title: Surgical impact of preoperative breast MRI in women below 40 years of age.
abstract: Our aim was to evaluate the surgical impact of preoperative MRI in young patients. We reviewed a single-institution database of 283 consecutive patients below 40 years of age and who were treated for breast cancer. Thirty-seven (13 %) patients who received neoadjuvant chemotherapy were excluded. The remaining 246 patients included 124 (50 %) who preoperatively underwent conventional imaging (CI), i.e., mammography/ultrasonography (CI-group), and 122 (50 %) who underwent CI and dynamic MRI (CI + MRI-group). Pathology of surgical specimens served as a reference standard. Mann-Whitney, χ (2), and McNemar statistics were used. There were no significant differences between groups in terms of age, tumor pathologic subtype, stage, receptor, or nodal status. The mastectomy rate was 111/246 (45 %) overall but was significantly different between groups (46/124, 37 %, for the CI group and 65/122, 53 %, for the CI + MRI group; p = 0.011). Of 122 CI + MRI patients, 46 (38 %) would have undergone mastectomy due to CI alone, while MRI determined 19 additional mastectomies, increasing the mastectomy rate from 38 % to 53 % (p < 0.001). The number of patients with multifocal, multicentric, synchronous, or bilateral cancers was significantly different between groups (10/124, 8 %, for the CI group and 33/122, 27 %, for the CI + MRI group; p < 0.001). In the CI + MRI group, multifocal, multicentric, or synchronous bilateral cancers were detected with mammography in 5/33 (15 %) patients, with ultrasonography in 15/33 (45 %) patients, and with MRI in 32/33 (97 %) patients (p < 0.005). Two mastectomies were due to false positives at both conventional tests in the CI group (2/124, 1.6 %) and two mastectomies were due to MRI false positives in the CI + MRI group (2/122, 1.6 %). In conclusion, breast cancer in young patients was treated with mastectomy in 37-38 % of cases on the basis of CI only and in these patients MRI was more sensitive than CI for multifocal, multicentric, or synchronous bilateral cancers, resulting in an additional mastectomy rate of 15 %. A low probability of inappropriate imaging-based decision-making for mastectomy exists for both CI alone and for CI + MRI, making presurgical needle biopsy mandatory for findings that suggest a need for mastectomy.
authors.affiliation: Struttura Complessa di Radiodiagnostica 1, Dipartimento di Diagnostica per Immagini, Terapia Radiante e Metabolica, Istituto Nazionale per lo studio e la cura dei Tumori, IRCCS Fondazione Giovanni Pascale, Naples, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Petrillo
authors.forename: Annamaria
authors.initials: A
authors.lastname: Porto
authors.forename: Roberta
authors.initials: R
authors.lastname: Fusco
authors.forename: Salvatore
authors.initials: S
authors.lastname: Filice
authors.forename: Paolo
authors.initials: P
authors.lastname: Vallone
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Rubulotta
authors.forename: Franco
authors.initials: F
authors.lastname: Fulciniti
authors.forename: Maurizio
authors.initials: M
authors.lastname: Di Bonito
authors.forename: Massimiliano
authors.initials: M
authors.lastname: D'Aiuto
authors.forename: Immacolata
authors.initials: I
authors.lastname: Capasso
authors.forename: Rubina Manuela
authors.initials: RM
authors.lastname: Trimboli
authors.forename: Francesco
authors.initials: F
authors.lastname: Sardanelli
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008327:Mammography / Q000379:methods; D008408:Mastectomy; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies