Estimation of tumour size by imaging and excision in breast conserving surgery for breast cancer

Currently, the optimal treatment for early breast cancer is breast conserving surgery (BCS) and postoperative whole breast radiotherapy. Studies have shown that breast conserving therapy (BCT) is at least as effective in terms of disease outcome and overall survival when compared to mastectomy. In addition to this, BCT has the benefits of superior cosmetic outcome, less psychological morbidity and improved self-esteem. The biggest factor in determining whether patients are suitable for BCT is tumour size and the balance between likely excision volume and overall breast volume.

The single most important factor influencing the likelihood of local recurrence is completeness of excision; patients who have involved margins have an increased risk of local recurrence compared with the risk in those who do not, even after adjuvant radiotherapy. An accurate estimation of tumour size prior to surgery is essential to determine the most appropriate treatment for the individual patient. Imaging by mammography and ultrasonography both underestimate tumour size. MRI does provide a better estimate of tumour size, although it has not been shown in a randomised trial to increase rates of complete excision or to reduce local recurrence after BCS. This review will focus on the imaging techniques commonly used to assess tumour size in breast cancer.

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