Does preoperative MRI improve clinical outcomes in breast cancer?

Abstract

SUMMARY There is little consensus regarding the use of preoperative MRI in newly diagnosed breast cancer. Although preoperative breast MRI detects additional disease (relative to conventional assessment) in the ipsilateral or contralateral breast of breast cancer patients, this does not translate into improved treatment or patient outcomes. Two randomized trials have reported that preoperative MRI does not reduce re-excision surgery. Meta-analysis of controlled studies provides strong evidence that preoperative MRI significantly increases the odds of having a mastectomy without significantly reducing re-excision rates. The role of MRI in patients with invasive lobular cancer is uncertain; there is a suggestion of decreased re-excisions at the expense of an increase in mastectomy. Although data on long-term outcomes are limited to three observational studies, the two larger and adequately adjusted studies have found that preoperative MRI does not reduce ipsilateral breast tumor recurrence. Routine use of preoperative MRI in breast cancer should be discouraged, except in the context of research studies.