SAGE-Hindawi Access to Research International Journal of Breast Cancer Volume 2011, Article ID 757234, 10 pages doi:10.4061/2011/757234 Clinical Study Breast Cancer Preoperative Staging: Does Contrast-Enhanced Magnetic Resonance Mammography Modify Surgery? Chiara Perono Biacchiardi, 1 Davide Brizzi, 2 Franco Genta, 1 Eugenio Zanon, 2 Marco Camanni, 1 and Francesco Deltetto 1 1 Ginteam, Mini-Invasive Gynaecological and Breast Surgery Unit, Evangelical Hospital, ASL TO1, Via Silvio Pellico 19, 10125 Torino, Italy 2 Breast Radiology Unit, Evangelical Hospital, ASL TO1, Via Silvio Pellico 19, 10125 Torino, Italy Correspondence should be addressed to Chiara Perono Biacchiardi, chiara.peronobiacchiardi@to.omceo.it Received 31 December 2010; Accepted 31 March 2011 Academic Editor: William Dooley Copyright © 2011 Chiara Perono Biacchiardi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Women with newly diagnosed breast cancer may have lesions undetected by conventional imaging. Recently contrast-enhanced magnetic resonance mammography (CE-MRM) showed higher sensitivity in breast lesions detection. The present analysis was aimed at evaluating the benefit of preoperative CE-MRM in the surgical planning. From 2005 to 2009, 525 consecutive women (25–75 years) with breast cancer, newly diagnosed by mammography, ultrasound, and needle-biopsy, underwent CE-MRM. The median invasive tumour size was 19 mm. In 144 patients, CE-MRM identified additional lesions. After secondlook, 119 patients underwent additional biopsy. CE-MRM altered surgery in 118 patients: 57 received double lumpectomy or wider excision (41 ben- eficial), 41 required mastectomy (40 beneficial), and 20 underwent contra lateral surgery (18 beneficial). The overall false-positive rate was 27.1% (39/144). CE-MRM contributed significantly to the management of breast cancer, suggesting more extensive disease in 144/525 (27.4%) patients and changing the surgical plan in 118/525 (22.5%) patients (99/525, 18.8% beneficial). 1. Introduction The primary objective of any diagnostic imaging modality is to accurately define the presence, the type, and the extent of disease in order to optimize patient management decisions and best plan therapeutic and surgical interventions. In women with suspected breast cancer, the aim of diagnostic imaging is to detect and accurately diagnose malignant tu- mors and to facilitate the correct choice of therapy, being mastectomy or breast-conserving surgery (e.g., lumpectomy) with or without preoperative neoadjuvant chemotherapy. The choice between breast-conserving surgery and mastecto- my depends on numerous factors including tumour size, lo- cation and grade, the ratio of tumour size to breast vol- ume, multifocality or multicentricity of the tumour, and patient preference. Currently, conventional mammography and ultrasound (US) are standard imaging techniques for the detection and evaluation of breast disease [1]. In recent years, contrast-enhanced magnetic resonance mammography (CE- MRM) has emerged as the most sensitive imaging modal- ity for the detection and diagnosis of breast lesions [2–5]. Numerous studies have confirmed the superior diagnostic performance of CE-MRM compared to conventional mam- mography and US [6–9]. Studies to evaluate the impact of CE-MRM on patient management decisions have similarly revealed its superiority compared to standard imaging [10– 13]. The present analysis was aimed at further evaluating the impact of CE-MRM on surgical decision making compared with those taken solely on the basis of clinical examination, conventional mammography, and ultrasound. The potential impact of CE-MRM on surgical decision making was, thereafter, evaluated for each patient. The CE-MRM was considered to accurately suggest the appropriateness of breast conservation images clearly which demonstrated the respect- ability of the lesion and in which CE-MRM was the only imaging modality able to do so. CE-MRM was considered to accurately suggest the necessity of changing surgery planning