Impact of selective use of breast MRI on surgical decision-making in women with newly diagnosed operable breast cancer

Abstract

BackgroundThis study evaluated the impact of breast MRI on surgical planning in selected cases of breast malignancy (invasive cancer or DCIS). MRI was used when there was ambiguity on clinical and/or conventional imaging assessment. MethodsConsecutive women with breast malignancy undergoing breast MRI were included. Clinical, mammogram and ultrasound findings and surgical plan before and after MRI were recorded. MRI findings and histopathology results were documented and the impact of MRI on treatment planning was evaluated. ResultsMRI was performed in 181/1416 (12.8%) cases (invasive cancer 155/1219 (12.7%), DCIS 26/197 (13.2%)). Indications for MRI were: clinically dense breast tissue difficult to assess (n = 66; 36.5%), discordant clinical/conventional imaging assessment (n = 61; 33.7%), invasive lobular carcinoma in clinically dense breast tissue (n = 22; 12.2%), palpable/mass-forming DCIS (n = 11; 6.1%); other (n = 19; 10.5%). The recall rate for assessment of additional lesions was 35% (63/181). Additional biopsy-proven malignancy was found in 11/29 (37.9%) ipsilateral breast recalls and 8/34 (23.5%) contralateral breast recalls. MRI detected contralateral malignancy (unsuspected on conventional imaging) in 5/179 (2.8%). The additional information from MRI changed management in 69/181 (38.1%), with more unilateral surgery (wider excision or mastectomy) in 53/181 (29.3%), change to bilateral surgery in 12/181 (6.6%), less surgery in 4/181 (2.2%). Clinical examination estimated histological size within 20 mm in 57%, conventional imaging in 55% and MRI in 71%. ConclusionMRI was most likely to show concordance with histopathology in the ‘discordant assessment’ and ‘invasive lobular’ groups and less likely for ‘challenging clinically dense breast tissue.’ MRI changed management in 69/181 (38.1%).