Relationship between preoperative breast MRI and surgical treatment of non‐metastatic breast cancer

Abstract

Background and Objectives More extensive surgical treatments for early stage breast cancer are increasing. The patterns of preoperative MRI overall and by stage for this trend has not been well established. Methods Using Breast Cancer Surveillance Consortium registry data from 2010 through 2014, we identified women with an incident non-metastatic breast cancer and determined use of preoperative MRI and initial surgical treatment (mastectomy, with or without contralateral prophylactic mastectomy (CPM), reconstruction, and breast conserving surgery +/− radiation). Clinical and sociodemographic covariates were included in multivariable logistic regression models to estimate adjusted odds ratios and 95% confidence intervals. Results Of the 13,097 women, 2,217 (16.9%) had a preoperative MRI. Among the women with MRI, results indicated 32% higher odds of unilateral mastectomy compared to breast conserving surgery and of mastectomy with CPM compared to unilateral mastectomy. Women with preoperative MRI also had 56% higher odds of reconstruction. Conclusion Preoperative MRI in women with DCIS and early stage invasive breast cancer is associated with more frequent mastectomy, CPM, and reconstruction surgical treatment. Use of more extensive surgical treatment and reconstruction among women with DCIS and early stage invasive cancer whom undergo MRI warrants further investigation.

Preoperative breast magnetic resonance imaging in patients with ductal carcinoma in situ: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC)

“…2a ) ( low certainty ) [ 19 , 21 ]. In 11 observational studies [ 11 , 12 , 22 – 24 , 27 , 32 – 36 ], the odds of BCS was lower but the evidence was very uncertain (OR 0.49; 95% CI 0.29 to 0.82) and only two cohort studies reported adjusted OR showing similar results ( very low certainty ) [ 32 , 35 ] (Fig. 2b ).…”

“…It is noteworthy that the definitions for positive margins across studies were heterogenous (i.e. < 1 mm [ 11 , 27 ] or < 5 mm [ 29 ]) or not clearly described [ 36 ], even among the included centres of the only RCT reporting this outcome [ 20 ].…”

“…Three studies were RCTs [19][20][21], 18 were comparative cohorts [11,12,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] and five were single arm cohorts [12,21,[37][38][39], with a total of 20,415 patients (260 from the RCTs and 20,155 from the observational studies). Most studies were conducted in the USA or in the Netherlands.…”

“…Of the 18 comparative cohorts included [11,12,[22][23][24][25][26][27][28][29][30][31][32][33][34], 16 were retrospective analyses of medical records or population registries [11,12,[22][23][24][25][26][27][29][30][31][32][33][34][35][36], three of them comparing different time periods (pre-and post-implementation of MRI) [23,24,26]. Three cohort studies had larger sample sizes, one used the Breast Cancer Surveillance Consortium registry data with 2437 patients with DCIS from 2010 to 2014 [27], another study included data of 2319 patients from a cancer centre in New York (USA) from 1997 to 2010 [28] and the last study used the Netherlands Cancer Registry (NCR) including 10,415 clinical records [33] (Table 1 and Supplementary table S3).…”

Rising rates of bilateral mastectomy with reconstruction following neoadjuvant chemotherapy

“…We found similar nationwide surgical trends among the population of patients receiving NAC. As in the non-NAC setting, the decision to pursue bilateral mastectomy for unilateral breast cancers after NAC is multifactorial and likely influenced by patient, physician and treatment factors, such as increased use of magnetic resonance imaging, 27,28 increased genetic testing and identification of high-risk patients who benefit from bilateral mastectomy, 29 surgeon's preference 30 and patient preference due to fear of additional therapies, recurrence or anticipated regret [31][32][33][34] or desire for cosmetic symmetry and increased access to reconstruction. 35 In our study, we observed that the receipt of bilateral mastectomy is more common among younger patients from a more advantaged sociodemographic background even though these characteristics were associated with attainment of pCR.…”