Role of Preoperative Magnetic Resonance Imaging in the Surgical Management of Early-Stage Breast Cancer

Abstract

To examine the role of preoperative magnetic resonance imaging (pMRI) on time to surgery and rates of reoperation and contralateral prophylactic mastectomy (CPM) using a population-based study of New Jersey breast cancer patients. The study included 289 African-American and 320 white women who participated in the Breast Cancer Treatment Disparity Study and underwent breast surgery for newly diagnosed early-stage breast cancer between 2005 and 2010. Patients were identified through rapid case ascertainment by the New Jersey State Cancer Registry. Association between pMRI and time to surgery was examined by using linear regression and, with reoperation and CPM, by using binomial regression. Half (49.9%) of the study population received pMRI, with higher use for whites compared with African-Americans (62.5 vs. 37.5%). After adjusting for potential confounders, patients with pMRI versus those without experienced significantly longer time to initial surgery [geometric mean=38.7days; 95% confidence interval (CI) 34.8-43.0; vs. 26.5days; 95% CI 24.3-29.0], a significantly higher rate of CPM [relative risk (RR)=1.82; 95% CI 1.06-3.12], and a nonsignificantly lower rate of reoperation (RR=0.76; 95% CI 0.54-1.08). Preoperative MRI was associated with significantly increased time to surgery and a higher rate of CPM, but it did not affect the rate of reoperation. Physicians and patients should consider these findings when making surgical decisions on the basis of pMRI findings.