title: Effect of preoperative breast magnetic resonance imaging on surgical decision making and cancer recurrence rates.
abstract: OBJECTIVE
  To evaluate breast magnetic resonance imaging (MRI) for cancer staging and surgical planning in patients with known breast cancer, and to evaluate recurrence rates at long-term follow-up.
  
  
  METHODS
  Institutional review board approval and patient consent were obtained. Preoperative MRI with 0.1 mmol/kg gadobenate dimeglumine (MultiHance) was performed in 203/274 women with confirmed breast cancer. The sensitivity, accuracy, and positive predictive value of MRI compared with mammography/ultrasound for malignant lesion detection were calculated, and the effect of MRI on surgical decision making evaluated. The cancer recurrence rate was determined for 172 patients with available 2- to 8-year follow-up data.
  
  
  RESULTS
  Mammography/ultrasound detected 229 suspicious lesions. Breast MRI detected 159 additional lesions in 48/203 (23.6%) patients; of which 110/110 were correctly classified as malignant and 28/49 as benign, giving sensitivity, accuracy, and positive predictive values for malignant lesion detection of 100% (110/110), 86.8% (138/159), and 84.0% (110/131), respectively. MRI revealed unsuspected multifocal, multicentric, and synchronous contralateral lesions in 7/48, 16/48, and 16/48 patients, respectively, and pectoralis muscle infiltration in 3/38 patients. In 6/48 women, MRI revealed lesions not seen on conventional imaging (n = 5) or discounted suspected multifocal disease (n = 1). Therapy was changed for 50/203 (24.6%) patients: 38 patients underwent more extensive surgery and 12 less extensive surgery. Six (3.5%) recurrences occurred, in all cases at >4 years.
  
  
  CONCLUSIONS
  Breast MRI positively affects patient management and is recommended for mapping tumor extent in patients with newly diagnosed cancer. The cancer recurrence rate at long-term follow-up after MRI is low.
authors.affiliation: Department of Radiological Sciences, University of Rome La Sapienza, Rome, Italy. federica.pediconi@uniroma1.it
authors.forename: Federica
authors.initials: F
authors.lastname: Pediconi
authors.forename: Elena
authors.initials: E
authors.lastname: Miglio
authors.forename: Marianna
authors.initials: M
authors.lastname: Telesca
authors.forename: Maria Laura
authors.initials: ML
authors.lastname: Luciani
authors.forename: Miles A
authors.initials: MA
authors.lastname: Kirchin
authors.forename: Roberto
authors.initials: R
authors.lastname: Passariello
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D003657:Decision Making; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008408:Mastectomy / Q000706:statistics & numerical data*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D055815:Young Adult