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MRI Findings After Cryoablation of Primary Breast Cancer Without Surgical Resection

Published:August 24, 2018DOI:https://doi.org/10.1016/j.acra.2018.07.012

      Rationale and Objectives

      To retrospectively evaluate findings on serial magnetic resonance imaging (MRI) after cryoablation for breast cancer lesions without subsequent surgical resection.

      Materials and Methods

      This study was approved by the Institutional Review Board and the requirement to obtain informed consent waived. Ductal carcinoma in situ or invasive carcinoma ≤15 mm, nuclear grade 1 or 2, estrogen receptor positive/human epidermal growth factor 2 negative without lymph node metastasis were treated with cryoablation without subsequent excision. Two observers independently reviewed the first two postcryoablation MRIs for shape (none, focus-to-mass, or nonmass enhancement) and suspicion of residual disease (positive or negative). Fisher's exact or the Mann–Whitney U test was used to assess significance. Interobserver agreement on findings was evaluated by calculating κ values.

      Results

      Fifty-four patients were enrolled. The first and second postcryoablation MRIs were performed 22–171 days and 82–487 days after cryoablation, respectively. Interobserver agreement ranged from fair to moderate (κ = 0.356–0.434). Observer 1 or 2 identified suspicious areas on the first postcryoablation MRI in seven cases (13.0%). These were significantly associated with focus-to-mass shape (vs non–focus-to-mass: nonmass enhancement or none) and residual disease or recurrence suspected by both observers (p < 0.001). There were no cases of both observers identifying suspicious findings on the second postcryoablation MRI.

      Conclusion

      Suspicious findings can be detected within the treated area at the first postcryoablation MRI. These can resolve during subsequent adjuvant therapies and follow-up.

      Key Words

      Abbreviations:

      DCIS (ductal carcinoma in situ), HER2 (human epidermal growth factor 2), ICC (intraclass correlation coefficient), MRI (magnetic resonance imaging)
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