Evaluating the Impact of Breast Density on Preoperative MRI in Invasive Lobular Carcinoma

Predictive value of breast magnetic resonance imaging in detecting mammographically occult contralateral breast cancer: Can we target women more likely to have contralateral breast cancer?

“…In the prospective randomized trial of 1623 patients in the COMICE trial, there was no difference in reoperation rates between patients who had preoperative MRI compared to those who did not . On the other hand, the increased rate of mastectomy and bilateral mastectomy associated with routine use of MRI, nearing 20% to 39%, is well established . Nevertheless, we were surprised to find the exceptionally high rate of bilateral mastectomy in the current study.…”

“…Although we did not collect pre-MRI surgical planning data and as such are not able to comment on how surgical decision changed with the MRI use, it may be assumed that some of the mastectomy rate is a result of MRI use, consistent with published data. 23 Although the rates in our study are higher than in published clinical trials and European studies, our data may provide insight as to what is happening in more broadly sampled, American community-based practices rather than highly regulated clinical trial settings.…”

“…17 On the other hand, the increased rate of mastectomy and bilateral mastectomy associated with routine use of MRI, nearing 20% to 39%, is well established. [19][20][21][22][23] Nevertheless, we were surprised to find the exceptionally high rate of…”

“…and Wong et al23 recently published that preoperative MRI resulted in additional biopsies in 21% to 44% of patients undergoing routine MRI imaging for DCIS or invasive lobular cancer, the majority of which were benign. In the current study, we found that 79% of patients who went on to bilateral mastectomy after MRI suggested contralateral findings in the absence of a pathologic diagnosis had a benign specimen.Similar to other recently published studies,25,26 we found that the majority of MRI-detected, mammographically occult CBC were diagnosed as stage 0 or stage IA, with DCIS representing over a third of all CBC.…”

The Impact of Preoperative Breast Magnetic Resonance Imaging on Surgical Management in Symptomatic Patients With Invasive Lobular Carcinoma

“…In our institution, the MR+ group had a higher proportion of patients with high-density breasts, suggesting a selective approach to preoperative MRI in ILC based on mammographic density. 25 Such an approach has been validated by Wong et al, 46 who demonstrated that higher breast density (BI-RADS density C and D) was a significant predictor (odds ratio 3.19) for additional suspicious lesions detected by MRI in ILC patient. Similarly, Bansal et al 47 demonstrated the value of selectively performing preoperative MRI based solely on high mammographic density.…”