Preoperative MRI may not benefit breast cancer patients

1. Patients having received preoperative magnetic resonance imaging (pMRI) experienced longer times to surgery and a higher rate of contralateral prophylactic mastectomy (CPM). 

2. Rates of reoperation were not dependent on patients having undergone pMRI testing. 

Evidence Rating Level: 3 (Average) 

Study Rundown: The use of pMRI testing for breast cancer patients is widespread and growing. It is held that MRI screening may increase breast cancer detection rates and previous studies have suggested MRI results correlate well with histological findings. More important to defining the utility of the MRI is clinical evidence that shows MRI testing is beneficial to patients. Interestingly, numerous studies have examined the clinical advantage of pMRI in breast cancer patients and found no indication for pMRI use. This study takes a close look at the relationship between pMRI and time to surgery, rates of reoperation and rates of CPM in early-stage breast cancer patients. Multivariate analysis was employed to account for confounding factors, such as race and socioeconomic status, which appeared to strongly correlate with pMRI testing events. The study findings suggest that preoperative MRI testing is directly associated with longer times to surgery and increased rates of CPM. No difference existed between rates of reoperation of patients having undergone MRI testing and those having not. The findings of this study are correlative and limited by the retrospectively collected data on which they are based. The lack of a benefit, and in some cases, a correlation with worse outcomes is somewhat surprising and it is possible that utility will increase as MRI imaging quality improves.

Click to read the study in the Annals of Surgical Oncology

Relevant Reading: Comparative effectiveness of MRI in breast cancer (COMICE) trial: a randomised controlled trial

In-Depth [retrospective study]: This study examined the utility of pMRI in 609 African-American and white female breast cancer patients diagnosed with stage I, II and T3N1M0 breast cancer between 2005 and 2010. For analysis purposes patients were separated into pMRI or no-pMRI groups. Mean time to surgery, rate of reoperation and rate of CMP were compared across these two cohorts. Patients were excluded from time-to-surgery analysis if they underwent neoadjuvant chemotherapy. Multivariate analysis was used to account for confounding factors including age, race, education, insurance, genotype testing, and histology. Approximately half (49.9%) of study patients received pMRI testing. The rate of pMRI testing was higher in women with characteristics associated with a higher socioeconomic status. Adjusted linear regression models were used to examine the relationship between pMRI and study endpoints. Time to surgery was found to be significantly longer in patients having undergone pMRI versus those having not (geometric mean = 38.7 days [95% CI 34.8-43.0] vs. 26.5 days [95% CI 24.33-29.0]). Preoperative MRI testing was associated with higher rates of CMP (pMRI group: 16.1% vs. no-pMRI group: 5.2%; p < 0.001) and increased numbers of additional biopsies. Reoperation rates were not significantly different between the two groups.

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Image: PD 

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