title: Impact of presurgical breast magnetic resonance imaging (MRI) on surgical planning - a retrospective analysis from a private radiology group.
abstract: Presurgical bilateral breast MRI is being increasingly utilized in newly diagnosed breast cancer patients to identify the presence of other potentially malignant lesions and thereby guide surgical planning. The authors have performed a retrospective analysis of presurgical MRIs in 445 breast cancer patients, consecutively seen in a community practice setting, to determine what risk factors may be associated with bilateral synchronous breast cancer. Clinical, imaging, surgical, and pathological data were collected on these newly diagnosed patients, who underwent presurgical breast MRIs from November 1, 2008 through October 31, 2009. The MRIs detected 84 incremental (additional) malignancies in 66 (14.8%) patients, including 22 patients in the contralateral breast (4.9%) and 48 patients who had ipsilateral incremental malignancies (10.8%). The presurgical breast MRIs had a sensitivity of 99% and a specificity of 86%. Based on the imaging study and the subsequent biopsy(s), 105 patients (23.6%) had changes in their surgical planning. For those with incremental breast malignancies, the synchronous bilateral breast cancer patients were older (67.5 ± 13.5 years, p = 0.01). Patients with ipsilateral incremental malignancies were younger (55.6 ± 10.4 years of age, p = 0.03). A strong family history and ductal carcinoma in situ (DCIS) as the index lesion also appeared to be associated with increased bilateral malignancy detection. The authors conclude that although presurgical MRI remains controversial, our data support its role in surgical planning for newly diagnosed breast cancer patients.
authors.affiliation: Windsong Radiology Group, Windsong Comprehensive Breast Care, 55 Spindrift Dr, Williamsville, NY 14221, USA. xfan@windsongradiology.com
authors.forename: X Cynthia
authors.initials: XC
authors.lastname: Fan
authors.forename: Takuma
authors.initials: T
authors.lastname: Nemoto
authors.forename: Karen
authors.initials: K
authors.lastname: Blatto
authors.forename: Emily
authors.initials: E
authors.lastname: Mangiafesto
authors.forename: Jodi
authors.initials: J
authors.lastname: Sundberg
authors.forename: Anna
authors.initials: A
authors.lastname: Chen
authors.forename: Anthony
authors.initials: A
authors.lastname: Foti
authors.forename: Markus
authors.initials: M
authors.lastname: Holzhauer
authors.forename: Patrick
authors.initials: P
authors.lastname: Lahr
authors.forename: Eric
authors.initials: E
authors.lastname: Snitzer
authors.forename: Thomas
authors.initials: T
authors.lastname: Summers
authors.forename: David
authors.initials: D
authors.lastname: Wolf
authors.forename: Janet
authors.initials: J
authors.lastname: Sung
mesh_terms: D000368:Aged; D001706:Biopsy; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D011331:Private Practice; D012189:Retrospective Studies; D012680:Sensitivity and Specificity