The use of breast MRI in early-stage breast cancer: Findings after implementation of an institutional protocol at a county hospital.

Abstract

5 Background: Breast MRI has recently become standard-of-care in many practices, however, its proper utility in the preoperative management of early-stage breast cancer has not been fully elucidated. Our program recently instituted a protocol to obtain breast MRI at the time of diagnosis of breast cancer. We report the outcomes of this new approach in patients with surgically resected, early-stage breast cancer. Methods: An institutional database was queried for all patients that underwent surgery after a new histopathologic diagnosis of either noninvasive or invasive breast cancer from November 2012, the time of protocol implementation, through March 2014. Patients that received neoadjuvant treatment and patients with stage IV disease were excluded. Demographic, diagnosti,c and clinical data were extracted and analyzed using summary statistics and student’s t-test. Results: Fifty-eight patients met criteria. The median size of the index lesion on mammogram, ultrasound, MRI, and final surgical pathology was 1.2, 1.4, 2.1, and 1.3 cm, respectively. MRI size was significantly larger than mammogram, ultrasound, and final surgical pathology size (p < 0.05). The median time between initial pathologic diagnosis and breast MRI was 16 days. MRI identified 20 additional lesions in 19 (33%) patients leading to 14 additional biopsies and the diagnosis of two additional invasive and two noninvasive cancers. The median time between initial pathologic diagnosis and final report of these 14 biopsies was 36 days. Nine (64%) of the 14 patients that underwent a second biopsy went on to have a partial mastectomy, all with negative margins. Of the remaining five patients that went on to have total mastectomy, all but one were offered partial mastectomy but desired reconstruction. Conclusions: In this cohort of patients with early-stage breast cancer, MRI overestimated the size of the index lesion when compared to other imaging modalities and final surgical pathologic size. The use of MRI did not alter the surgical management in the majority of cases and increased the time from initial diagnosis to definitive surgical management. More studies are needed to determine the role of breast MRI in early-stage breast cancer.