Pre-operative estimation of primary breast cancer size: a comparison of clinical assessment, mammography and ultrasound

doi:10.1054/brst.2000.0255

The Breast

Volume 10, Issue 4, August 2001, Pages 299-305

https://doi.org/10.1054/brst.2000.0255 Get rights and content

Abstract

This prospective study aimed to determine which is the most precise modality for the pre-operative measurement of primary breast cancers: clinical palpation; mammography; or ultrasound. Analysis of the difference between the measurement of the maximum tumour diameter by these three modalities and by the histological measurement was performed in 210 cases. Clinical palpation tended to overestimate tumour size and gave the largest standard deviation of the difference. Ultrasound and mammography both gave a similar standard deviation of the difference, with ultrasound tending to underestimate tumour size. For all modalities, the standard deviation and the 95% confidence intervals of the difference increased with increasing tumour size. There is little difference between the precision of ultrasound and mammography in measuring tumour size. The wide 95% confidence intervals for any method of pre-operative tumour measurement should be considered when planning patient management.

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Cited by (20)

Assessing tumor extent on contrast-enhanced spectral mammography versus full-field digital mammography and ultrasound
2017, Clinical Imaging
Citation Excerpt :
The role of imaging in breast cancer staging has evolved rapidly, and radiologic findings are now incorporated into clinical staging [6]. Once a diagnosis of cancer has been established, determining extent of disease by imaging is important for accurate preoperative staging and treatment planning [5,6]. Currently, preoperative magnetic resonance imaging (MRI) is the best tool for determining the extent of disease for locoregional staging and for evaluation of the contralateral breast before treatment [7–13].
To compare breast cancer size measurements on full-field digital mammography (FFDM), contrast-enhanced spectral mammography (CEDM), and ultrasound (US), with histologic tumor size used as the reference standard.
Material and methods
The HIPAA complaint, IRB approved study comprised 88 women with newly diagnosed breast cancer who underwent FFDM and CEDM;74 also had US. Breast density, histologic subtype, and maximum tumor measurements were recorded.
Pearson correlation coefficients for FFDM, US, and CEDM vs histopathology were 0.598, 0.639, and 0.859, respectively (P < 0.001). The following correlation coefficients were calculated for dense breasts (n = 48): histopathology vs FFDM (0.555), US (0.633), and CEDM (0.843) (P < 0.001); for nondense breasts (n = 40), they were FFDM (0.618), US (0.512), and CEDM (0.885) (P < 0.001). For size difference, the mean (SD) for histopathology vs FFDM, US, and CEDM was − 1.3 (11.9) mm, − 2.8 (11.1) mm, and 2.9 (9.5) mm, respectively. Limits of agreement were − 24.8 to 22.0 mm, − 24.5 to 18.8 mm, and − 15.6 to 21.4 mm, respectively.
In patients with biopsy-proven malignancy, size measurements correlated well with histopathologic size, and were higher on CEDM than those for FFDM and US in patients with dense or nondense breasts. The added value of CEDM as a supplement to FFDM in determining tumor size, however, was greater in patients with dense breasts. CEDM may be a promising alternative preoperative measurement tool for breast cancer patients with dense breasts and/or limited access or contraindications to MRI.
Shear Wave Elastography (SWE): An Analysis of Breast Lesion Characterization in 83 Breast Lesions
2015, Ultrasound in Medicine and Biology
Qualitative and quantitative shear wave elastography (SWE) criteria were assessed to differentiate between malignant and benign breast lesions. This prospective study included 83 lesions. SWE features measured included maximal stiffness values inside the lesion (E_lesion) and in the peri-lesion area (E_perilesion) and ratio values (R_lesion and R_perilesion) according to the formula E_lesion or E_perilesion/E_fat, with E_fat corresponding to normal fatty tissue. We compared ultrasonography (B-mode), SWE and histologic sizes. With qualitative and quantitative SWE analysis, sensitivity was 94% and specificity 73%. Malignant lesions appeared more heterogeneous, with higher stiffness and ratio values than benign lesions (p < 0.001). For malignant lesions, SWE size was better correlated to histologic size than B-mode size. Using benign SWE signs to selectively downgrade category 4a and 4b lesions, the specificity improved from 13% to 51% without loss in sensitivity (100%) compared to ultrasound.
How to measure breast cancer tumoral size at MR imaging?
2013, European Journal of Radiology
Citation Excerpt :
As initially shown by McGhan et al., our study confirms that size overestimation on MRI is more frequent for tumors larger than 2 cm, regardless of imaging sequence [27]. As demonstrated first by Allen et al., the magnitude of the difference depends upon the size of the tumor being measured, larger tumors yielding larger differences [2]. Some authors have attempted to minimize this effect with automated volume analysis, but observed a linear relationship between the size of lesion based on 3D manual segmentation and the volume underestimation by automated volume analysis [33].
To compare the accuracy of different MR sequences to measure tumor size.
Eighty-six women (mean age: 53 years (30–78)) who underwent preoperative MRI for breast cancer were included. Maximal diameters of the index tumor (IT) and of the whole extent of the tumor (WET) were measured on T2-weighted (T2W) sequences, on dynamic contrast-enhanced (DCE) T1-weighted (T1W) sequences and on Maximal Intensity Projection (MIP) reconstructions. Agreements with pathological size were evaluated using concordance correlation coefficient (k).
Median pathological size of IT was 20 mm (13–25 mm, interquartile range). Median pathological size of the WET was 29 mm (16–50 mm, interquartile range). Measurement of IT showed a good concordance with pathological size, with best results using T2W (k = 0.690) compared to MIP (k = 0.667), early-subtracted DCE frame (k = 0.630) and early-native DCE frame (k = 0.588). IT was visible on T2W in 83.7% and accurately measured within 5 mm in 69.9%. Measurement of WET was superior using early-subtracted DCE frame (k = 0.642) compared to late-native frame (k = 0.635), early-native frame (k = 0.631), late-subtracted frame (k = 0.620) and MIP (k = 0.565). However, even using early-subtracted frame, WET was accurately measured within 5 mm only 39.3%.
If visible, IT size is best measured on T2W with a good accuracy (69%) whereas WET is best estimated on early-subtracted DCE frame. However, when adjacent additional sites exist around IT, suspected surrounding disease components need to be proved by pathological analysis.
Prediction of breast tumor size by mammography and sonography-A breast screen experience
2007, Breast
Citation Excerpt :
Six of these made a direct comparison between the predictive power of the mammographic and sonographic measurement. Four8–11 found sonographic measurement to be a better predictor of pre-surgical tumor size; one found mammography to be superior12 while one reported that there was similar precision between the two imaging modalities.13 One study had a very small sample size with a mean tumor size of 33 mm.8
Concise preoperative assessment of breast Tumor size is important when considering surgical approach and the staging of breast cancer. A retrospective study of 400 uni-focal, invasive ductal carcinomas compared the accuracy of sonographic and mammographic measuring modalities with histological size. Sub-groups for tumor size, type and grade, with other variables, were also considered in intra-modal correlations of lesion dimension. Mammography ( $R^{2} = 0.74$ ), although slightly over estimating tumor size, appeared to be more useful than sonography ( $R^{2} = 0.60$ ) following logistical analysis of the data. Correlational significance for both imaging modalities decreased for tumors larger than 20 mm. Sonography under estimated lesions in over 50% of cases; the average underestimate being 9.9 mm, and ranging from 1 mm to 30 mm. Consideration of both imaging measurements in cohort should improve the accuracy of radiological reporting of pre-surgical tumor size.
The accuracy of ultrasonic indentation in detecting simulated bone displacement: A comparison of three techniques
2006, Journal of Manipulative and Physiological Therapeutics
Palpation is used most commonly to assess tissue stiffness despite its well-known deficiencies. As an improvement, a mechanical technique known as ultrasonic indentation has been proposed. The purpose of this study was to compare the accuracy of 3 ultrasonic indentation techniques in quantifying bone displacement in a specially constructed tissue simulator.
Three ultrasonic indentation techniques were tested for their accuracy: a rigid, laboratory-based method (rigid), a less rigid system actuated by hand (assisted), and a totally free-hand system (handheld). Each indentation technique was applied on a tissue simulator, which consisted of a deformable phantom overlying a displaceable piston to simulate soft tissue overlying bone. Measures of piston (ie, bone) displacement obtained by each indentation technique were compared with a gold standard of piston displacement to determine the accuracy of each technique. Statistical tests were used to determine if differences between experimental and reference measures of piston displacement were significant.
When indented, phantom deformation preceded piston displacement because of unequal stiffness between the two. The rigid and assisted indentation techniques showed the best accuracy for measuring simulated bone displacement. Differences in accuracy between the rigid and assisted techniques were insignificant. The accuracy of the handheld technique was significantly less than the rigid and assisted techniques.
The clinical utility of assisted ultrasonic indentation should be explored given its accuracy and the excessive size, cost, and complexity of the rigid technique. The large error magnitude of the handheld technique may exclude it from clinical use now.
Preoperative evaluation of breast cancer: Contrast-enhanced mammography versus contrast-enhanced magnetic resonance imaging: A systematic review and meta-analysis
2022, Breast Disease

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^f1: Address correspondence to: Dr S A Allen, Beds & Herts Breast Screening Centre, Luton and Dunstable Hospital, Lewsey Road, Luton, Bedfordshire, LU4 0DZ, UK. Tel.: +44 01582 497597; Fax: +44 01582 497598; E-mail: [email protected]

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ArticlesPre-operative estimation of primary breast cancer size: a comparison of clinical assessment, mammography and ultrasound

Abstract

The Nottingham Prognostic Index in primary breast cancer

Breast Cancer Research and Treatment

The Nottingham prognostic index applied to 9149 patients from the studies of the Danish breast cancer co-operative group

Breast Cancer Research and Treatment

Statistical methods for assessing agreement between two methods of clinical measurement

Lancet

Construction of age-related reference centiles using absolute residuals

Statistics in Medicine

Assessment of breast cancer size: a comparison of methods

European Journal of Surgical Oncology

Clinical assessment, mammography and ultrasonography as methods of measuring breast cancer: a comparison

The Breast

Clinical, mammographic, and sonographic determination of preoperative size

Cancer

Ultrasonography as a method of measuring breast tumour size and monitoring response to primary systemic treatment

British Journal of Surgery

The use of ultrasound for monitoring breast tumour response to pro-adjuvant therapy

Clinical Radiology

A clinical, mammographic, sonographic and histologic evaluation of breast cancer

International Journal of Gynaecology and Obstetrics

Clinical assessment of tumour size in primary breast cancer

Clinical Oncology

British Medical Journal

Articles
Pre-operative estimation of primary breast cancer size: a comparison of clinical assessment, mammography and ultrasound