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Background Breast magnetic resonance imaging (MRI) has high sensitivity in detecting invasive neoplasms. Controversy remains about its impact on the preoperative staging of breast cancer surgery. This study evaluated survival and surgical outcomes of preoperative MRI in conservative breast cancer surgery. Methods A phase III, randomized, open-label, single-center trial including female breast cancer participants, stage 0–III disease, and eligible for breast-conserving surgery. We compared the role of including MRI in preoperative evaluation versus radiologic exam routine with mammography and ultrasound in breast cancer conservative candidates. The primary outcome was local relapse-free survival (LRFS), and secondary outcomes were overall survival (OS), mastectomy rate, and reoperation rate. Results 524 were randomized to preoperative MRI group (n = 257) or control group (n = 267). The survival analysis showed a 5.9-years LRFS of 99.2% in MRI group versus 98.9% in control group (HR = 0.72; 95% CI 0.12—4.28; p = 0.7) and an OS of 95.3% in the MRI group versus 96.3% in the control group (HR = 1.37 95% CI 0.59–3.19; p = 0.8). Surgical management changed in 21 ipsilateral breasts in the MRI group; 21 (8.3%) had mastectomies versus one in the control group. No difference was found in reoperation rates, 22 (8.7%) in the MRI group versus 23 (8.7%) in the control group (RR = 1.002; 95% CI 0.57–1.75; p = 0.85). Conclusion Preoperative MRI increased the mastectomy rates by 8%. The use of preoperative MRI did not influence local relapse-free survival, overall survival, or reoperation rates.

OBJECTIVES: This study aimed to evaluate the clinical and imaging predictive factors for the diagnosis of phyllodes tumors in patients with inconclusive results from core needle biopsy (fibroepithelial lesions). METHODS: We retrospectively analyzed data of patients who underwent surgical excision of breast lesions previously diagnosed as fibroepithelial lesions. Numeric variables were analyzed using the Shapiro-Wilk and t-tests, and categorical variables were analyzed using the chi-square and Fisher’s exact tests. Multivariate logistic regression was performed to calculate odds ratios and detect predictive factors for the diagnosis of PT. RESULTS: A total of 89 biopsy samples were obtained from 77 patients, of which 43 were confirmed as fibroadenomas, 43 as phyllodes tumors, and 3 as other benign, non-fibroepithelial breast lesions. The mean tumor size was 3.61 cm (range, 0.8-10 cm) for phyllodes tumors and 2.4 cm (range, 0.8-7.9 cm) for fibroadenomas. The predictive factor for phyllodes tumor diagnosis was lesion size >3 cm ( p <0.001). CONCLUSION: Our data indicate that fibroepithelial lesions of the breast larger than 3 cm are more likely to be phyllodes tumors.

Objective: The aim of this study is to investigate the correlation between background parenchymal enhancement (BPE) in magnetic resonance imaging (MRI) examination and mammographic breast density (MBD) and also the association of BPE with clinical and tumoral characteristics. Methodology: The post hoc analysis from a prospective database (BREASTMRI trial) was performed. Patients with breast cancer stages 0 to III for breast-conserving surgery, from November 2014 to October 2018, were selected. All patients were evaluated with triple assessment and stratified by MBD. Then, they were randomized on a 1:1 basis in two groups whether to perform breast MRI. BPE was classified into four categories according to the ACR BI-RADS MRI (minimal, mild, moderate, and marked). The MBD was also classified according to the ACR BI-RADS (A, B, C, and D). Results: A total of 217 patients were included. The mean age was 57.4 years (33.7–81.7, SD 10.8). Of these, 25 (11.5%) patients had ductal carcinoma in situ (DCIS) and 192 (88.5%) had invasive breast cancer. The MBD classification was 12 (5.5%) for A, 93 (42.9%) for B, 99 (45.6%) for C, and 13 (6%) for D. The BPE classification was 105 (48.4%) minimum, 78 (35.9%) mild, 29 (13.4%) moderate, and 5 (2.3%) marked. Both MBD and BPE were similar in 63 (29%) of 217 patients and differed in 154 (71%) of 217 patients. There is no correlation between MBD and BPE (Spearman’s rank of 0.240, p<0.001). Minimum/mild BPE breasts were more frequent in postmenopausal women (p=0.01). B3 lesions were identified significantly higher in moderate/marked BPE breasts (p=0.04). The median lesion size in breast MRI for minimum/mild BPE breasts was 2.2 cm, and the pathological median size was 2.0 cm (p=0.001, 95%CI). Conclusion: The background parenchymal enhancement does not correlate with MBD.

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