Tumor size assessment of invasive breast cancers: which pathological features affect MRI-pathology agreement?

Background: Preoperative assessment of tumor size is important in breast cancer treatment planning, especially in breast conservation surgeries. The use of the Magnetic Resonance Imaging (MRI) is increasing among patients with newly diagnosed breast cancers. However, some pathological features can overestimate the measurement of tumor size by MRI, increasing mastectomy rates. The objective is to evaluate which pathological features may affect the agreement between MRI and pathologic tumor size on invasive breast carcinomas. Methods: Eighty seven patients with breast cancer who underwent preoperative breast MRI were retrospectively evaluated. The main tumor size measured by MRI was compared with pathology (gold standard) and concordance was defined as a greater diameter difference of less than 10 mm. Results: There was MRI-pathology concordance in 60 cases (69.0%), MRI overestimated tumor size in 21 (24.1%) and underestimated in 6 (6.9%). After multivariate analysis, only associated ductal carcinoma in situ (DCIS) remained significantly related to overestimation of tumor size on MRI (OR: 9.00; 95% IC:1.13-71.87; p = 0.038). Conclusion: There was good correlation between tumor size evaluation on MRI and pathology. The presence of associated DCIS was the only pathological parameter associated with size overestimation on MRI.