title: Does preoperative breast MRI significantly impact on initial surgical procedure and re-operation rates in patients with screen-detected invasive lobular carcinoma?
abstract: OBJECTIVE
  To investigate whether magnetic resonance imaging (MRI) changes the management of patients with screen-detected invasive lobular carcinoma (ILC).
  
  
  METHODS
  A retrospective, controlled, single-centre analysis of 138 cases of screen-detected ILC was performed. All patients were assessed by a single multidisciplinary team as to whether preoperative MRI altered the initial management decision or reduced re-operation rates.
  
  
  RESULTS
  Forty-three percent of patients had preoperative MRI. MRI guided surgical management in 40.7% patients. Primary mastectomy rates were not significantly different between the MRI and non-MRI groups (32% and 30% respectively, p=0.71). The MRI group had a lower secondary surgery rate (6.8% versus 15.2%); however, the results did not reach statistical significance, and there were no unnecessary mastectomies.
  
  
  CONCLUSIONS
  MRI can be used appropriately to guide primary surgery in screen-detected ILC cases and affects the initial management decision in 40.7% of patients. It does not significantly affect the overall mastectomy rate or re-operation rates, but reduces the likelihood of the latter. As a result of this review, the authors' local policy for the use of MRI in screen-detected ILC patients has been modified. For patients undergoing mastectomy for ILC, MRI is no longer performed routinely to search for contralateral malignancy as this has no proven added benefit.
authors.affiliation: West of Scotland Breast Screening Centre, Stock Exchange Court, 77 Nelson Mandela Place, Glasgow, G2 1QT, UK. Electronic address: kathrynsinclair@nhs.net.
authors.forename: K
authors.initials: K
authors.lastname: Sinclair
authors.affiliation: West of Scotland Breast Screening Centre, Stock Exchange Court, 77 Nelson Mandela Place, Glasgow, G2 1QT, UK.
authors.forename: S
authors.initials: S
authors.lastname: Sakellariou
authors.affiliation: West of Scotland Breast Screening Centre, Stock Exchange Court, 77 Nelson Mandela Place, Glasgow, G2 1QT, UK.
authors.forename: N
authors.initials: N
authors.lastname: Dawson
authors.affiliation: West of Scotland Breast Screening Centre, Stock Exchange Court, 77 Nelson Mandela Place, Glasgow, G2 1QT, UK.
authors.forename: J
authors.initials: J
authors.lastname: Litherland
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008408:Mastectomy / Q000706:statistics & numerical data*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011300:Preoperative Care / Q000379:methods / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D012086:Reoperation / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D012680:Sensitivity and Specificity; D016896:Treatment Outcome