Preoperative MRI does not affect breast cancer outcomes [Arch Surg.]

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 Key study points:

1. Breast cancer patients who had an MRI prior to mastectomy (full or partial) were just as likely to undergo additional surgeries as those who did not have preoperative imaging.

Primer: MRIs are becoming increasingly popular after a diagnosis of breast cancer to rule out multicentric disease. They have been shown to be more sensitive than standard imaging in detecting these as well improved surgical planning. However, MRIs also carry a risk of false-positive interpretation which may lead to a more invasive treatment plan. The authors of this study sought to investigate the effect of pre-op MRI on the reoperation rate for women with operable breast cancer.

This [retrospective cohort] study:  313 patients with operable breast cancer were reviewed in this analysis.  The women selected to receive MRIs were considered candidates for breast conservation surgery and had difficulty with conventional imaged due to tissue density. 120 patients received pre-op MRI. This group was, on average, younger (mean 53.6y vs 59.5y; p<0.001) and more likely to be white non-Hispanic (61.7% vs 52.3%; p<0.05) than those who did not receive pre-op MRI. While the type of surgery performed (mastectomy vs partial mastectomy) was consistent between groups, there was no significant difference observed in the reoperation rates between the 2 groups (19.1% in pre-op MRI group and 17.3% in the no pre-op MRI group, p=0.91). This association held even after stratifying by breast density and tumor size.

In Sum: Pre-op MRI had no affect on the reoperation rate for breast cancer patients. The authors also comment on the risk of pathologically avoidable mastectomy and the risk of false-positive interpretation associated with MRIs. While this study is limited to involved only cases from a single surgeon at one institution, the findings of no improvement in outcomes with pre-op MRI are consistent with population-based analyses. Additionally, the authors stress the importance of practicing evidence-based medicine guidelines and insist on breast MRIs for every newly diagnosed breast cancer patient.

Click to read the study in the Archives of Surgery

By AM

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