RESUMO
UNLABELLED: The purpose of the study was to compare the accuracy of breast MRI and ultrasonography in assessing the tumor focality and tumor size of newly diagnosed non-high risk breast cancer patients. METHODS: The tumor focality status and the maximal tumor diameter by MRI and ultrasonography were retrospectively compared with the corresponding histopathological findings as reference. Test characteristics concerning the tumor focality status were calculated. Bland-Altman plots were generated to evaluate the agreement of the tumor size measurements by imaging and histopathology. The t-test for dependent samples and the Fisher exact test were used to test differences between groups for statistical significance. The Pearson correlation coefficient r was calculated to measure the degree of association between the tumor diameter by imaging and histopathology. RESULTS: Sixty-four patient diagnosed between 2011 and 2013 were analyzed. MRI showed a good sensitivity of 83% for detecting multifocal disease (ultrasonography, 75%). The positive predictive value was 67% and the ratio of true-positive to false-positive findings 2.0. MRI showed better limits of agreement (-21 to 26 mm versus -29 to 26 mm) and a better correlation (r=0.77 versus r=0.66) with the histopathological tumor diameter compared to ultrasonography. The mean differences between the tumor diameter by MRI and histopathology and ultrasonography and histopathology were not significantly different (p=0.09). The T classification (T1a, T1b, T1c, T2, T3) was correctly estimated by MRI in 43 patients (67.2%) and by ultrasonography in 39 patients (60.9%) (p=0.58). CONCLUSION: In our patient cohort only a modest diagnostic advantage of MRI compared to ultrasonography could be detected.
RESUMO
BACKGROUND: Breast cancer is the most common cancer in Saudi Arabia. However, detailed published epidemiologic data are scarce. In this study, breast cancer patients at a tertiary care hospital were characterized and compared with data from the United States. METHODS: Medical records were retrospectively reviewed of female patients with confirmed diagnosis of invasive breast cancer who consulted with Saad Specialist Hospital between 2004 and 2011. Descriptive statistics were calculated and compared with published data. RESULTS: Two-hundred and sixty-two female patients with cytologically or histologically confirmed diagnosis of invasive breast cancer were identified and analyzed. Compared to published American data derived from the SEER database, patients were diagnosed at a markedly younger age (<50 years: 57.5% versus 12.5%) and more advanced disease (localized disease: 28.6% versus 61.2%). The difference of the age at diagnosis could not be fully explained by the different age structures of the Saudi Arabian and American population in our analysis. Although the overall mastectomy rate was higher (58.2% versus 38.5%), no relevant difference in the mastectomy rates was found if analyzed by stage. CONCLUSION: Our data suggest that breast cancer in this part of Saudi Arabia is diagnosed at a much higher stage compared to the United States. More effort in awareness campaigns, easier access to screening and treatment are needed to improve the prognosis and to reduce the currently relatively high mastectomy rate.