Preoperative Breast MRI for Early-Stage Breast Cancer: Effect on Surgical and Long-Term Outcomes

Sung, Janice S.; Li, Jie; Costa, Glenys Da; Patil, Sujata; Zee, Kimberly J. Van; Dershaw, D. David; Morris, Elizabeth A.

doi:10.2214/ajr.13.11355

Cited by 99 publications

(65 citation statements)

References 23 publications

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“…We believe that invasive cancer larger than 1 cm is clinically relevant. In approximately three-quarters of the patients in this series, MR imaging-detected multicentric cancers that represent DCIS or invasive cancer smaller than 1 cm could, arguably, result in overtreatment and more aggressive surgical treatment, whereas 3% (two of 73; 95% CI: 0.3, 10) of patients had unsuspected invasive cancer in the setting of DCIS, resulting in underdiagnosis and, possibly, improve surgical planning and patient outcomes (20).…”

Section: Discussionmentioning

confidence: 94%

Multicentric Cancer Detected at Breast MR Imaging and Not at Mammography: Important or Not?

Iacconi

Galman²,

Zheng³

et al. 2016

Radiology

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).q RSNA, 2015 Purpose:To review the magnetic resonance (MR) imaging and pathologic features of multicentric cancer detected only at MR imaging and to evaluate its potential biologic value. Materials and Methods:This retrospective study was institutional review board approved and HIPAA compliant; informed consent was waived. Results:Known index cancers were more likely to be invasive than MR imaging-detected multicentric cancers (88% vs 76%, P = .023). Ductal carcinoma in situ (21 of 87 lesions [24%]; 95% CI: 15, 36) represented a minority of additional MR imaging-detected multicentric cancers. Overall, the size of MR imaging-detected multicentric invasive cancers (median, 0.6 cm; range, 0.1-6.3 cm) was smaller than that of the index cancer (median, 1.2 cm; range, 0.05-7.0 cm; P = .023), although 17 of 73 (23%) (95% CI: 14, 35) patients had larger MR imaging-detected multicentric cancers than the known index lesion, and 18 of 73 (25%) (95% CI: 15, 36) had MR imaging-detected multicentric cancers larger than 1 cm. MR imaging-detected multicentric cancers and index cancers differed in histologic characteristics, invasiveness, and grade in 27 of 73 (37%) patients (95% CI: 26, 49). In four of 73 (5%) patients (95% CI: 2, 13), MR imaging-detected multicentric cancers were potentially more biologically relevant because of the presence of unsuspected invasion or a higher grade. Conclusion:Multicentric cancer detected only at MR imaging was invasive in 66 of 87 patients (76%), larger than 1 cm in 18 of 73 patients (25%), larger than the known index cancer in 17 of 73 patients (23%), and more biologically important in four of 73 women (5%). An unsuspected additional multicentric cancer seen only at MR imaging is likely clinically relevant disease.q RSNA, 2015

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Section: Discussionmentioning

confidence: 94%

Multicentric Cancer Detected at Breast MR Imaging and Not at Mammography: Important or Not?

Iacconi

Galman²,

Zheng³

et al. 2016

Radiology

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“…Its widespread use to locally stage breast cancer prior to breast conserving surgery is controversial as the multicentre randomised controlled COMICE study showed that MRI use did not reduce re-operation rates (24). MRI use in this clinical setting has also been shown to be associated with increased mastectomy rates (25) but not a reduction in local recurrence or disease free survival (26,27). The problem is not that MRI gives false positive results, but that it is so sensitive that it detects real tumour foci which after radiotherapy and systemic therapy do not, in many cases go on and cause local recurrence if the women had had no MRI and undergone breast conservation and adjuvant therapy with these small foci left in situ.…”

Section: Mri and Over Diagnosismentioning

confidence: 99%

Overdiagnosis in breast imaging

Evans

Vinnicombe

2017

The Breast

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The main harm of overdiagnosis is overtreatment. However a form of overdiagnosis also occurs when foci of cancer are found by imaging in addition to the symptomatic lesion when this leads to additional treatment which does not benefit the patient. Even if overtreatment is avoided, knowledge of the diagnosis can still cause psychological harm.Overdiagnosis is an inevitable effect of mammographic screening as the benefit comes from diagnosing breast cancer prior to clinical detectability. Estimates of the rate of overdiagnosis at screening are around 10%. DCIS represents 20% of cancers detected by screening and is the main focus in the overdiagnosis debate. Detection and treatment of low grade DCIS and invasive tubular cancer would appear to represent overdiagnosis in most cases. Supplementary screening with tomosynthesis or US are both likely to increase overdiagnosis as both modalities detect predominantly low grade invasive cancers. MRI causes overdiagnosis because it is so sensitive that it detects real tumour foci which after radiotherapy and systemic therapy do not, in many cases go on and cause local recurrence if the women had had no MRI and undergone breast conservation and adjuvant therapy with these small foci left in situ.

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“…Two prospective studies and a meta-analysis reported that patients undergoing pre-operative MR imaging have not experienced reduced re-excision or improved survival rates (12–15). Critics of the existing studies performed to examine the value of preoperative breast MR imaging have highlighted the lack of a consistent strategy to manage MR imaging data (16,17). Additional findings were not always addressed and often did not generate specific modifications at the time of surgery.…”

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confidence: 99%

Intraoperative Supine Breast MR Imaging to Quantify Tumor Deformation and Detection of Residual Breast Cancer: Preliminary Results

Gombos¹,

Jayender²,

Richman³

et al. 2016

Radiology

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Purpose To use intraoperative supine magnetic resonance (MR) imaging to quantify breast tumor deformation and displacement secondary to the change in patient positioning from imaging (prone) to surgery (supine) and to evaluate residual tumor immediately after breast-conserving surgery (BCS). Materials and Methods Fifteen women gave informed written consent to participate in this prospective HIPAA-compliant, institutional review board–approved study between April 2012 and November 2014. Twelve patients underwent lumpectomy and postsurgical intraoperative supine MR imaging. Six of 12 patients underwent both pre- and postsurgical supine MR imaging. Geometric, structural, and heterogeneity metrics of the cancer and distances of the tumor from the nipple, chest wall, and skin were computed. Mean and standard deviations of the changes in volume, surface area, compactness, spherical disproportion, sphericity, and distances from key landmarks were computed from tumor models. Imaging duration was recorded. Results The mean differences in tumor deformation metrics between prone and supine imaging were as follows: volume, 23.8% (range, −30% to 103.95%); surface area, 6.5% (range, −13.24% to 63%); compactness, 16.2% (range, −23% to 47.3%); sphericity, 6.8% (range, −9.10% to 20.78%); and decrease in spherical disproportion, −11.3% (range, −60.81% to 76.95%). All tumors were closer to the chest wall on supine images than on prone images. No evidence of residual tumor was seen on MR images obtained after the procedures. Mean duration of pre- and postoperative supine MR imaging was 25 minutes (range, 18.4–31.6 minutes) and 19 minutes (range, 15.1–22.9 minutes), respectively. Conclusion Intraoperative supine breast MR imaging, when performed in conjunction with standard prone breast MR imaging, enables quantification of breast tumor deformation and displacement secondary to changes in patient positioning from standard imaging (prone) to surgery (supine) and may help clinicians evaluate for residual tumor immediately after BCS.

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Preoperative Breast MRI for Early-Stage Breast Cancer: Effect on Surgical and Long-Term Outcomes

Abstract: Reexcision rates among patients with early breast cancer undergoing conservation therapy were lower among women who underwent preoperative breast MRI. There was no statistically significant effect of the use of preoperative MRI on rates of locoregional recurrence or disease-free survival.

Cited by 99 publications

References 23 publications

Multicentric Cancer Detected at Breast MR Imaging and Not at Mammography: Important or Not?

Multicentric Cancer Detected at Breast MR Imaging and Not at Mammography: Important or Not?

Overdiagnosis in breast imaging

Intraoperative Supine Breast MR Imaging to Quantify Tumor Deformation and Detection of Residual Breast Cancer: Preliminary Results

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