Rethinking Preoperative Breast Magnetic Resonance Imaging

Rahbar, Habib; Lehman, Constance D.

doi:10.1001/jamaoncol.2015.3029

Cited by 9 publications

(6 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…But just as high-quality diagnostic mammography made possible the shift from mastectomy to breast-conserving surgery and radiation for patients with unifocal disease, today's new imaging technologies and precision diagnostics may usher in the next advance in treatment options, tailored to the individual patient's disease profile. 57 Our goal is to further change the face of this devastating disease, so that some 40,000 women in the United States aren't dying every year of breast cancer. Advanced imaging technology such as tomosynthesis and improved supplementary modalities such as breast MRI and ultrasound will be essential in reaching this goal.…”

Section: S-8 Morris Et Almentioning

confidence: 99%

Implications of Overdiagnosis: Impact on Screening Mammography Practices

Morris

Feig

Drexler

et al. 2015

Population Health Management

View full text Add to dashboard Cite

This review article explores the issue of overdiagnosis in screening mammography. Overdiagnosis is the screen detection of a breast cancer, histologically confirmed, that might not otherwise become clinically apparent during the lifetime of the patient. While screening mammography is an imperfect tool, it remains the best tool we have to diagnose breast cancer early, before a patient is symptomatic and at a time when chances of survival and options for treatment are most favorable. In 2015, an estimated 231,840 new cases of breast cancer (excluding ductal carcinoma in situ) will be diagnosed in the United States, and some 40,290 women will die. Despite these data, screening mammography for women ages 40-69 has contributed to a substantial reduction in breast cancer mortality, and organized screening programs have led to a shift from late-stage diagnosis to early-stage detection. Current estimates of overdiagnosis in screening mammography vary widely, from 0% to upwards of 30% of diagnosed cancers. This range reflects the fact that measuring overdiagnosis is not a straightforward calculation, but usually one based on different sets of assumptions and often biased by methodological flaws. The recent development of tomosynthesis, which creates high-resolution, three-dimensional images, has increased breast cancer detection while reducing false recalls. Because the greatest harm of overdiagnosis is overtreatment, the key goal should not be less diagnosis but better treatment decision tools. (Population Health Management 2015;18:S3-S11)

show abstract

Section: S-8 Morris Et Almentioning

confidence: 99%

Implications of Overdiagnosis: Impact on Screening Mammography Practices

Morris

Feig

Drexler

et al. 2015

Population Health Management

View full text Add to dashboard Cite

show abstract

“…It is important to determine more appropriate use of preoperative MR imaging in a heterogeneous group of patients with breast cancer (15). Two ongoing prospective studies (33)(34)(35) have perspectives of the patient and surgeon to help determine the role of preoperative MR imaging in the decision-making process for breast cancer treatment.…”

Section: Discussionmentioning

confidence: 99%

Preoperative MR Imaging in Women with Breast Cancer Detected at Screening US

et al. 2017

View full text Add to dashboard Cite

Purpose To determine additional cancer yield of magnetic resonance (MR) imaging in women with breast cancer detected at screening ultrasonography (US) and to identify a subgroup of women who are likely to benefit from preoperative MR imaging. Materials and Methods This study was approved by the institutional review board, and the requirement for informed consent was waived. A retrospective review of 374 women (median age, 48 years; age range, 30-74 years) with breast cancer detected at screening US (invasive, n = 321) who underwent preoperative breast MR imaging between 2007 and 2013 was performed. Cancer yield and positive predictive value of biopsy were calculated. Multivariate logistic regression analysis was performed to identify clinical-pathologic features associated with additional cancer detected at MR imaging. Results Of 374 women, 21 (5.6%; 95% confidence interval [CI]: 3.5%, 8.5%) were diagnosed with additional cancer (positive predictive value of biopsy, 42.0% [21 of 50 women]; 95% CI: 28%, 57%). Index invasive lobular cancer (ILC) histologic type was significantly associated with additional cancer detected at MR imaging (odds ratio, 4.0; 95% CI: 1.2, 13.6; P = .03). In women with index invasive cancer, premenopausal status (odds ratio, 5.7; 95% CI: 1.2, 35.8; P = .03) and lobular histologic type (odds ratio, 3.9; 95% CI: 1.1, 12.3; P = .03) were factors associated with additional cancer detected at MR imaging. Conclusion Preoperative MR imaging helped to detect additional sites of cancer in 5.6% of women with breast cancer detected at screening US. Women with index ILC and premenopausal women are more likely to benefit from preoperative MR imaging. RSNA, 2016 Online supplemental material is available for this article.

show abstract

“…The preoperative evaluation might include multiple breast imaging modalities, which can result in additional biopsies. Breast magnetic resonance imaging has increasingly been used preoperatively during the past 10 years because of its high sensitivity for detecting additional lesions and its negative predictive value . Although the use of breast magnetic resonance imaging for staging after a breast cancer diagnosis is controversial, for women with an increased likelihood of MFBC, it might be an important and appropriate component of preoperative management.…”

Section: Discussionmentioning

confidence: 99%