title: Role of breast MRI in the preoperative evaluation of patients with newly diagnosed breast cancer.
abstract: OBJECTIVE
  The purpose of our study was to evaluate in a non-investigational setting the effect of preoperative breast MRI on the diagnosis of unsuspected additional malignant tumors and on surgical management choices.
  
  
  METHODS
  One hundred ninety-nine patients with a new diagnosis of breast cancer who underwent preoperative bilateral breast MRI were enrolled. Data included additional imaging and biopsies performed, final surgical management, and pathologic correlation. To reduce bias due to patient preference and variable surgical approaches, ipsilateral malignant lesions found on breast MR images were retrospectively reviewed by a surgeon blinded to final surgical treatment.
  
  
  RESULTS
  MRI detected additional suspicious previously unsuspected lesions in 74 patients (37%). Fifty-four of these lesions, in 38 patients (19%), were identified as malignant, of which 41 (76%) were invasive. Retrospective review of the MRI-identified ipsilateral malignant lesions resulted in hypothetical recommendations that would have altered the surgical treatment of 26 of the patients (13%), principally as mastectomy or wider excision.
  
  
  CONCLUSIONS
  For patients with a new diagnosis of breast cancer, breast MRI in a mid-sized regional hospital depicts unsuspected malignant lesions in both the ipsilateral and contralateral breasts in proportions consistent with the results of earlier studies at larger institutions. Whether clinical outcome is improved by changes in surgical management consequent to MRI detection of unsuspected malignant lesions remains unproven.
authors.affiliation: Department of Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Schell
authors.forename: Kari
authors.initials: K
authors.lastname: Rosenkranz
authors.forename: Petra J
authors.initials: PJ
authors.lastname: Lewis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D003287:Contrast Media; D019786:Gadolinium DTPA; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA