Abstract
PurposeTo assess the impact of pre-operative breast MRI on surgical waiting time, and to identify factors contributing to the delay.Materials and MethodsA retrospective cohort study involving 1274 patients was conducted after obtaining institutional ethics review. Surgical candidates for newly diagnosed breast cancer from 2007 to 2013 at a tertiary center were divided into 2 groups: those who had pre-operative MRI and those who did not. Linear regression using matched populations was used to compare the surgical waiting times, defined as time from the date of the first positive biopsy to the date of surgery. Potential influences on surgical waiting time and subgroup analysis were obtained using median regression analysis and the Kruskal-Wallis test.ResultsMean surgical waiting time was 57.9 days (95% CI: 55.6–60.1) for MRI patients, compared to 46.8 days (95% CI: 45.1–48.9) for the control group, after matching for potential confounding factors (p<0.0001). Increased surgical waiting time was associated with more favorable pathology, later year of diagnosis, older patient age, surgeon and summer time. Second-look ultrasound and subsequent biopsies were associated with increased waiting time (p = 0.001).ConclusionsPre-operative breast MRI increased surgical waiting time by 11 days using a conventional average of differences, and by 12 days after using a full matching statistical method (p<0.0001), with the main contributor being additional post-MRI procedures and imaging.
Highlights
Breast cancer is the most common cancer among women and is a major cause of cancer death worldwide [1]
Mean surgical waiting time was 57.9 days for magnetic resonance imaging (MRI) patients, compared to 46.8 days for the control group, after matching for potential confounding factors (p
Pre-operative breast MRI increased surgical waiting time by days using a conventional average of differences, and by days after using a full matching statistical method (p
Summary
Breast cancer is the most common cancer among women and is a major cause of cancer death worldwide [1]. Breast MRI could detect mammographically occult multicentricity in 7.7% and occult bilaterality in 3.7% of cases [2] While this could be helpful information for pre-operative planning and staging, it simultaneously carries the risk of additional procedures, potentially increasing mastectomy rates and lengthening surgical waiting times [4]. There are few studies and no consensus in the literature concerning the impact of pre-operative MRI on surgical waiting time, in a publicly funded health care environment. Another article in the surgical literature published around the same time suggests otherwise: time from diagnosis to operative treatment of breast cancer has increased over the years, with the advent of breast MRI [6]. A population-based European study suggests that age, co-morbidity, size of tumor and other factors impact surgical waiting time [7]
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