title: Usefulness of magnetic resonance in patients with invasive cancer eligible for breast conservation: a comparative study.
abstract: BACKGROUND
  The role of magnetic resonance imaging (MRI) in newly detected breast cancer remains controversial. We investigated the impact of preoperative MRI on surgical management of infiltrating breast carcinoma (IBC).
  
  
  METHODS
  We reviewed data of 237 patients with IBC who were suitable for breast-conserving surgery (BCS) between 2009 and 2011. Of these patients, 109 underwent preoperative MRI (46%; MRI group) and 128 did not (54%; no-MRI group). We analyzed MRI-triggered changes in surgical plan and compared differences in rates of positive margins and mastectomy.
  
  
  RESULTS
  Tumor size was larger in the MRI group (16.8 mm vs. 13.9 mm; P < .001). MRI changed the initial surgical planning in 18 of 109 patients (16.5%) because of detection of larger tumor diameter requiring wider resection (8 patients [7.3%]) or additional malignant lesions in the ipsilateral (9 patients [8.2%]) or contralateral breast (1 patient [0.9%]). MRI-triggered treatment changes included mastectomy (n = 12), wider excision (n = 5), and contralateral BCS (n = 1). Reoperation rates for positive margins after BCS appeared higher in the no-MRI group (4.1% vs. 8.6%), but the difference missed statistical significance (P = .9). Overall mastectomy rates were higher in the MRI group (13.7% vs. 7.0%; P < .05). The likelihood of having a change of treatment resulting from MRI was significantly higher for patients with tumors > 15 mm and for those with positive lymph nodes.
  
  
  CONCLUSIONS
  Lymph node positivity and tumor size > 15 mm may predict an MRI-triggered change in surgical plan. Preoperative MRI resulted in higher mastectomy rates justified by biopsy-proven additional foci of carcinoma and did not significantly reduce reoperation rates for positive margins.
authors: Unit of General Surgery II, Clinica Chirurgica, University of Sassari, Sassari, Italy. Electronic address: afancel@uniss.it.
authors: Alessandro
authors: A
authors: Fancellu
authors: Department of Radiology, University of Sassari, Sassari, Italy.
authors: Daniela
authors: D
authors: Soro
authors: Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
authors: Paolo
authors: P
authors: Castiglia
authors: Department of Pathology, University of Sassari, Sassari, Italy.
authors: Vincenzo
authors: V
authors: Marras
authors: New York University School of Medicine and Department of Surgery, NY Harbor Healthcare System VAMC, New York, NY.
authors: Marcovalerio
authors: M
authors: Melis
authors: Unit of General Surgery II, Clinica Chirurgica, University of Sassari, Sassari, Italy.
authors: Pietrina
authors: P
authors: Cottu
authors: Unit of General Surgery II, Clinica Chirurgica, University of Sassari, Sassari, Italy.
authors: Alessandra
authors: A
authors: Cherchi
authors: Department of Nuclear Medicine, University of Sassari, Sassari, Italy.
authors: Angela
authors: A
authors: Spanu
authors: Unit of General Surgery II, Clinica Chirurgica, University of Sassari, Sassari, Italy.
authors: Silvia
authors: S
authors: Mulas
authors: Department of Radio-oncology, Oncological Hospital of Cagliari, Cagliari, Italy.
authors: Claudio
authors: C
authors: Pusceddu
authors: Department of Radiology, University of Sassari, Sassari, Italy.
authors: Luca
authors: L
authors: Simbula
authors: Department of Radiology, University of Sassari, Sassari, Italy.
authors: Giovanni B
authors: GB
authors: Meloni
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D060787:Neoplasm Grading; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data*
keywords: Breast cancer treatment; Breast-conserving surgery; Invasive carcinoma; Magnetic resonance imaging; Margins