Trends in mastectomy rates at the Mayo Clinic Rochester: Effect of surgical year and preoperative MRI

Katipamula, Rajini; Hoskin, Tanya L.; Boughey, JC; Degnim, Amy C.; Grant, Clive S.; Brandt, Kathy R.; Loprinzi, Charles L.; Pruthi, Sandhya; Goetz, Matthew P.

doi:10.1200/jco.2008.26.15_suppl.509

Cited by 25 publications

(17 citation statements)

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“…The finding that lobular histology, tumor size, and preoperative chemotherapy also did not correlate with the use of MRI, suggests that it is being employed in the breast cancer patient population at large rather than in subgroups determined by genetic risk, tumor characteristics, or planned treatment. The observation that MRI use increased during the relatively brief time period of this study is consistent with the findings of a study from the Mayo Clinic Rochester18 and suggests that this pattern is not limited to a single geographic area.…”

Section: Discussionsupporting

confidence: 88%

Association of Routine Pretreatment Magnetic Resonance Imaging with Time to Surgery, Mastectomy Rate, and Margin Status

Bleicher

Ciocca

Egleston

et al. 2009

Journal of the American College of Surgeons

240

146

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Section: Discussionsupporting

confidence: 88%

Association of Routine Pretreatment Magnetic Resonance Imaging with Time to Surgery, Mastectomy Rate, and Margin Status

Bleicher

Ciocca

Egleston

et al. 2009

Journal of the American College of Surgeons

240

146

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“…1,2 In 2007, the American Cancer Society released guidelines recommending screening MRI as an adjunct to x-ray mammography for women with a 20%-25% lifetime risk of developing breast cancer 3 and DCE-MRI has been used increasingly in the clinic. 4,5 Despite recent advances, many issues remain to be fully addressed in DCE-MRI. Although DCE-MRI demonstrates high sensitivity, it has a welldocumented low and variable specificity ͑26%-97%͒.…”

Section: Introductionmentioning

confidence: 99%

An anthropomorphic phantom for quantitative evaluation of breast MRI

et al. 2011

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Purpose: In this study, the authors aim to develop a physical, tissue-mimicking phantom for quantitative evaluation of breast MRI protocols. The objective of this phantom is to address the need for improved standardization in breast MRI and provide a platform for evaluating the influence of image protocol parameters on lesion detection and discrimination. Quantitative comparisons between patient and phantom image properties are presented. Methods: The phantom is constructed using a mixture of lard and egg whites, resulting in a random structure with separate adipose-and glandular-mimicking components. T 1 and T 2 relaxation times of the lard and egg components of the phantom were estimated at 1.5 T from inversion recovery and spin-echo scans, respectively, using maximum-likelihood methods. The image structure was examined quantitatively by calculating and comparing spatial covariance matrices of phantom and patient images. A static, enhancing lesion was introduced by creating a hollow mold with stereolithography and filling it with a gadolinium-doped water solution. Results: Measured phantom relaxation values fall within 2 standard errors of human values from the literature and are reasonably stable over 9 months of testing. Comparison of the covariance matrices of phantom and patient data demonstrates that the phantom and patient data have similar image structure. Their covariance matrices are the same to within error bars in the anterior-posterior direction and to within about two error bars in the right-left direction. The signal from the phantom's adipose-mimicking material can be suppressed using active fat-suppression protocols. A static, enhancing lesion can also be included with the ability to change morphology and contrast agent concentration. Conclusions: The authors have constructed a phantom and demonstrated its ability to mimic human breast images in terms of key physical properties that are relevant to breast MRI. This phantom provides a platform for the optimization and standardization of breast MRI imaging protocols for lesion detection and characterization.

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“…There have been multiple studies evaluating the effect of the use of MRI in the decision to undergo CPM One institution found that patients who underwent a preoperative MRI with early stage breast cancer were more likely to undergo CPM [6] . This may be related to the patients undergoing MRI being younger with denser breast tissue and more specific findings.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, many health care institutions have attempted to assess their rates of mastectomy, and clarify the factors associated with treatment choice. Previous studies have examined the use of MRI [6][7][8] , genetic testing [9] , availability of immediate reconstruction in order to achieve a more symmetric cosmetic outcome [10][11] , tumor characteristics [12][13] , and surgeon subspecialty [14] as they related to mastectomy rates. Clinicians and epidemiologists alike are curious as to why women are choosing more aggressive treatment.…”

Section: Introductionmentioning

confidence: 99%

Contralateral Prophylactic Mastectomy: Characteristics Influencing Utilization

Sams¹,

Rumberger²,

A³

et al. 2014

IJCO

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Abstract:Purpose: Breast conservation has been shown to have similar mortality rates as compared to mastectomy. We hypothesized that variables involving the patient, tumor and surgeon influence the treatment a patient may choose. Methods:Retrospective review of a prospectively maintained database of all patients who underwent surgical treatment for breast cancer between 2000 and 2009 was performed. Multivariate logistic regression models were used to compare characteristics associated with breast conservation therapy (BCT) and contralateral prophylactic mastectomy (CPM).Results: Of 1826 patients, 806 underwent BCT and 207 underwent CPM. Exclusion criteria included unilateral mastectomy (n=761), bilateral disease, stage IV disease, and incomplete records. Larger average tumor size and number of lymph nodes examined were associated with CPM (both p<0.0001). There were higher odds of patients who underwent CPM when younger than 40 (OR=3.1), less than 50 years of age (OR=2.5), with a history of breast cancer (OR=4.7), lobular histology (OR=2.3), invasive histology (OR=2.1), and multi-centric (OR=8.2). Patients treated by surgeons with greater than 10 years of experience were less than half as likely to undergo CPM (OR=0.4), however when treated by a surgeon not subspecialty trained in surgical oncology the patient was more likely to undergo CPM (OR=3.4). Conclusions: Our study is one of the first to evaluate patient comorbidities, personal history of breast cancer, and length of surgeon experience and the influence each may have on usage of CPM. Our data also suggest that there may be a training gap to bridge for general surgeons, because more surgery is becoming subspecialized.

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Trends in mastectomy rates at the Mayo Clinic Rochester: Effect of surgical year and preoperative MRI

Cited by 25 publications

References 0 publications

Association of Routine Pretreatment Magnetic Resonance Imaging with Time to Surgery, Mastectomy Rate, and Margin Status

Association of Routine Pretreatment Magnetic Resonance Imaging with Time to Surgery, Mastectomy Rate, and Margin Status

An anthropomorphic phantom for quantitative evaluation of breast MRI

Contralateral Prophylactic Mastectomy: Characteristics Influencing Utilization

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