Abstract
ObjectivesPreoperative breast magnetic resonance imaging (MRI) can inform surgical planning but might cause overtreatment by increasing the mastectomy rate. The Multicenter International Prospective Analysis (MIPA) study investigated this controversial issue.MethodsThis observational study enrolled women aged 18–80 years with biopsy-proven breast cancer, who underwent MRI in addition to conventional imaging (mammography and/or breast ultrasonography) or conventional imaging alone before surgery as routine practice at 27 centers. Exclusion criteria included planned neoadjuvant therapy, pregnancy, personal history of any cancer, and distant metastases.ResultsOf 5896 analyzed patients, 2763 (46.9%) had conventional imaging only (noMRI group), and 3133 (53.1%) underwent MRI that was performed for diagnosis, screening, or unknown purposes in 692/3133 women (22.1%), with preoperative intent in 2441/3133 women (77.9%, MRI group). Patients in the MRI group were younger, had denser breasts, more cancers ≥ 20 mm, and a higher rate of invasive lobular histology than patients who underwent conventional imaging alone (p < 0.001 for all comparisons). Mastectomy was planned based on conventional imaging in 22.4% (MRI group) versus 14.4% (noMRI group) (p < 0.001). The additional planned mastectomy rate in the MRI group was 11.3%. The overall performed first- plus second-line mastectomy rate was 36.3% (MRI group) versus 18.0% (noMRI group) (p < 0.001). In women receiving conserving surgery, MRI group had a significantly lower reoperation rate (8.5% versus 11.7%, p < 0.001).ConclusionsClinicians requested breast MRI for women with a higher a priori probability of receiving mastectomy. MRI was associated with 11.3% more mastectomies, and with 3.2% fewer reoperations in the breast conservation subgroup.Key Points• In 19% of patients of the MIPA study, breast MRI was performed for screening or diagnostic purposes.• The current patient selection to preoperative breast MRI implies an 11% increase in mastectomies, counterbalanced by a 3% reduction of the reoperation rate.• Data from the MIPA study can support discussion in tumor boards when preoperative MRI is under consideration and should be shared with patients to achieve informed decision-making.
Highlights
In patients newly diagnosed with breast cancer, the routine use of breast magnetic resonance imaging (MRI) before surgery is a controversial topic [1, 2], attracting extensive debate and little consensus [3,4,5]
In 19% of patients of the Multicenter International Prospective Analysis (MIPA) study, breast MRI was performed for screening or diagnostic purposes
Centers were selected for participation among those that documented high breast MRI volumes and the use of protocols recommended by international societies [11, 12, 15]
Summary
In patients newly diagnosed with breast cancer, the routine use of breast magnetic resonance imaging (MRI) before surgery is a controversial topic [1, 2], attracting extensive debate and little consensus [3,4,5]. Proponents reasonably draw on the established evidence of MRI sensitivity to detect additional disease, allowing more tailored surgical planning [6, 7]. Opponents point out the lack of evidence on clinical benefit from preoperative MRI and raise concerns that it causes more mastectomies than needed [8,9,10]. The Multicenter International Prospective Analysis (MIPA) study was undertaken to provide new knowledge on this topic, building evidence on whether and to what extent MRI impacts surgical treatment in breast cancer practice Guidelines are heterogenous, ranging from defined but limited indications [11, 12] to recommendations against [13].
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