Does a Supplementary Preoperative Breast MRI in Patients with Invasive Lobular Breast Cancer Change Primary and Secondary Surgical Interventions?

Heil, Joerg; Bühler, Anne; Golatta, Michael; Rom, Joachim; Harcos, Aba; Schipp, Anne; Rauch, Geraldine; Junkermann, H.; Sohn, Christof

doi:10.1245/s10434-011-1565-y

Cited by 25 publications

(27 citation statements)

References 26 publications

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“…Previous research examining the association between breast MRI and surgical outcomes for ILC patients found conflicting results regarding the benefit of breast MRI [5, 8, 18-20]. Our findings are similar to a meta-analysis among ILC patients which found that breast MRI was significantly associated with an increased likelihood of an initial mastectomy and weakly associated with a lower likelihood of a reoperation [8].…”

Section: Discussionsupporting

confidence: 70%

“…Our results differed from the meta-analysis in that the meta-analysis reported that preoperative breast MRI was associated with an increased likelihood of a final mastectomy whereas we found that ILC patients with breast MRI were no more likely to have a final mastectomy than those ILC women who did not receive a preoperative breast MRI. Our results may differ because the included studies were single institution studies [18-20] and one RCT [5] which included only a small number of patients with ILC. Furthermore, these studies reflect surgical practices from single institutions or in the United Kingdom, where breast cancer treatment patterns, decision-making factors, health service/insurance structures, and fiscal considerations may be different than and not generalizable to the US elderly population.…”

Section: Discussionmentioning

confidence: 96%

“…Preoperative breast MRI has been found to be highly sensitive in detecting lesions not seen using mammography or ultrasound among patients with ILC [17]. However, only a few studies have examined the association between breast MRI and surgical outcomes in women with ILC [5, 18-20]. These studies were limited in that they were single institution studies [18-20] and an RCT from the United Kingdom[5] with a small number of ILC patients from settings with distinct surgical treatment patterns, health service resources, and insurance structures that may not be generalizable to the US elderly population.…”

Section: Introductionmentioning

confidence: 99%

“…However, only a few studies have examined the association between breast MRI and surgical outcomes in women with ILC [5, 18-20]. These studies were limited in that they were single institution studies [18-20] and an RCT from the United Kingdom[5] with a small number of ILC patients from settings with distinct surgical treatment patterns, health service resources, and insurance structures that may not be generalizable to the US elderly population. A meta-analysis among ILC patients found that breast MRI was associated with an increased likelihood of mastectomy but found only weak evidence that breast MRI was associated with a lower likelihood of a reoperation [8].…”

Section: Introductionmentioning

confidence: 99%

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Preoperative breast MRI and surgical outcomes in elderly women with invasive ductal and lobular carcinoma: a population-based study

Fortune-Greeley

Wheeler

Meyer

et al. 2013

Breast Cancer Res Treat

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Background Existing evidence suggests that preoperative breast magnetic resonance imaging (MRI) might not improve surgical outcomes in the general breast cancer population. To determine if patients differentially benefit from breast MRI, we examined surgical outcomes—initial mastectomy, reoperation, and final mastectomy rates—among patients grouped by histologic type. Methods We identified women diagnosed with early-stage breast cancer from 2004-2007 in the SEER-Medicare dataset. We classified patients as having invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), mixed ductal/lobular carcinoma (IDLC) or other histologic type. Medicare claims were used to identify breast MRI and definitive surgeries during the initial surgical treatment episode. We used propensity score methods to account for the differential likelihood of exposure to MRI. Results Of the 20,333 patients who met our inclusion criteria for this study, 12.2% had a preoperative breast MRI. Patients with ILC as compared to other histologic groups were most likely to receive MRI (OR: 2.32; 95% CI: [2.02, 2.67]). In the propensity score adjusted analyses, breast MRI was associated with an increased likelihood of an initial mastectomy for all patients and among all histologic subgroups. Among patients with ILC, having a breast MRI was associated with lower odds of a reoperation (OR: 0.59; 95% CI [0.40, 0.86]), and an equal likelihood of a final mastectomy compared to similar patients without a breast MRI. Overall and among patients with IDC and IDLC, breast MRI was not significantly associated with a likelihood of a reoperation but was associated with greater odds of a final mastectomy. Conclusion Our study provides evidence in support of the targeted use of preoperative breast MRI among patients with ILC to improve surgical planning; it does not provide evidence for the routine use of breast MRI among all newly diagnosed breast cancer patients or among patients with IDC.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Preoperative breast MRI and surgical outcomes in elderly women with invasive ductal and lobular carcinoma: a population-based study

Fortune-Greeley

Wheeler

Meyer

et al. 2013

Breast Cancer Res Treat

View full text Add to dashboard Cite

show abstract

“…Most recently, Heil et al 45 have contributed to the literature regarding outcomes in lobular cancer and found that MRI made no significant difference on the mastectomy rate (P = 0.119), no significant difference in the second surgery rate (P = 0.429) but it made a significant increase in bilateral procedure rate (P = 002, although the numbers were small N = 5).…”

Section: Impact On Treatmentmentioning

confidence: 99%

The role of magnetic resonance imaging in early breast cancer

Skandarajah

Mann

2012

Asia-Pac J Clncl Oncology

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Despite recent evidence that fails to detect a benefit in surgical and local recurrence outcomes in those who receive optimal surgery and adjuvant systemic and radiotherapy, magnetic resonance imaging (MRI) is still being employed. We review the recent literature to clarify the role in the use of MRI in early breast cancer. A literature search using the Medline and Ovid databases was conducted between 2004 and 2011 using the terms "magnetic resonance imaging' and 'early breast cancer'. Only articles with clinical trials published in English in adult humans with available abstracts were included. Articles on high-risk women, response to neoadjuvant therapy, advanced breast cancer, the occult primary, the contralateral breast and technical articles were excluded. Articles examining the role of MRI in the staging of early breast cancer were retained. Over 260 articles regarding breast MRI have been published in the last 5 years. Additional foci may be found in 16% of patients but the impact on the extent of surgery and local recurrence rate is yet to be defined. Certain sub-groups who may benefit include those with invasive lobular carcinoma and mammographically dense breasts and those for consideration of partial breast irradiation. With standard adjuvant radiotherapy, there is no benefit in routine MRI with respect surgical extent and local recurrence. Should MRI be used, pre-operative biopsy to confirm additional disease must be undertaken prior to a change in surgical extent of resection. However, MRI may be useful in the evaluation of those who can be considered for partial breast irradiation. Centres undertaking breast MRI must have MRI-biopsy capabilities and constantly audit the reporting of MRI with correlation to the final pathology.

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Magnetic resonance imaging in patients with newly diagnosed breast cancer: A review of the literature

Pilewskie

King

2014

Cancer

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The use of magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer remains controversial. Here we review the current use of breast MRI and the impact of MRI on short-term surgical outcomes and rates of local recurrence. In addition, we address the use of MRI in specific patient populations, such as those with ductal carcinoma in situ, invasive lobular carcinoma, and occult primary breast cancer, and discuss the potential role of MRI for assessing response to neoadjuvant chemotherapy. Although MRI has improved sensitivity compared with conventional imaging, this has not translated into improved short-term surgical outcomes or long-term patient benefit, such as improved local control or survival, in any patient population. MRI is an important diagnostic test in the evaluation of patients presenting with occult primary breast cancer and has shown promise in monitoring response to neoadjuvant chemotherapy; however, the data do not support the routine use of perioperative MRI in patients with newly diagnosed breast cancer. Cancer 2014;120:2080-9. V C 2014 American Cancer Society.KEYWORDS: magnetic resonance imaging (MRI), breast cancer, breast-conserving surgery, local recurrence. INTRODUCTIONThe use of magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer requires balancing the positive and negative aspects of additional imaging and, as evidenced by the growing number of editorials and reviews arguing for or against the routine use of MRI, 1-8 remains an area of significant controversy. This debate has been fueled by inconsistent data largely comprised of small, single-institution retrospective studies, although 2 randomized controlled trials (RCTs) and several meta-analyses have provided more robust data evaluating MRI in the perioperative setting. The "pros" of perioperative MRI include improved sensitivity compared with conventional imaging and therefore increased identification of multifocal, multicentric, or contralateral disease. With improved sensitivity comes a theoretical improvement in short-term surgical management and/or long-term outcomes. The "cons" of perioperative MRI include the high falsepositive rate, potential treatment delays, increased mastectomy rates and cost, and, some argue, overdiagnosis and overtreatment of MRI-only detected disease. Here we review the relevant data regarding MRI use in patients with newly diagnosed breast cancer, examining both the short-term and long-term outcomes, MRI use in populations of women with ductal carcinoma in situ (DCIS) and invasive lobular carcinoma (ILC), MRI's role in patients presenting with occult primary breast cancer, and MRI's ability to evaluate neoadjuvant chemotherapy (NAC) response.

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Does a Supplementary Preoperative Breast MRI in Patients with Invasive Lobular Breast Cancer Change Primary and Secondary Surgical Interventions?

Abstract: The implementation of preoperative breast MRI tended to result in more primary mastectomies and bilateral surgeries and did not seem to decrease the secondary surgery rate.

Cited by 25 publications

References 26 publications

Preoperative breast MRI and surgical outcomes in elderly women with invasive ductal and lobular carcinoma: a population-based study

Preoperative breast MRI and surgical outcomes in elderly women with invasive ductal and lobular carcinoma: a population-based study

The role of magnetic resonance imaging in early breast cancer

Magnetic resonance imaging in patients with newly diagnosed breast cancer: A review of the literature

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