Increase in mastectomies performed in patients in the community settings undergoing MRI.

Abstract

Abstract Abstract #6010 Background: It is estimated that about 182,460 new cases of breast cancer will be diagnosed in 2008 with an estimated 40,500 deaths. Contrast-enhanced MRI has been shown to have a high sensitivity for the detection of breast cancer in high-risk women with variable specificity. MRI offers an advantage that it is less operator dependent and can demonstrate small cancers, ductal carcinoma in-situ (DCIS), and multifocal disease effectively. The role of MRI in average-risk women however is not well elucidated. In these patients, MRI detects more lesions than mammography but it is uncertain if these lesions have significant pathologic potential or if the use MRI alters the ultimate surgical intervention in these patients.
 Material and Methods:This is a retrospective study of 178 female patients over the age of 18 with breast carcinoma who underwent mammogram and MRI between January 2000 and December 2005. The patients' records were obtained from physician offices affiliated with three community hospitals in Baltimore, Maryland. The radiological and pathological reports of these patients were also examined.Of the 178 charts screened, 18 patients were excluded in the analysis because of missing data.
 Results: MRI detected more lesions than mammogram; however, these lesions were not cancerous. The lesions detected by mammogram correlated more with pathological lesions. MRI detected more lesions as compared to the pathological specimens.
 
 More patients who had both imaging modalities underwent mastectomies compared to those who had mammogram alone.
 
 Discussion: The ability of MRI to detect an increased number of truly pathologic lesions has been a matter of controversy. In our patient pool, we demonstrated that MRI lesions did not correlate significantly with the number of pathological lesions found in subsequent surgical specimens. These findings suggest that MRI has a high sensitivity and low specificity in the detection of pathologic lesions in our study population. Based on this data, we can hypothesize that the use of MR imaging resulted in a higher number of lesions necessitating conversion to a mastectomy over treatment with lumpectomy alone. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6010.