Reoperation Rate For Breast Cancer Is Nearly Halved When MRI Findings Are Included in Planned Surgical Treatment

“Using bilateral MRI when planning surgery for breast cancer improved results in 1,926 patients.” Bill Chesnut, MD

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Reoperation Rate Is Nearly Halved When MRI Findings Are Included in Planned Surgical Treatment       Doctors Guide News__March 8, 2016    By Jenny Powers

VIENNA, Austria — March 8, 2016 — A comparison between two cohorts of patients who did and did not receive magnetic resonance imaging (MRI) in addition to mammography or ultrasound before breast cancer surgery revealed that MRI detected additional contralateral lesions and provided information that significantly altered surgical plans, researchers reported here on March 3 at the 2016 Annual European Congress of Radiology (ECR).

The study included women with newly-diagnosed breast cancer who were not candidates for neoadjuvant therapy. Surgical treatment was pre-planned for all women in the study based on mammography and or ultrasound, but one cohort received an MRI prior to surgery and one group did not.

To date 4,295 women have been enrolled in the ongoing study. The current analysis included data from 1,926 women aged 18 to 80 years, of whom 972 received MRI and 954 did not.

“The cohorts were not homogenous and significant differences in age and breast density were seen in the groups,” noted Giovanni Di Leo, MD, Radiology Unit, IRCCS Policlinico, Milan, Italy.

Patient age was 56 years in the MRI group versus 61 years in the non-MRI group and ACR breast density was 12% versus 18%, respectively (P < .001 for both).

The mastectomy rate was significantly higher in patients having MRI in addition to mammography or ultrasound (20.1% vs 14.0%; P < .001).

Pre-planned breast conserving surgery based upon MRI results was unchanged in 74% of women in the MRI cohort, altered to less extensive surgical treatment in 13%, and to a broader surgical treatment in 13% of women.

The rate of MRI-detected new contralateral cancers was (2%).

Importantly, the number of subsequent surgeries was significantly reduced in patients receiving MRI. The reoperation rate for positive margins was 7% in the MRI group compared with 13% in the non-MRI group (P < .001).

“The order for an MRI was made by a radiologist in 67% of the cases and by a surgeon in 40% of cases,” said Dr. Di Leo. “More mastectomies had already been planned on the basis of mammography or ultrasound in patients receiving MRI; this higher rate is due to a selection bias. One could say MRI is a confirmation tool for mastectomy.”

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