

[14] Madjar H., Mundinger A., Degenhardt F., Duda V., Hackelöer B.J., Osmers R.: “Quaitätskontrolle in der Mamma-Sonographie”. Ultraschall. Med., 2003, 24, 190.

[15] Duda V.F., Bock K., Ipsen A., Schulz K.D.: “Sonographisches Mehrstufenkonzept in der Mammadiagnostik”. Röfo, 2001, 173, 54.

[16] Schulz-Wendtland R., Krämer S., Döinghaus K., Mitze M., Lang N.: “Sonographisch gesteuerte Mikrobiopsie der Brust: Eine neue interventionelle Technik”. Gynecol., 1997, 2, 50.

[17] Krämer S., Schulz-Wendtland R., Aichinger U., Bautz W., Lang N.: “Panorama-Sonographie (Siescape 3D) der Brust – Planung der brusterhaltenden Therapie beim Mammakarzinom”. Ultraschall. Med., 1999, 20, 104.

[18] Watermann D.O., Földi M., Hanjalic-Beck A., Hasenburg A., Lüghausen A., Prömpeler H., et al.: “Three-dimensional ultrasound for the assessment of breast lesions”. Ultrasound Obstet. Gynecol., 2005, 25, 592.

[19] Liberman L., Morris E.A., Kim C.M.: “MR imaging findings in the contralateral breast of women with recently diagnosed breast cancer”. Am. J. Roentgenol., 2003, 180, 333.

[20] Krämer S., Schulz-Wendtland R., Hagedorn K., Bautz W., Lang N.: “Magnetic resonance imaging and its role in the diagnosis of multicentric breast cancer”. Anticancer Res., 1998, 18, 2163.

[21] Krämer S., Schulz-Wendtland R., Hagedorn K.: “Magnetic resonance imaging in the diagnosis of local recurrences in breast cancer”. Anticancer Res., 1998, 18, 2159

[22] Rieber A., Brambs H.J., Gabelmann A.: “Breast MRI for monitoring response of primary breast cancer to neo-adjuvant chemotherapy”. Eur. Radiol., 2002, 12, 1711

[23] Schulz-Wendtland R., Aichinger U., Krämer S., Lang N., Bautz W.: “Scars and local recurrences – the role of the MRI”. Eur. Radiol., 2000, 10, 41.

[24] Kaiser W.A., Zeitler E.: “MR imaging of the breast: fast imaging sequences with and without Gd-DTPA: preliminary observations”. Radiology, 1989, 170, 681.

[25] Heywang S.H., Wolf A., Pruss E.: “MR imaging of the breast with Gd-DTPA: use and limitations”. Radiology, 1989, 171, 95.

[26] Sittek H., Kessler M., Bredl T.: “Lebeau A, Bohmert H, Reiser MF: Breast malignancies: dynamic FLASH 3D MR-mammography versus mammography”. Radiology, 1994, 193, 121.

[27] Orel S.G., Schnall M.D., LiVolsi V.A.: “MR imaging of the breast with rotating delivery of excitation off resonance: clinical experience with pathologic correlation”. Radiology, 1993, 187, 493.

[28] Orel S.G., Mendonca M.H., Reynolds C.: “MR imaging of ductal carcinoma in situ”. Radiology, 1997, 202, 413.

[29] Schulz-Wendtland R., Aichinger U., Krämer S., Wilhelmi U., Lell M., Lang N., Bautz W.: “Follow-up after breast-conserving therapy: Comparison of conventional imaging methods with MRI”. Geburtsh. Frauenheilk., 2001, 61, 396.

[30] Aichinger U., Schulz-Wendtland R., Dobritz M., Lell M., Krämer S., Lang N., Bautz W.: “Scar or recurrence – comparison of MRI and color-coded ultrasound with echo signal amplifiers”. Fortschr. Röntgenstr., 2002, 174, 395.

[31] Veronesi U., Cascinelli N., Mariani L.: “Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer”. N. Engl. J. Med., 2002, 347, 1227.

[32] Fisher B., Anderson S., Bryant J.: “Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer”. N. Engl. J. Med., 2002, 347, 1233.

[33] Holland R., Connolly J., Gelman R.: “Histologic multifocality of Tis, T1-2 breast carcinomas: implications for clinical trials of breast-conserving treatment”. Cancer, 1985, 56, 979.

[34] Fischer U., Kopka L., Grabbe E.: “Breast carcinoma: effect of preoperative contrast-enhanced MR imaging on the therapeutic approach”. Radiology, 1999, 213, 881.

[35] Skaane P., Young K., Skjennald A.: “Comparison of film-screen mammography and full-field mammography with soft-copy reading in a population-based screening program: the Oslo II study”. Radiology, 2002, 225, 267

[36] Tabar L., Fagerberg C.J., Gad A., Baldetorp I., Holmberg L.H., Grontoft O., et al.: “Reduction in mortality from breast cancer after mass screening with mammography”. Lancet, 1985, I, 829.

[37] Olsen O., Gotzsche P.C.: C”ochrane review on screening for breast cancer with mammography”. Lancet, 2001, 358, 1340

[38] Nystrom L., Andersson I., Bjurstam N.: “Long-term effects of mammographic screening: update overview of the Swedish randomised trials”. Lancet, 2002, 359, 909.

[39] Schulz-Wendtland R., Becker N., Bock K., Anders K., Bautz W.: “Mammography screening”. Radiologe, 2007, 47, 359.

[40] Schulz-Wendtland R., Krämer S., Döinghaus K., Säbel M., Lang N., Bautz W.: “Die Bedeutung der Röntgen-Mammographie für das Mammakarzinomscreening”. Röntgenpraxis, 1997, 50, 103.

[41] Tabar L., Vitak B., Tony H.H.: “Beyond randomised controlled trials: organised mammographic screening substantially reduces breast carcinoma mortality”. Cancer, 2001, 91, 1724.

[42] Beckmann M.W., Fasching R.A., Gall C., Bani M., Brumm C., Krämer S.: “Genetic risk factors in breast cancer”. Gynäkologe, 2002, 35, 527.

[43] Beckmann M.W., Bani M.R., Fasching P.A., Strick R., Lux M.P.: “Risk and risk assessment for breast cancer: molecular and clinical aspects”. Maturitas, 2007, 57, 56.

[44] Kuhl C.K., Schmutzler R.K., Leutner C.C.: “Breast MR imaging screening in 192 women proved or suspected to be carriers of a breast cancer susceptibility gene: preliminary results”. Radiology, 2000, 215, 267.

[45] Fersis N., Smyczek-Gargya B., Krainick U., Mielke G., MüllerSchimpfle M., Kiesel L., Wallwiener D.: “Clinical experience with large-core needle biopsies of the breast and evaluation of histopathology”. Zentralbl. Gynäkol., 2001, 123, 132.

[46] Schulz-Wendtland R., Krämer S., Lang N., Bautz W.: “Ultrasonic guided microbiopsy in mammary diagnosis: indications, technique and results”. Anticancer Res., 1998, 18, 2145.

[47] Parker S.H., Jobe W.E., Dennis M.A.: “US-guided automated largecore breast biopsy”. Radiology, 1993, 187, 507.

[48] Schulz-Wendtland R., Krämer S., Döinghaus K., Mitze M., Lang N.: “Interventionelle Techniken in der Mammadiagnostik: sonographisch gezielte Stanzbiopsie”. Akt. Radiol., 1997, 7, 30.

[49] Sickles E.A., Parker S.H.: “Appropriate role of core biopsy in the management of probably benign lesions”. Radiology, 1994, 190, 313.

[50] Schulz-Wendtland R., Aichinger U., Krämer S., Tartsch M., Kuchar I., Magener A., Bautz W.: “Sonographical breast biopsy: How many core biopsy specimens are needed?’ Fortschr. Röntgenstr., 2003, 173, 94.

[51] Liberman L., Feng T.L., Dershaw D.D.: “US-guided core breast biopsy: use and cost-effectiveness”. Radiology, 1998, 208, 717.

[52] Kettritz U., Rotter K., Murauer M.: “Stereotaxic vacuum biopsy in 2874 patients: a multicenter study”. Cancer, 2004, 100, 245.

[53] Heywang-Koebrunner S.H., Schaumloeffel U., Viehweg P.: “Minimally invasive stereotaxic vacuum core breast biopsy”. Eur. Radiol., 1998, 8, 377

[54] Azavedo E., Svane G., Auer G.: “Stereotaxic fine needle biopsy in 2594 mammographically detected nonpalpable lesions”. Lancet, 1989, 1, 1033

[55] Parker S.H., Lovin J.D., Jobe W.E.: “Nonpalpable breast lesions: stereotactic automated large core biopsies”. Radiology, 1991, 180, 403

[56] Liberman L., Dershaw D.D., Rosen P.P.: “Stereotaxic 14-gauge breast biopsy: how many core biopsy specimens are needed?” Radiology, 1994, 192, 793

[57] Burbank F.: “Mammographic findings after 14 gauge automated needle and 14 gauge directional vacuum assisted stereotactic breast biopsy”. Radiology, 1997, 204, 153.

[58] Liberman L., Dershaw D., Morris E.A.: “Clip placement after stereotactic vacuum-assisted breast biopsy”. Radiology, 1997, 205, 417.

[59] Krämer S., Schulz-Wendtland R., Lang N.: “Qualitätssicherung bei der stereotaktischen Stanzbiopsie durch Einsatz eines Phantoms”. Akt. Radiol., 1996, 6, 153

[60] Schulz-Wendtland R., Heywang-Köbrunner S., Aichinger U., Krämer S., Wenkel E., Bautz W.: “Do tissue marker clips after sonographically or stereotactically guided breast biopsy improve followup of small breast lesions and localisation of breast cancer after chemotherapy?” Fortschr. Röntgenstr., 2002, 174, 620.

[61] Parker S.H., Klaus A.J., McWey M.: “Sonographically guided directional vacuum-assisted breast biopsy using a handheld device”. Am. J. Roentgenol., 2001, 177, 405.

[62] Schulz-Wendtland R., Krämer S., Bautz W.: “First experiences with a new vacuum-assisted device for breast biopsy”. Fortschr. Röntgenstr., 2003, 173, 1496.

[63] Krainick-Strobel U., Majer I., Huber B., Gall C., Krämer B., Gruber I., et al.: “Development of a gel-simulation model and generation of standard tables for the complete extirpation of benign breast lesions with vacuum assisted biopsy under ultrasound guidance”. Ultrasound Med. Biol., 2006, 32, 1539.

[64] Krämer S., Schulz-Wendtland R., Bautz W., Lang N.: “Neue Aspekte in der interventionellen Mammdiagnostik und Brustchirurgie – ABBI (Advanced Breast Biopsy Instrumentation) in der Diagnostik und minimal invasiven Mammachirurgie”. In: Waclawiczek H.W. (ed). “Die interdisziplinäre kurative Behandlung des Mammakarzinoms”. Heidelberg: Johann Ambrosius Barth Verlag, 1998.

[65] Kuhl C.K., Elevelt A., Leutner C.C.: “Interventional breast MR imaging: clinical use of stereotactic localization and biopsy device”. Radiology, 1997, 204, 667

[66] Heywang-Koebrunner S.H., Schaumlöffel-Schulze U., Heinig A.: “MR-guided percutaneous vacuum biopsy of breast lesions: experience with 100 lesions”. Radiology, 1999, 213, 289.

[67] Fischer U., Vosshenrich R., Döler W., Hamadeh A., Oestmann J.W., Grabbe E.: “MR-imaging-guided breast intervention: Experience with two systems”. Radiology, 1995, 195, 533.

[68] Krämer S., Jäger W., Lang N., Beckmann M.W.: “Surgical treatment of breast cancer in the elderly”. J. Menopause, 2004, 2, 9.

[69] Meyer J.E., Kopans D.B., Stomper P.C.: “Occult breast abnormalities: percutaneous preoperative needle localization”. Radiology, 1984, 150, 335.

[70] Schulz-Wendtland R., Bauer M., Krämer S., Büttner A., Lang N.: “Stereotaxie – Eine Methode zur Punktion, Stanzbiopsie und Markierung kleinster mammographischer Herdbefunde”. Chir. Praxis, 1995, 49, 123.

[71] Orel S.G., Schnall M.D., Newman R.W.: “MR imaging-guided localization and biopsy of breast lesions: initial experience”. Radiology, 1994, 193, 97.

[72] Golshan M., Fung B.B., Wolfman J.: “The effect of ipsilateral whole breast ultrasound on the surgical management of breast carcinoma”. Am. J. Surg., 2003, 186, 391.

[73] Tillman G.F., Orel S.G., Schnall M.D.: “Effect of breast magnetic resonance imaging on the clinical management of women with earlystage breast carcinoma”. J. Clin. Oncol., 2002, 20, 3413.