Who may benefit from preoperative breast MRI? A single-center analysis of 1102 consecutive patients with primary breast cancer

Abstract

Several authors question the potential benefit of preoperative magnetic resonance imaging (MRI) against the background of possible overdiagnosis, false-positive findings, and unnecessary resections in patients with newly diagnosed breast cancer. In order to reveal a better selection of patients who should undergo preoperative MRI after histological confirmed breast cancer, the present analysis was implemented. We aimed to evaluate the influence of preoperative breast MRI in patients with newly diagnosed breast cancer to find subgroups of patients that are most likely to benefit from preoperative MRI by the detection of occult malignant foci. A total of 1102 consecutive patients who underwent treatment for primary breast cancer between 2002 and 2013 were retrospectively analyzed. All patients underwent triple assessment by breast ultrasound, mammography, and bilateral breast MRI. MRI findings not seen on conventional imaging that suggested additional malignant disease was found in 344 cases (31.2 %). Histological confirmed malignant foci were found in 223 patients (20.2 %) within the index breast and in 28 patients (2.5 %) in the contralateral breast. The rate of false-negative biopsies was 31 (2.8 %) and 62 (5.6 %), respectively. Premenopausal women (p = 0.024), lobular invasive breast cancer (p = 0.02) as well as patients with high breast density [American College of Radiology (ACR) 3 + 4; p = 0.01] were significantly associated with additional malignant foci in the index breast. Multivariate analysis confirmed lobular histology (p = 0.041) as well as the co-factors "premenopausal stage" and "high breast density (ACR 3+4)" (p = 0.044) to be independently significant. Previous studies revealed that breast MRI is a reliable tool for predicting tumor extension as well as for the detection of additional ipsilateral and contralateral tumor foci in histological confirmed breast cancer. In the present study, we demonstrate that especially premenopausal patients with high breast density as well as patients with lobular histology seem to profit from preoperative MRI.

Impact of value based breast cancer care pathway implementation on pre-operative breast magnetic resonance imaging utilization

“…Contralateral BC has been shown to increase in those with ILC and breast MRI should be considered (14,15). Women with dense breasts also pose a challenge because the sensitivity of mammography is significantly decreased and focused breast ultrasound can miss extensive and multicentric disease (5,16). MRI is used in planning for partial breast irradiation because these patients will not receive sterilizing effect of whole breast irradiation (17).…”

“…These situations include evaluation of patients with invasive lobular carcinoma (ILC), which can be difficult because of a unique growth pattern and an increased risk of contralateral BC (14,15). Women with dense breasts have decreased mammography sensitivity which can also pose a challenge (5,16). MRI should also be used in planning for partial breast irradiation because these patients will not receive the sterilizing effect of whole breast irradiation (17).…”

“…MRI use is recommended in the care path for patients with invasive lobular cancer (ILC) (14,15), candidates for neo-adjuvant chemotherapy (20), heterogeneously or extremely dense mammographic tissue (5,16), malignancy of unknown primary origin (18), candidates for partial breast irradiation (17), or suspicion of contralateral BC (i.e., pathogenic genetic mutation) (19).…”

Incremental cancer detection using breast ultrasonographyversusbreast magnetic resonance imaging in the evaluation of newly diagnosed breast cancer patients

“…42 A single-centre analysis of 1102 consecutive patients with primary breast cancer found that pre-menopausal females with dense breasts and patients with lobular histology seemed to benefit from pre-operative MRI. 43 The controversy over pre-operative staging breast MRI is not likely to be resolved any time soon. Future research including prospective randomized multi-institutional trials involving large numbers of patients is needed to further define the role of preoperative breast MRI in light of the low recurrence rate of breast cancer with the current standard treatment regimen.…”

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

“…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).…”