Does pre-operative breast magnetic resonance imaging in addition  to mammography and breast ultrasonography change  the operative management of breast carcinoma?
Magnetic resonance imaging (MRI) has been used for the local staging of breast cancer, especially to determine the extent of multiple lesions and to identify occult malignancies. The aim of this study was to evaluate the effect of pre-operative MRI on the surgical treatment of breast cancer. Between January 2006 and May 2007, 535 newly diagnosed breast cancer patients who planned to undergo breast conserving surgery had clinical examinations, bilateral mammography, breast ultrasonography, and breast MRI. The radiologic findings and clinicopathologic data were reviewed retrospectively. Ninety-eight (18.3%) patients had additional lesions, shown as suspicious lesions on breast MRI, but not detected with conventional methods. Eighty-four (15.7%) of these patients had a change in surgical treatment plans based on the MRI results. Forty-seven (8.8%) of the 84 patients had additional malignancies;the other 37 patients (6.9%) had benign lesions. The positive predictive value for MRI-based surgery was 56.0% (47 of 84 patients). During the period of study, the use of pre-operative MRI was increased with time (OR 1.20; 95% CI 1.16-1.23; P < 0.001), but the mastectomy rate did not change significantly (OR 0.98; 95% CI 0.95-1.00; P = 0.059). Multiple factors were analyzed to identify the patients more likely to undergo appropriate and complete surgery based on the additional findings of the pre-operative MRI, but the results were not statistically significant. This research suggests that a pre-operative MRI can potentially lower the rate of incompletely excised malignancies by identifying additional occult cancer prior to surgery and does not lead to an increase in the mastectomy rate; however, because some benign lesions are indistinguishable from suspicious or malignant lesions, excessive surgical procedures are unnecessarily performed in a significant portion of patients. In the future, the criteria for the use of MRI in local staging of breast cancer should be established.
Lim
Hye In
HI
Department of Surgery, Bundang Jesaeng General Hospital, Seongnam, Korea.
Choi
Jae Hyuck
JH
Yang
Jung-Hyun
JH
Han
Boo-Kyung
BK
Lee
Jeong Eon
JE
Lee
Se-Kyung
SK
Kim
Wan Wook
WW
Kim
Sangmin
S
Kim
Jee Soo
JS
Kim
Jung-Han
JH
Choe
Jun-Ho
JH
Cho
Eun Yoon
EY
Kang
Seok Seon
SS
Shin
Jung Hee
JH
Ko
Eun Young
EY
Kim
Sang Wook
SW
Nam
Seok Jin
SJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008327:Mammography / Q000379:methods*; D008408:Mastectomy / Q000379:methods*; D008495:Medical Oncology / Q000379:methods; D008875:Middle Aged; D057234:Preoperative Period; D016896:Treatment Outcome; D016217:Ultrasonography, Mammary / Q000379:methods*