title: Is there a role for routine use of MRI in selection of patients for breast-conserving cancer therapy?
abstract: BACKGROUND
  The role of preoperative bilateral breast MRI in breast cancer patients being considered for breast-conserving therapy has been controversial. We hypothesized that preoperative MRI, along with an active program in MRI-directed biopsies, would lead to a change in multidisciplinary treatment planning for patients being considered for breast-conserving cancer therapy, and it would be associated with reduced rates of margin-positive partial mastectomies.
  
  
  METHODS
  A retrospective review of a consecutive series of patients who were treated for breast cancer at a single center between January 2005 and July 2007 was conducted. Patients in the study were candidates for breast-conserving cancer therapy based on physical examination, mammography, and ultrasonography. All patients were evaluated by a preoperative breast MRI. Analysis included number and result of MRI-directed biopsies, impact of MRI on treatment planning, and incidence of margin-positive partial mastectomy within the series of patients.
  
  
  RESULTS
  Seventy-nine female patients were analyzed. Median age was 57 years. MRI led to the performance of 25 MRI-directed biopsies for previously unrecognized suspicious lesions in 21 patients. Forty-four percent of MRI-directed biopsies were positive for cancer. MRI was associated with a change in management in 15 patients (19%) for multicentric ipsilateral cancer (n = 7), a more extensive primary lesion size (n = 6), or contralateral breast cancer (n = 2). Incidence of margin-positive partial mastectomy requiring additional resective operation was very low in this series (10%).
  
  
  CONCLUSIONS
  Bilateral breast MRI, when used in conjunction with MRI-directed biopsy procedures, can be helpful in planning multidisciplinary treatment of candidates for breast-conserving cancer therapy. By allowing more accurate local staging of tumors, MRI is a tool that can be used to help reduce high reexcision rates for margin-positive partial mastectomies.
authors.affiliation: Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610, USA. stephen.grobmyer@surgery.ufl.edu
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Grobmyer
authors.forename: Vincent E
authors.initials: VE
authors.lastname: Mortellaro
authors.forename: Julia
authors.initials: J
authors.lastname: Marshall
authors.forename: Giselle Moore
authors.initials: GM
authors.lastname: Higgs
authors.forename: Steven N
authors.initials: SN
authors.lastname: Hochwald
authors.forename: Nancy P
authors.initials: NP
authors.lastname: Mendenhall
authors.forename: Edward M
authors.initials: EM
authors.lastname: Copeland
authors.forename: William G
authors.initials: WG
authors.lastname: Cance
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D015412:Mastectomy, Segmental; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies