Does the use of pretreatment MRI change the management of patients with newly diagnosed breast cancer?

Hlubocky, James; Bhavnagri, Sharukh J; Swinford, Ann; Mitri, Carol; Rebner, Murray; Pai, Vidya

doi:10.1111/tbj.12946

Cited by 13 publications

(8 citation statements)

References 25 publications

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“…Our pooled estimation showed that 17% (95% CI 12 to 24%) of the initial surgical decisions may change to a more extensive resection or mastectomy when breast MRI is used (low certainty) (Supplementary Figure 2). There was important heterogeneity, with the five studies with a larger sample size [12,21,[37][38][39] reporting between 9 and 18% and those with a smaller sample size reporting much higher proportions (39% [41] to 50% [26]).…”

Section: Mri Triggered Treatment Changementioning

confidence: 98%

“…Three studies were RCTs [19][20][21], 18 were comparative cohorts [11,12,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] and five were single arm cohorts [12,21,[37][38][39], with a total of 20,415 patients (260 from the RCTs and 20,155 from the observational studies). Most studies were conducted in the USA or in the Netherlands.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…We also included five single MRI-arm cohorts [37][38][39][40][41] and the MRI arm of three comparative cohorts and one RCT [12,21,26], where all surgical treatment changes due to the MRI findings were recorded. We did not find studies directly reporting the quality of life of patients receiving pre-operative breast MRI.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Eight cohorts [12,26,33,35,[37][38][39][40][41] and the intervention arm of one RCT [21] informed this outcome. Our pooled estimation showed that 17% (95% CI 12 to 24%) of the initial surgical decisions may change to a more extensive resection or mastectomy when breast MRI is used (low certainty) (Supplementary Figure 2).…”

Section: Mri Triggered Treatment Changementioning

confidence: 99%

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Preoperative breast magnetic resonance imaging in patients with ductal carcinoma in situ: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC)

et al. 2021

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Objective To evaluate the impact of preoperative MRI in the management of Ductal carcinoma in situ (DCIS). Methods We searched the PubMed, EMBASE and Cochrane Library databases to identify randomised clinical trials (RCTs) or cohort studies assessing the impact of preoperative breast MRI in surgical outcomes, treatment change or loco-regional recurrence. We provided pooled estimates for odds ratios (OR), relative risks (RR) and proportions and assessed the certainty of the evidence using the GRADE approach. Results We included 3 RCTs and 23 observational cohorts, corresponding to 20,415 patients. For initial breast-conserving surgery (BCS), the RCTs showed that MRI may result in little to no difference (RR 0.95, 95% CI 0.90 to 1.00) (low certainty); observational studies showed that MRI may have no difference in the odds of re-operation after BCS (OR 0.96; 95% CI 0.36 to 2.61) (low certainty); and uncertain evidence from RCTs suggests little to no difference with respect to total mastectomy rate (RR 0.91; 95% CI 0.65 to 1.27) (very low certainty). We also found that MRI may change the initial treatment plans in 17% (95% CI 12 to 24%) of cases, but with little to no effect on locoregional recurrence (aHR = 1.18; 95% CI 0.79 to 1.76) (very low certainty). Conclusion We found evidence of low to very low certainty which may suggest there is no improvement of surgical outcomes with pre-operative MRI assessment of women with DCIS lesions. There is a need for large rigorously conducted RCTs to evaluate the role of preoperative MRI in this population. Key Points • Evidence of low to very low certainty may suggest there is no improvement in surgical outcomes with pre-operative MRI. • There is a need for large rigorously conducted RCTs evaluating the role of preoperative MRI to improve treatment planning for DCIS.

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Section: Mri Triggered Treatment Changementioning

confidence: 98%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Mri Triggered Treatment Changementioning

confidence: 99%

See 2 more Smart Citations

Preoperative breast magnetic resonance imaging in patients with ductal carcinoma in situ: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC)

et al. 2021

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“…In the previous study, although the decision whether to perform breast conserving therapy or mastectomy is based on not only the imaging findings but also on other factors such as breast size, surgeon preference, and expected cosmetic results, the use of preoperative MRI for a change in the management of breast cancer could be recommended especially for patients with pathology of invasive lobular carcinoma, and tumors in the lower quadrant. 17 Weclser et al reported that the African-American race, heterogeneously or extremely dense mammographic density, and progesterone receptor-positivity were associated with additional biopsy-proven cancers based on the preoperative MRI for occult lesions in breast cancer. 21 These confirm that a larger number of patients, more accurate analyses, and more advanced imaging techniques are likely to lead to the expansion of the preoperative MRI applications for newly diagnosed breast cancer.…”

Section: Discussionmentioning

confidence: 99%

Which Patients With Newly Diagnosed Breast Cancer Benefit From Preoperative Magnetic Resonance Imaging?

Lee

Kim

Lee

et al. 2021

International Surgery

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Objective The aim of this study was to identify the effectiveness and selective applications of preoperative magnetic resonance imaging (MRI) by investigating clinicopathologic factors of the index tumor with or without false lesions on MRI. Summary of background data Preoperative MRI is commonly performed in patients with newly diagnosed breast cancer, but its clinical significance is unclear. Methods A total of 103 breast cancer patients who had undergone MRI or ultrasound followed by mastectomy were included in this retrospective investigation of pathologic, clinical, and imaging findings. Results MRI showed 29 false-positive lesions in 57 patients, 5 false-negative lesions in 5 patients, and 69 true-positive lesions in 103 patients. More false lesions on MRI were found in patients with more lesions on ultrasound, small-sized index tumors on ultrasound, or early-stage cancer. The sensitivity of MRI and ultrasound were 96.5% and 92.3% (P = 0.119), respectively, and the positive predictive value of them were 71.5% and 72.5% (P = 0.828), respectively. Conclusions Preoperative MRI is more useful in patients with newly diagnosed breast cancer who have large-sized or more advanced cancers or fewer lesions on ultrasound.

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Locoregional staging of breast cancer: contrast-enhanced mammography versus breast magnetic resonance imaging

Terzoni,

Basile,

Gambaro

et al. 2024

Radiol med

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Purpose Breast cancer diagnosis often involves assessing the locoregional spread of the disease through MRI, as multicentricity, multifocality and/or bilaterality are increasingly common. Contrast-enhanced mammography (CEM) is emerging as a potential alternative method. This study compares the performance of CEM and MRI in preoperative staging of women with confirmed breast carcinoma. Patients were also asked to fill in a satisfaction questionnaire to rate their comfort level with each investigation. Methods From May 1st, 2021 to May 1st, 2022, we enrolled 70 women with confirmed breast carcinoma who were candidates for surgery. For pre-operative locoregional staging, all patients underwent CEM and MRI examination, which two radiologists evaluated blindly. We further investigated all suspicious locations for disease spread, identified by both CEM and MRI, with a second-look ultrasound (US) and eventual histological examination. Results In our study cohort, MRI and CEM identified 114 and 102 areas of focal contrast enhancement, respectively. A true discrepancy between MRI and CEM occurred in 9 out of 70 patients examined. MRI reported 8 additional lesions that proved to be false positives on second-look US in 6 patients, while it identified 4 lesions that were not detected by CEM and were pathological (true positives) in 3 patients. Conclusions CEM showed results comparable to MRI in the staging of breast cancer in our study population, with a high rate of patient acceptability.

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Does the use of pretreatment MRI change the management of patients with newly diagnosed breast cancer?

Cited by 13 publications

References 25 publications

Preoperative breast magnetic resonance imaging in patients with ductal carcinoma in situ: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC)

Preoperative breast magnetic resonance imaging in patients with ductal carcinoma in situ: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC)

Which Patients With Newly Diagnosed Breast Cancer Benefit From Preoperative Magnetic Resonance Imaging?

Locoregional staging of breast cancer: contrast-enhanced mammography versus breast magnetic resonance imaging

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