Current clinical indications for magnetic resonance imaging of the breast

Knuttel, Floortje M.; Menezes, Gisela L. G.; Bosch, Maurice A.A.J. van den; Gilhuijs, Kenneth G. A.; Peters, Niek A.

doi:10.1002/jso.23655

Cited by 30 publications

(23 citation statements)

References 63 publications

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“…While this is understandable given the tendency of mammography to underestimate the extent of lobular carcinoma 43 , our meta-analysis does not indicate an improvement in surgical outcomes in women with ILC undergoing the test, suggesting that it is an unnecessary cost 44 when used routinely based on a diagnosis of ILC. Some of the confusion regarding pre-operative indications for MRI stems from guidelines that were predominantly based on expert opinion 10 , promulgating its use for pre-operative evaluation of the ipsilateral and contralateral breast, even while radiologists acknowledge that the level of consensus on its use in patients with invasive ductal cancer undergoing primary surgery is low 45 . Now that a large body of evidence from comparative studies exists and has been synthesized in this meta-analysis, indicating that pre-operative MRI is not associated with improved surgical treatment, and given the broader health context of appropriate use of medical services that also recognises drivers of ineffective practice 46;47 , it is time to question the routine use of pre-operative MRI for BC patients.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of pre-operative magnetic resonance imaging (MRI) and surgical treatment for breast cancer

Houssami

Turner

Morrow

2017

Breast Cancer Res Treat

171

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Background Although there is no consensus on whether pre-operative MRI in women with breast cancer (BC) benefits surgical treatment, MRI continues to be used pre-operatively in practice. This meta-analysis examines the association between pre-operative MRI and surgical outcomes in BC. Methods A systematic review was performed to identify studies reporting quantitative data on pre-operative MRI and surgical outcomes (without restriction by type of surgery received or type of BC) and using a controlled design. Random-effects logistic regression calculated the pooled odds ratio (OR) for each surgical outcome (MRI versus no-MRI groups), and estimated ORs stratified by study-level age. Subgroup analysis was performed for invasive lobular cancer (ILC). Results Nineteen studies met eligibility criteria: 3 RCTs and 16 comparative studies that included newly diagnosed BC of any type except for 3 studies restricted to invasive lobular cancer (ILC). Primary analysis (85975 subjects) showed that pre-operative MRI was associated with increased odds of receiving mastectomy [OR 1.39 (1.23, 1.57); p<0.001]; similar findings were shown in analyses stratified by study-level median age. Secondary analyses did not find statistical evidence of an effect of MRI on the rates of re-excision, re-operation, or positive margins; however MRI was significantly associated with increased odds of receiving contralateral prophylactic mastectomy [OR 1.91 (1.25, 2.91); p= 0.003]. Subgroup analysis for ILC did not find any association between MRI and the odds of receiving mastectomy [OR 1.00 (0.75, 1.33); p= 0.988] or the odds of re-excision [OR 0.65 (0.35, 1.24); p= 0.192]. Conclusions Pre-operative MRI is associated with increased odds of receiving ipsilateral mastectomy and contralateral prophylactic mastectomy as surgical treatment in newly diagnosed BC patients.

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Section: Discussionmentioning

confidence: 99%

Meta-analysis of pre-operative magnetic resonance imaging (MRI) and surgical treatment for breast cancer

Houssami

Turner

Morrow

2017

Breast Cancer Res Treat

171

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“…1,2 In comparison to mammography and ultrasound, it also expresses superior sensitivity for detection of additional or residual disease. [1][2][3][4] Recently, computer algorithms have been applied to automatically extract large numbers of quantitative features that thoroughly describe various characteristics of tumors and their surroundings. These features have been applied to the determination of patient diagnosis, 5,6 prognosis of outcomes, [7][8][9][10] and for their association with genomics.…”

Section: Introductionmentioning

confidence: 99%

Breast cancer MRI radiomics: An overview of algorithmic features and impact of inter‐reader variability in annotating tumors

2018

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“…In spite of this, guidelines promulgated by breast imaging societies continue to endorse MRI for preoperative staging of the ipsilateral and contralateral breast 16 , although radiologists acknowledge that the level of consensus on its use in patients with infiltrating ductal carcinoma undergoing surgery as the initial step in treatment is low. 17 The lack of consensus on the benefit of routine preoperative MRI is also evident among the surgeons in our study, with 26% endorsing MRI for preoperative evaluation of a patient with an uncomplicated clinical stage I screen-detected cancer. A substantially greater proportion, 72%, favored MRI in patients with infiltrating lobular cancer, an entity known to be underestimated by mammography, and the clinical scenario with the greatest number of studies suggesting benefit for preoperative MRI.…”

Section: Discussionmentioning

confidence: 84%

Surgeon Attitudes and Use of MRI in Patients Newly Diagnosed with Breast Cancer

et al. 2017

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Background Usage of magnetic resonance imaging (MRI) in newly diagnosed breast cancer patients is increasing, despite scant evidence that it improves outcomes. Little is known about the knowledge, perspectives, and clinical characteristics of surgeons associated with MRI use. Methods Women with early-stage breast cancer undergoing definitive surgery between 7/2013–8/2015 were identified from the Los Angeles and Georgia Surveillance, Epidemiology and End Results (SEER) registries, and asked to name their attending surgeons. The 489 surgeons were sent a questionnaire; 77% (n=377) responded. Questions addressing the likelihood of ordering an MRI in different scenarios were used to create a scale measuring surgeon propensity for MRI use. Knowledge and practice characteristics were also assessed. Results Mean surgeon age was 54 years, 25% were female, and median number of years in practice was 21. Wide MRI use variation was observed, with 26% obtaining MRI for a clinical stage I screen-detected breast cancer and 72% for infiltrating lobular cancer. High users of MRI were significantly more likely to be higher-volume surgeons (p<.001) and to have misconceptions about MRI benefits (p<.001). Of surgeons who felt they used MRI more often, 60% were high MRI users; only 6% were low MRI users. Conclusions Our findings suggest relatively frequent use of MRI, even in uncomplicated clinical scenarios, in the absence of evidence of benefit, and use was more common among high-volume surgeons. A substantial number of surgeons who are high MRI users harbor misconceptions about MRI benefit, suggesting an opportunity for education and consensus building regarding appropriate use.

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Current clinical indications for magnetic resonance imaging of the breast

Cited by 30 publications

References 63 publications

Meta-analysis of pre-operative magnetic resonance imaging (MRI) and surgical treatment for breast cancer

Meta-analysis of pre-operative magnetic resonance imaging (MRI) and surgical treatment for breast cancer

Breast cancer MRI radiomics: An overview of algorithmic features and impact of inter‐reader variability in annotating tumors

Surgeon Attitudes and Use of MRI in Patients Newly Diagnosed with Breast Cancer

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