Preoperative MRI of the Breast (POMB) Influences Primary Treatment in Breast Cancer: A Prospective, Randomized, Multicenter Study

Gonzalez, Virginia; Sandelin, Kerstin; Karlsson, Anders; Åberg, Wiveca; Löfgren, Lars; Iliescu, Gabriela; Eriksson, Staffan; Arver, Brita

doi:10.1007/s00268-014-2605-0

Cited by 102 publications

(90 citation statements)

References 20 publications

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“…Two prospective randomized trials have failed to demonstrate a reduction in the number of additional surgeries after initial lumpectomy in patients selected with MRI 4,5 , while a third showed a decrease in re-excision rate which was balanced by an increase of the same magnitude in initial mastectomies. 14 Single-institution retrospective studies 12,15 and an individual patient level meta-analysis 6 show no decrease in locoregional recurrence in patients having preoperative MRI. 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.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…Only the complete analysis of thin-sliced gross section specimen using large-format histology would represent a perfect golden standard of pathology to prove the extension of all malignant foci as recommended by Tot and co-workers [ 11 ]. To date, MRI may show more invasive foci than described by pathological analysis after resection of a mastectomy or segmental specimen if only the representative approach of current margin analysis and no gross section specimens are used [ 12 ]. For ultrasound and mammography, this is true to a less extent.…”

Section: What Is the Blind Side Of Imaging And Pathology?mentioning

confidence: 98%

Breast Ultrasound: BI-RADS Update and Imaging Pathologic

Mundinger

2016

Diseases of the Brain, Head and Neck, Spine 2016-2019

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“…Fibrocystic changes (8) Fibroadenoma (1) Ductal hyperplasia (10) Stromal fibrosis (1) Fat necrosis (1) Columnar cell hyperplasia (1) No change by MR follow-up (13)…”

Section: Benign (35)mentioning

confidence: 99%

“…Ductal carcinoma in situ (8) Mucinous carcinoma (4) Invasive micropapillary carcinoma (2) Invasive lobular carcinoma (1)…”

Section: Malignancy (76)mentioning

confidence: 99%

“…For determining the extent of the lesion and the presence of multifocal or multicentric lesions, patients with breast carcinoma undergo preoperative evaluations including breast magnetic resonance imaging (MRI), which has proven to be the most sensitive tool for the detection of breast carcinoma (4)(5)(6)(7). Even though the use of preoperative breast MRI is increasing, controversy still exists for low specificity, unnecessary mastectomies, and cost-effectiveness (8).…”

Section: Introductionmentioning

confidence: 99%

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Comparison and Combination of Two Ultrasound Modalities, Handheld Ultrasound and Automated Breast Volume Scanner, With and Without Knowledge of MRI

et al. 2018

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Background: When a suspicious lesion is found on MRI but is not observed on conventional imaging, targeted ultrasound of the MRI-detected lesion is commonly performed for its detection and characterization. Nonetheless, there are limitations of handheld ultrasound (HHUS). Another ultrasound modality named automated breast volume scanner (ABVS) has achieved automation and high resolution recently. The detection rate and accuracy of conjunctive and disjunctive combination of each ultrasound modality (HHUS and ABVS) have not yet been evaluated. Objectives: To compare the diagnostic performance using HHUS, ABVS, and the combination method for suspicious lesions found on MRI. Patients and Methods: From March to September on 2014, we prospectively enrolled 40 consecutive breast cancer patients who underwent HHUS and ABVS for newly detected suspicious lesions found on MRI. All patients underwent mammography and HHUS before MRI. Whole breast ABVS and another HHUS were performed after MRI. We reviewed the detection rate and diagnostic accuracy of each imaging and analyzed the conjunctive and disjunctive combination results of two ultrasound modalities. We then compared them with or without knowledge of MRI. Results: In 120 suspicious lesions of 40 patients, seventy-six malignant and 44 nonmalignant lesions were included. With knowledge of MRI, cancer detection sensitivities of HHUS, ABVS, conjunctive and disjunctive combination were higher than those without knowledge of MRI (94.7%, 98.7%, 100%, 93.4% vs. 65.8%, 64.5%, 67.1%, 63.2%). In conjunctive combination of HHUS and ABVS, the detection sensitivities were improved in both cases with and without knowledge of MRI. Conclusion: With knowledge of MRI, HHUS and ABVS imaging detected most lesions and the conjunctive combination showed the highest detection sensitivity.

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Preoperative MRI of the Breast (POMB) Influences Primary Treatment in Breast Cancer: A Prospective, Randomized, Multicenter Study

Cited by 102 publications

References 20 publications

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

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

Breast Ultrasound: BI-RADS Update and Imaging Pathologic

Comparison and Combination of Two Ultrasound Modalities, Handheld Ultrasound and Automated Breast Volume Scanner, With and Without Knowledge of MRI

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