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Bleicher RJ , Ciocca RM , Egleston BL , Sesa L , Evers K , Sigurdson ER , Morrow M
Association of routine pretreatment magnetic resonance imaging with time to surgery, mastectomy rate, and margin status
J Am Coll Surg. 2009 Aug;209(2) :180-7; quiz 294-5
PMID: 19632594    PMCID: PMC2758058    URL: https://www.ncbi.nlm.nih.gov/pubmed/19632594
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Abstract
BACKGROUND: The benefit of breast MRI for newly diagnosed breast cancer patients is uncertain. This study characterizes those receiving MRI versus those who did not, and reports on their short-term surgical outcomes, including time to operation, margin status, and mastectomy rate. STUDY DESIGN: All patients seen in a multidisciplinary breast cancer clinic from July 2004 to December 2006 were retrospectively reviewed. Patients were evaluated by a radiologist, a pathologist, and surgical, radiation, and medical oncologists. RESULTS: Among 577 patients, 130 had pretreatment MRIs. MRI use increased from 2004 (referent, 13%) versus 2005 (24%, p=0.014) and 2006 (27%, p=0.002). Patients having MRIs were younger (52.5 versus 59.0 years, p < 0.001), but its use was not associated with preoperative chemotherapy, family history of breast or ovarian cancer, presentation, or tumor features. MRI was associated with a 22.4-day delay in pretreatment evaluation (p=0.011). Breast conserving therapy (BCT) was attempted in 320 of 419 patients with complete surgical data. The odds ratio for mastectomy, controlling for T size and stage, was 1.80 after MRI versus no MRI (p=0.024). Patients having MRIs did not have fewer positive margins at lumpectomy (21.6% MRI versus 13.8% no MRI, p=0.20), or conversions from BCT to mastectomy (9.8% MRI versus 5.9% no MRI, p=0.35). CONCLUSIONS: Breast MRI use was not confined to any particular patient group. MRI use was not associated with improved margin status or BCT attempts, but was associated with a treatment delay and increased mastectomy rate. Without evidence of improved oncologic outcomes as a result, our study does not support the routine use of MRI to select patients or facilitate the performance of BCT.
Notes
Bleicher, Richard J Ciocca, Robin M Egleston, Brian L Sesa, Linda Evers, Kathryn Sigurdson, Elin R Morrow, Monica 5P30 CA06927/CA/NCI NIH HHS/United States Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S. United States Journal of the American College of Surgeons J Am Coll Surg. 2009 Aug;209(2):180-7; quiz 294-5. Epub 2009 Jun 18.