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    Research Grants Awarded

    Sonography Compared with MRI in Pre-operative Evaluation of Patients with Breast Cancer to Determine Extent of Breast Disease

    Study Section:
    Detection, Diagnosis and Prognosis

    Scientific Abstract:
    Over 250,000 women will be diagnosed with breast cancer in the United States this year. At highest risk are the uninsured of Spanish descent. In our Los Angeles County Women’s Clinic, we see at least 200 newly-diagnosed breast cancer patients each year, of which 70% are Hispanic. In the USC Norris Lee Breast Center , over 230 new breast cancers are diagnosed annually. More than half of all these women will be treated with breast conserving surgery (limited surgical resection) instead of mastectomy. Results of prospective randomized trials comparing mastectomy with breast conserving surgery & radiation therapy have shown equal overall survival between the two at 25 years follow-up. Conventional mammography is the standard imaging test used to pre-operatively evaluate the extent of breast cancer, but its ability is limited when accurately determining extent of the lesion, especially in dense breasts. Preliminary studies indicate that whole breast ultrasound (US) may assist mammography in preoperative evaluation, and contrast-enhanced Magnetic Resonance Imaging (CE-MRI) has shown to have a higher sensitivity than mammography. This is a 2 year, non-randomized, prospective clinical study recruiting 300 women with core biopsy proven invasive breast carcinoma. Our main objective is to determine the optimal imaging paradigm for defining extent of breast cancer prior to surgery. Subjects will undergo imaging evaluation using conventional mammography, US, and CE-MRI. Each modality will be evaluated for its ability to define extent of breast disease prior to surgery. We will compare the diagnostic value of whole breast US and CE-MRI as adjunctive techniques to mammography, with special attention to its influence on surgical treatment. Using surgical pathology as the gold standard, sensitivity, specificity, accuracy, and positive and negative predictive value will be calculated for each imaging modality. We will also determine which technique is most valuable when imaging dense breasts. Identifying the imaging modality that most accurately defines extent of breast disease would greatly impact decisions for surgical treatment. Clinically, this will translate into more precise treatment planning, thereby minimizing the need for multiple surgeries to successfully treat the cancer. Hopefully, this will increase life expectancy (especially in the minority patient base), minimize psychological stress and anxiety, and reduce healthcare costs for all women.

    Lay Abstract:
    More than 250,000 women will be diagnosed with breast cancer in the United States this year. At highest risk are the uninsured, especially women of Spanish descent. In our Los Angeles County Hospital Women’s Clinic, we see at least 200 newly-diagnosed breast cancer patients each year, of which 70% are Hispanic. In the USC Norris Cancer Center ’s Henrietta Lee Breast Center , we see over 230 newly-diagnosed breast cancer patients annually. More than half of all these women will be treated with breast conserving surgery (limited surgical resection) instead of mastectomy. The decision to have breast conserving surgery or a mastectomy is most often based upon the extent of the breast disease. Conventional mammography is the standard x-ray method used before surgery to evaluate the extent of breast cancer. U nfortunately, mammography is limited in its ability to accurately determine extent of the cancer, especially in women with dense breasts. As such, radiologists often use ultrasound ( US ) to assist in evaluating breast abnormalities. Preliminary studies have shown that US is useful in determining if cancer has spread to surrounding breast tissue and to identify other sites of cancer in the breast that were not seen mammographically. Magnetic Resonance Imaging with contrast (CE-MRI) can also be helpful, as studies have reported that CE-MRI is more sensitive than mammography in detailing the scope and degree of the breast disease. Our goal is to identify the more precise imaging method to determine the extent of breast cancer prior to breast surgery. We will compare whole breast ultrasound with CE-MRI, both as an adjunct to mammography to determine which imaging technique is more accurate, with special attention paid to their influence on surgical treatment. Patients with newly-diagnosed invasive breast cancer will be invited to participate in this clinical trial and will have several imaging tests including mammography, US, and CE-MRI to see which test can best determine the actual size and extent of the breast cancer. The results of the imaging tests will be compared with tissue samples taken at surgery to determine the accuracy of each test. Finding an imaging test that will serve to accurately define the extent of breast cancer would greatly impact decisions for surgical treatment, especially in our minority patient base, and hopefully increase life expectancy while reducing healthcare costs for women everywhere.