title: Evaluation of expert criteria for preoperative magnetic resonance imaging of newly diagnosed breast cancer.
abstract: Despite 2 randomized trials reporting no reduction in operations or local recurrence at 1 year, preoperative magnetic resonance imaging (MRI) is increasingly used in diagnostic workup of breast cancer. We evaluated 5 utilization criteria recently proposed by experts. Of women (n = 340) newly diagnosed with unilateral breast cancer who underwent bilateral MRI, most (69.4%) met at least 1 criterion before MRI: mammographic density (44.4%), under consideration for partial breast irradiation (PBI) (19.7%), genetic-familial risk (12.9%), invasive lobular carcinoma (11.8%), and multifocal/multicentric disease (10.6%). MRI detected occult malignant lesion or extension of index lesion in 21.2% of index, 3.3% of contralateral, breasts. No expert criterion was associated with MRI-detected malignant lesion, which associated instead with pre-MRI plan of lumpectomy without PBI (48.2% of subjects): Odds Ratio 3.05, 95% CI 1.57-5.91 (p adjusted for multiple hypothesis testing = 0.007, adjusted for index-vs-contralateral breast and covariates). The expert guidelines were not confirmed by clinical evidence.
authors: Biostatistics, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA. Electronic address: cbehrendt@coh.org.
authors: Carolyn E
authors: CE
authors: Behrendt
authors: Diagnostic Radiology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA.
authors: Lusine
authors: L
authors: Tumyan
authors: General Surgery, University of California San Francisco, Fresno Campus/Community Regional Medical Center, 2823 Fresno St., Fresno, CA 93721, USA.
authors: Laura
authors: L
authors: Gonser
authors: Diagnostic Radiology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA.
authors: Sara L
authors: SL
authors: Shaw
authors: Diagnostic Radiology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA.
authors: Lalit
authors: L
authors: Vora
authors: Surgical Oncology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA.
authors: I Benjamin
authors: IB
authors: Paz
authors: Surgical Oncology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA.
authors: Joshua D I
authors: JD
authors: Ellenhorn
authors: Surgical Oncology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA. Electronic address: jyim@coh.org.
authors: John H
authors: JH
authors: Yim
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000473:pathology* / Q000601:surgery; D000071060:Breast Density; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis* / Q000235:genetics / Q000601:surgery; D018275:Carcinoma, Lobular / Q000175:diagnosis* / Q000235:genetics / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D042361:Mammary Glands, Human / Q000002:abnormalities*; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis* / Q000235:genetics / Q000601:surgery; D018579:Patient Selection; D017410:Practice Guidelines as Topic / Q000592:standards; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D055815:Young Adult
keywords: Background parenchymal enhancement; Breast cancer; Hormone replacement; Magnetic resonance imaging; Mammographic density; Partial breast irradiation; Practice guidelines; Preoperative screening; Smoking