In our study cohort the mastectomy rate did not differ (39 % vs. 39 %) between patients with and without preoperative breast MRI, although tumor stages and focality were higher in the group of patients undergoing MRI. Breast MRI was beneficial for 20.3 % (127/626) of the patients as additional foci of cancer in the same or contralateral breast were diagnosed (n=122) or MRI could prove a lesser extent of carcinoma (n=5). Patients receiving preoperative MRI had a lower chance of repeated surgery (p=0.007). Preoperative breast MRI did not delay surgery (20.3 days vs. 19.8 days, p=0.7).
Introduction
Breast MRI is the imaging modality with the highest diagnostic accuracy in the detection of primary or recurrent breast cancer with published sensitivity values of 89-100 % [1-3]. However, preoperative breast MR Imaging in case of biopsy-proven breast cancer is only recommended in individual cases by national and international guidelines [4]. The basis of breast cancer therapy is local surgical excision with tumor free margins. In the literature, the rate of re-excisions in patients with breast cancer varies from 14 to 25 % [5; 6]. The impact of preoperative MRI on re-excisions and mastectomy rate is discussed controversially in the literature [6-9]. Aim of this study was to evaluate the effect of preoperative breast MRI on the surgical procedure and rate of repeated surgeries.Methods
Approval for retrospective patient data analysis was waived by the institutional review board (No. 308/2012R). A retrospective analysis of 991 consecutive patients in the years 2009 and 2010 with 1036 primary breast cancers was performed. Sixty percent (599 patients with 626 cancers) received preoperative breast MRI. Planned surgical procedures before and after MRI and the numbers of repeated surgeries in patients with (MR+) and without preoperative MRI (MR-) were compared.Results
The result of preoperative MRI changed the surgical procedure in 25 % (157/626) of the cases (wider local excision (n=45), local excision to a lesser extent (n=5), excision of a contralateral carcinoma (n=7), or mastectomy (n=100)). Surgical therapy of the 1036 breast cancers was breast conserving therapy (BCT) in 636 cancers (61.4 %) and mastectomy in 400 cancers (38.6 %). Mastectomy rates did not differ between MR+ and MR- group (39 % vs. 39 %). In 81 % (127/157), MRI was beneficial for the patients, as otherwise occult carcinomas were removed (n=122) or further biopsy could be prevented (n=5). On multiple regression analysis, the MR+ group had a lower chance for repeated surgery (p<0.05). Mammography was obtained after 13.0 and 12.2 days (mean) before histopathologic diagnosis and surgery was performed 33.3 and 32.0 days (mean) after mammography in the MR+ and MR- group, respectively. Surgery was performed 20.3 days (mean) after cancer diagnosis in the MR+ group and 19.8 days in the MR- group (p=0.7).Discussion
In our study on patients with primary breast cancer, performing a preoperative MRI led to a significantly lower chance of repeated surgery. In the prospectively randomized COMICE trial, the re-excision rate in patients with and without preoperative MRI did not differ [6]. In the MONET study, another prospectively randomized trial, even a higher re-excision rate was found in the MR+ group (34 %) compared to the MR- group (12 %) [7]. Our data support the results of Grady et al. [10] and Mann et al. [11], who report from lower re-excision rates (11 % vs. 26 % and 9 % vs. 27 %) in patients with and without preoperative MRI, respectively. In our study, the mastectomy rate did not differ between the groups (39 % vs. 39 %), although tumor stages and focality were significantly higher in the MR+ group. An increase of the mastectomy rate in patients with pure DCIS who received preoperative breast MRI compared to those without MRI has been described [12]. Several studies showed no significant difference of BCT and mastectomy rates between MR+ and MR- groups [6-8; 10]. Mann et al. analyzed patients with smaller cancers who were scheduled for BCT and there was a significantly lower final mastectomy rate in the MR+ group [11]. In 25 % (157/626) preoperative MRI led to a change of the surgical procedure in our study. This is in accordance with a published rate of 12-34 % changes of the surgical procedure due to breast MRI findings [1; 13; 14]. The change was beneficial for the patients in 81 % (127/157) in our study. Hence, in 20.3 % (127/626) patients receiving preoperative MRI had a benefit from this procedure. In this study, there also was no relevant delay of surgery by MRI (19.8 vs. 20.3 days, p=0.7). This is consistent with other published results [7; 11]. A time delay of breast surgery through preoperative MRI has been described [15].1 Bedrosian I, Mick R, Orel SG et al
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