Repeated surgeries in invasive lobular breast cancer with preoperative MRI: Role of additional carcinoma in situ and background parenchymal enhancement

Eur J Radiol. 2017 May;90:181-187. doi: 10.1016/j.ejrad.2017.02.045. Epub 2017 Mar 2.


Objectives: Analysing the influence of additional carcinoma in situ (CIS) and background parenchymal enhancement (BPE) in preoperative MRI on repeated surgeries in patients with invasive lobular carcinoma (ILC) of the breast.

Methods: Retrospective analysis of 106 patients (mean age 58.6±9.9years) with 108 ILC. Preoperative tumour size as assessed by MRI, mammography and sonography was recorded and compared to histopathology. In contrast-enhanced MRI, the degree of BPE was categorised by two readers. The influence of additionally detected CIS and BPE on the rate of repeated surgeries was analysed.

Results: Additional CIS was present in 45.4% of the cases (49/108). The degree of BPE was minimal or mild in 80% of the cases and moderate or marked in 20% of the cases. In 17 cases (15.7%) at least one repeated surgery was performed. In n=15 of these cases, repeated surgery was performed after BCT (n=9 re-excisions, n=6 conversions to mastectomy), in n=2 cases after initial mastectomy. The initial surgical procedure (p=0.008) and additional CIS (p=0.046) significantly influenced the rate of repeated surgeries, while tumour size, patient age and BPE did not (p=ns).

Conclusions: Additional CIS was associated with a higher rate of repeated surgeries, whereas BPE had no influence.

Keywords: Background parenchymal enhancement; DCIS; Invasive lobular breast cancer; Preoperative MRI; Repeated surgery.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Breast / diagnostic imaging
  • Breast / pathology
  • Breast / surgery
  • Breast Neoplasms / diagnostic imaging*
  • Breast Neoplasms / pathology
  • Breast Neoplasms / surgery
  • Carcinoma in Situ / diagnostic imaging*
  • Carcinoma in Situ / pathology
  • Carcinoma in Situ / surgery
  • Carcinoma, Ductal, Breast / pathology
  • Carcinoma, Lobular / diagnostic imaging*
  • Carcinoma, Lobular / pathology
  • Carcinoma, Lobular / surgery
  • Contrast Media
  • Female
  • Humans
  • Image Enhancement / methods
  • Magnetic Resonance Imaging / methods*
  • Mammography / methods
  • Mastectomy / methods
  • Middle Aged
  • Parenchymal Tissue / diagnostic imaging*
  • Parenchymal Tissue / pathology
  • Parenchymal Tissue / surgery
  • Preoperative Care / methods*
  • Reoperation*
  • Retrospective Studies
  • Sensitivity and Specificity


  • Contrast Media