title: Association of routine pretreatment magnetic resonance imaging with time to surgery, mastectomy rate, and margin status.
abstract: BACKGROUND
  The benefit of breast MRI for newly diagnosed breast cancer patients is uncertain. This study characterizes those receiving MRI versus those who did not, and reports on their short-term surgical outcomes, including time to operation, margin status, and mastectomy rate.
  
  
  METHODS
  All patients seen in a multidisciplinary breast cancer clinic from July 2004 to December 2006 were retrospectively reviewed. Patients were evaluated by a radiologist, a pathologist, and surgical, radiation, and medical oncologists.
  
  
  RESULTS
  Among 577 patients, 130 had pretreatment MRIs. MRI use increased from 2004 (referent, 13%) versus 2005 (24%, p=0.014) and 2006 (27%, p=0.002). Patients having MRIs were younger (52.5 versus 59.0 years, p < 0.001), but its use was not associated with preoperative chemotherapy, family history of breast or ovarian cancer, presentation, or tumor features. MRI was associated with a 22.4-day delay in pretreatment evaluation (p=0.011). Breast conserving therapy (BCT) was attempted in 320 of 419 patients with complete surgical data. The odds ratio for mastectomy, controlling for T size and stage, was 1.80 after MRI versus no MRI (p=0.024). Patients having MRIs did not have fewer positive margins at lumpectomy (21.6% MRI versus 13.8% no MRI, p=0.20), or conversions from BCT to mastectomy (9.8% MRI versus 5.9% no MRI, p=0.35).
  
  
  CONCLUSIONS
  Breast MRI use was not confined to any particular patient group. MRI use was not associated with improved margin status or BCT attempts, but was associated with a treatment delay and increased mastectomy rate. Without evidence of improved oncologic outcomes as a result, our study does not support the routine use of MRI to select patients or facilitate the performance of BCT.
authors.affiliation: Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA19111, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bleicher
authors.forename: Robin M
authors.initials: RM
authors.lastname: Ciocca
authors.forename: Brian L
authors.initials: BL
authors.lastname: Egleston
authors.forename: Linda
authors.initials: L
authors.lastname: Sesa
authors.forename: Kathryn
authors.initials: K
authors.lastname: Evers
authors.forename: Elin R
authors.initials: ER
authors.lastname: Sigurdson
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D011300:Preoperative Care; D012189:Retrospective Studies; D013997:Time Factors