Review of Preoperative Magnetic Resonance Imaging (MRI) in Breast Cancer: Should MRI Be Performed on All Women with Newly Diagnosed, Early Stage Breast Cancer?

Abstract

Randomized controlled trials have shown equivalent survival for women with early stage breast cancer who are treated with breast-conservation therapy (local excision and radiotherapy) or mastectomy. Decades of experience have demonstrated that breast-conservation therapy provides excellent local control based on defined standards of care. Magnetic resonance imaging (MRI) has been introduced in preoperative staging of the affected breast in women with newly diagnosed breast cancer because it detects additional foci of cancer that are occult on conventional imaging. The median incremental (additional) detection for MRI has been estimated as 16% in meta-analysis. In the absence of consensus on the role of preoperative MRI, we review data on its detection capability and its impact on treatment. We outline that the assumptions behind the adoption of MRI, namely that it will improve surgical planning and will lead to a reduction in re-excision surgery and in local recurrences, have not been substantiated by trials. Evidence consistently shows that MRI changes surgical management, usually from breast conservation to more radical surgery; however, there is no evidence that it improves surgical care or prognosis. Emerging data indicate that MRI does not reduce re-excision rates and that it causes false positives in terms of detection and unnecessary surgery; overall there is little high-quality evidence at present to support the routine use of preoperative MRI. Randomized controlled trials are needed to establish the clinical, psychosocial, and long-term effects of MRI and to show a related change in treatment from standard care in women newly affected by breast cancer.

Tumor Size of Invasive Breast Cancer on Magnetic Resonance Imaging and Conventional Imaging (Mammogram/Ultrasound): Comparison with Pathological Size and Clinical Implications

“…Although many studies have assessed the value of using magnetic resonance imaging (MRI) in invasive breast cancer, its role in clinical practice is still disputed. Some studies have suggested that MRI may increase rates of mastectomies, probably by overestimating the extent of local disease (1,2). In many of these studies, short-term clinical outcomes were the primary endpoints.…”

Impact of magnetic resonance imaging on preoperative planning for breast cancer surgery

“…Several review articles published by Houssami et al [11][12][13] strongly maintained that breast MRI would only cause more patients suitable for BCT to undergo more radical surgery without evidence to indicate improved survival. However, missed multicentric disease may be responsible for future recurrences.…”

“…Several reviews by Houssami et al [11][12][13] argued that consistently, MRIs changed surgical management, usually from breast conservation to more radical surgery, but there was no evidence of associated improved surgical outcomes or prognosis. More importantly, the recent randomised COMICE trial 14 concluded that MRI might be unnecessary as a means of reducing reoperation rates.…”

Impact of preoperatory magnetic resonance imaging in oncoplastic surgery

“…It is not known whether additional tumors detected on MRI could be treated exclusively with adjuvant radiotherapy [31][32][33]35 . So, several studies reported a rate of change of surgical plan to mastectomy or to wider resections between 8.3 and 43% 18,19,23,24,28,30 .…”

“…The rates of multifocality, multicentricity and contralateral breast lesions in the 60 patients of our series were 26.7, 1.7 and 8.3% respectively. Houssami and Hayes, in a series with 2,610 patients, detected 40% of multifocal and multicentric tumors 31 . COMICE trial detected 16% of multifocal tumors 13 .…”