Background The value of magnetic resonance imaging (MRI) for patients with breast cancer remains under debate. Breast MRI may contribute to the planning of local therapy, but also bears the risk of overtreatment. We analyzed the use of MRI and its impact on surgical treatment and risk of detecting contralateral breast cancer in the Netherlands. Patients and methods All patients who underwent primary surgery for stage I-III invasive breast cancer in the years 2011-2013 were identified through the Netherlands Cancer Registry. The following data were documented: year of diagnosis, hospital type and volume, age at diagnosis, clinical T and N stage, histological type and grade, presence of multifocality in resection specimen, hormone receptor status, HER2 status and use of MRI. We analyzed whether MRI use was related to type of surgery (primary or secondary mastectomy or breast conserving surgery), surgical margin involvement, and diagnosis of synchronous contralateral breast cancer. Results MRI was performed in 10,819 (29,8%) out of 36,333 patients newly diagnosed with invasive breast cancer and treated with primary surgery in the years 2011-2013 in the Netherlands. Use of MRI did not clearly increase in this period. In the multivariate analysis, patients younger than 50 years of age compared to patients aged 70 years or older (OR 6.34, 95% CI 5.86-6.87), patients with lobular breast cancer compared to those with ductal carcinoma (OR 3.46; 95% CI 3.23-3.70) and patients with multifocal tumors compared to those without multifocality (OR 2.30, 95% CI 2.15-2.45) were more likely to undergo MRI. Hospital volume (<150 versus >150) was only marginally related to MRI use (OR 0.93; 95% CI 0.87-0.99). Patients with invasive breast cancer undergoing MRI were more likely to undergo primary mastectomy than those without MRI (OR 1.21; 95% CI 1.15-1.28), but the subgroup with invasive lobular cancer undergoing MRI were less likely to undergo primary mastectomy (OR 0.85; 95% CI 0.75-0.98). A significantly lower risk of positive surgical margins was seen in patients with lobular breast cancer and breast conserving surgery who had undergone MRI as compared to those without MRI (OR 0.58, 95% CI 0.44-0.78) and, consequently, also a lower risk of secondary mastectomy (OR 0.60, 95% CI 0.41-0.87). Risk of positive surgical margins was not reduced by MRI use in patients with invasive ductal carcinoma (OR 0.91; 95% CI 0.77-1.07). Patients who underwent MRI were almost four times more frequently diagnosed with contralateral breast cancer, compared to those in whom MRI was not performed (OR 3.60, 95% CI 3.06-4.24). Conclusion Breast MRI was significantly more often used in younger patients, patients with lobular and/or multifocal breast cancer. Interestingly, MRI use was associated with less primary and secundary mastectomies in lobular invasive breast cancer, in contrast to an increased number of primary mastectomies in patients with invasive ductal cancer. MRI was further associated with an almost fourfold higher incidence of contralateral breast cancer. Citation Format: Tjan-Heijnen VC, Lobbes MB, Vriens IJ, van Bommel AC, Nieuwenhuijzen GA, Smidt ML, Boersma LJ, van Dalen T, Smorenburg CH, Siesling S, Voogd AC. Only in lobular breast cancer MRI use is associated with a lower risk of positive surgical margins and a reduced number of mastectomies. A real-world analysis in The Netherlands. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-02-01.
Background: Screening guidelines for women with a family history of breast cancer without a known causative gene mutation differ per country. No randomized controlled trial has been performed to assess the optimal screening strategy for these women. Methods: In twelve centers, 1355 women aged 30–55 years with a cumulative lifetime risk of ≥20% without a BRCA1/2 mutation were randomized into two arms. From January 2011 until December 2017, women in the MRI-arm received yearly MRI-screening, clinical breast examination (CBE), and mammography every other year; and in the Mx-arm yearly mammography and CBE. Outcomes were number and stage of detected breast cancers, sensitivity, specificity and positive predictive value, and stratified by screening round and by mammographic density. Results: After on average 4.3 screening rounds per woman, in the MRI-arm (N=675) compared to the Mx-arm (N=680) more breast cancers were detected (41 versus 14, p<0.001), invasive cancers were smaller (median size 8 versus 17 mm, p=0.006) and less often node positive (20% versus 71.4%, p=0.019)(Table). In the MRI-arm, sensitivity was slightly higher (95.1% versus 92.9%, p=1), and specificity significantly lower (82% versus 90.1%, p<0.001), compared to the Mx-arm. After two rounds, specificity improved for both modalities (87.1% for MRI; 93.0% for Mx; p<0.001) and no ≥T2 tumors or interval cancers occurred in the MRI-arm. All tumors ≥T2 were in the two highest density categories. MRI detected more small invasive tumors than Mx across all density categories. Conclusions: In real-life practice the MRI-arm detected more, relevantly smaller, and far more often node negative tumors, and also at low density in women with a familial risk for breast cancer. Table 1Characteristics of participating women at baseline and of the detected breast cancers, according to study armParticipantsMRI-arm n=675Mx-arm n=680MRI-arm vs. Mx-arm p-valueMean age yr ± SD44.6 ± 6.244.7 ± 6.3 Premenopausal512 (76%)505 (74%) Previous Mx ≤ 2 yr536 (79 %)542 (80%) Previous Mx > 2 years ago23 ( 3%)29 ( 4%) Previous MRI ≤ 2 years ago62 ( 9%)81 (12%) Previous MRI > 2 years ago91 (14%)89 (13%) BI-RADS density category* I (entirely fat)88 (13%)92 (14%) II (scattered densities)248 (37%)229 (34%) III (heterogeneously dense)238 (35%)243 (36%) IV (extremely dense)98 (15%)102 (15%) Mean age at cancer detection49,6 ± 7.049,8 ± 4,70.74No cancer – no. (%)634 (94%)666 (98%) Invasive breast cancers – no. (%)25 (4%)7 (1%)<0.001 (noBC/inv BC/DCIS)DCIS – no. (%)16 (2%)7 (1%) Median size of invasive cancers8 mm17 mm0.006T1a/b15 (60%)1 (14%) T1c7 (28%)4 (57%)0.078 (T1a-b/T1c/≥ T2)≥ T23 (12%)2 (29%) Node pos5 (20%)5 (71%)0.019 (N+/-)Node negative20 (80%)2 (29%) DCIS grade 15 (31%)2 (29%) DCIS grade 28 (50%)4 (57%)1 (dcis gr1,2,3)DCIS grade 33 (19%)1 (14%) *Determined by radiologists, according to the fourth ACR BI-RADS edition Citation Format: Tilanus-Linthorst MM, Saadatmand S, Geuzinge AH, Rutgers EJ, Mann R, de Roy van Zuidewijn DB, Zonderland HM, Tollenaar RA, Lobbes MB, Ausems MG, van 't Riet M, Hooning MJ, Mares-Engelbert I, Luiten EJ, Heijnsdijk EA, Verhoef C, Karssemeijer N, Oosterwijk JC, Obdeijn I-M, de Koning HJ. MRI breast cancer screening compared to mammography in women with a familial risk: A multicenter randomized controlled trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-13-01.
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