Role Of Preoperative MRI Research Articles

ASO Visual Abstract: Preoperative MRI and Its Impact on Surgical Outcomes in Patients with Triple Negative Breast Cancer Treated with Primary Surgery: Did New Margin Guidelines or Cavity Shave Margins Practice Diminish the Role of Preoperative MRI?

ASO Visual Abstract: Preoperative MRI and Its Impact on Surgical Outcomes in Patients with Triple Negative Breast Cancer Treated with Primary Surgery: Did New Margin Guidelines or Cavity Shave Margins Practice Diminish the Role of Preoperative MRI?

P268 - Role of preoperative MRI in guiding the surgical treatment decision in patients with invasive breast cancer

P268 - Role of preoperative MRI in guiding the surgical treatment decision in patients with invasive breast cancer

Abstract P2-13-04: The role of preoperative MRI in negative margins after breast conserving surgery in patients with invasive breast cancer or purely DCIS

Abstract Introduction Clinical benefit of preoperative MRI in invasive breast cancer (IBC) patients and patients with purely ductal carcinoma-in-situ (DCIS) remains controversial. We aimed to study the role of preoperative MRI in negative margins after breast conserving surgery (BCS) and reexcision rate in a large population-based cohort. Methods Retrospective analyses were performed in women diagnosed with IBC and purely DCIS and surgically treated between 2011-2013 extracted from the Eindhoven Cancer Registry. Patients were excluded in case of: neo-adjuvant systemic therapy, (clinical or pathological) tumor stadium T4, distant metastasis, and unknown resection margin status. According to preoperative MRI use, the study population was divided into a non-MRI and MRI group. All multivariable analyses were adjusted for baseline differences between non-MRI and MRI group with P<0.1. No information was available on the exact reason to perform MRI preoperatively in these patients. Results A total of 3,116 patients were eligible of which 2,238 (71.8%) patients were treated by breast conserving surgery (BCS) and included for analyses. Preoperative MRI was performed in 592 (30.6%) IBC patients and 55 (18.3%) DCIS patients. In IBC patients, differences in non-MRI and MRI group were: median age (62 vs 58), histology (lobular type in 5.7% vs 24.5%), median tumor size (13 mm vs 15 mm), her2neu receptor status and specific tumor locations. Median (interquartile range) time between diagnosis and surgery in the non-MRI and MRI group were 21 (16-28) and 31 (22-40) days respectively (univariable and multivariable P<0.001). Negative margin was attained in 1,135 (84.4%) and 489 (82.6%) patients respectively (OR 0.88 95%CI 0.68-1.14 P=0.326). After adjustment for baseline differences and for factors associated with negative margin with P<0.1 (i.e. histology, tumor size, differentiation grade, progesterone receptor %, her2neu receptor status, regional lymph node stadium, and tumor location) MRI use was not associated with negative margin (OR 1.09 95%CI 0.81-1.45 P=0.587). Reexcision was performed in 96 (7.1%) and 62 (10.5%) patients (P=0.013). In case reexcision was needed, conversion to mastectomy occurred in 32 (2.4%) vs 20 (3.4%) patients (P=0.210). In patients with purely DCIS, only median age differed in non-MRI and MRI group (61 vs 57). Median (interquartile range) time between diagnosis and surgery in the non-MRI and MRI group were 22 (16-31) and 35 (23-49) days respectively (univariable P<0.001 and multivariable P=0.024). Negative margin was attained in 197 (80.1%) and 42 (76.4%) patients respectively (OR 0.80 95%CI 0.40-1.61 P=0.538). After adjustment for baseline differences and for factors associated with negative margin with P<0.1 (i.e. differentiation grade and tumor location) MRI use was not associated with negative margin (OR 1.51 95%CI 0.72-3.16 P=0.280). Reexcision was performed in 39 (15.9) and 10 (18.2) (P=0.672). In case reexcision was needed, conversion to mastectomy occurred in 12 (4.9%) vs 3 (5.5%) patients (P=0.859). Conclusion In both IBC and DCIS patients, preoperative MRI delayed time between diagnosis and surgery, but was not associated with a higher percentage of negative margins after BCS. Citation Format: Elvira L Vos, Adri C Voogd, Cornelis Verhoef, Inge-Marie Obdeijn, Linetta B Koppert. The role of preoperative MRI in negative margins after breast conserving surgery in patients with invasive breast cancer or purely DCIS [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-13-04.

Preoperative MRI: Much ado about nothing?

16 Background: Preoperative MRI has been used to identify mammographically occult lesions and to determine extent of disease. However, the role of preoperative MRI in breast cancer remains controversial. We previously found that preoperative MRI does not increase total mastectomy (TM) rate. In this study we sought to identify a specific subgroup of patients in which preoperative MRI may be useful. Methods: In this IRB approved study, we conducted a retrospective review of 257 patients with breast cancer who underwent preoperative MRI from 2010 to 2012. We evaluated whether additional imaging and biopsies were recommended after MRI and whether it influenced the final surgical plan and decreased re-excision rate after partial mastectomy (PM). We collected data on several clinical factors and tested these for significant associations with both upgrading to TM and with the need for post-MRI imaging and biopsy using crosstab analysis and Fisher’s Exact test. Age as a continuous variable was also evaluated using binary logistic regression. Results: In our study cohort, 158 patients (62%) had additional imaging and 78 patients (30%) had additional biopsies recommended based on the MRI report. Of those biopsies prompted by MRI, 32 of them (39%) revealed cancer. The clinical significance, however, is subject to further study as only 3% of the 257 patients, eight upgraded to TM. We did not find any statistically significant differences in patients who were upgraded to TM by clinical factors such as age, menopausal status, mammographic breast density, ER/PR, HER2/neu status, or pathologic T stage; though there was a trend towards upgrade to TM in those who required additional imaging (p = 0.16). We found no clinical factors associated with the need for additional biopsies. Conclusions: We did not find a specific subgroup of patients in which preoperative MRI influenced management. Although preoperative MRI slightly increased the rate of TM, it does lead to numerous additional imaging studies and biopsies. Given these results, we are no longer using preoperative MRI routinely at our institution. Additional studies will be needed to determine strict indications for the use of MRI in the preoperative setting.

Role of sentinel lymph node biopsy (SLNB) and preoperative MRI in the management of patients with pure high-grade ductal carcinoma in situ (DCIS).

87 Background: The overall incidence of SLN metastases in pure DCIS is < 1% and the results of SLNB do not usually impact treatment or survival but adds significant surgical morbidity. In addition, there is no evidence regarding the role of preoperative MRI in the management of DCIS. The purpose of our study was to identify the efficacy of SLNB and the benefit of preoperative MRI in high-grade DCIS. Methods: We performed retrospective review of 364 patients with DCIS, identified through our cancer registry database, that were seen from 2003 to 2012 at our institution. Of these, 62 patients were diagnosed with high-grade DCIS (Grade 3 or 2 with comedonecrosis) by core needle biopsy, and underwent SLNB. The remaining 302 patients had either low-grade DCIS or did not have a SLNB. Results: Median age was 56 years (range 33-80). Sixty two patients had high-grade DCIS on definitive excision and 2/62 patients were noted to have small invasive focus of disease. 15/62 (24.19%) patients underwent mastectomy and 47/62(78.1%) underwent lumpectomy. No patient had a positive SLN (0/62). 15/62 (24.2%) patients had breast MRI preoperatively and among them, in 5 (33.3%) patients, MRI findings changed the surgical decision to mastectomy. Among these 5 mastectomy patients, four of them (80%) had pathologically confirmed findings consistent with preoperative MRI suspicions. In lumpectomy patients, close margin of less than 1mm was seen in 4/9 (44.4%) patients with staging MRI and in 24/38 (63.15%) patients without MRI (p = 0.45. Fisher’s exact test). However the positive margin leading to re-excision was seen in 2/9 (22.2%) patients who underwent lumpectomy with staging MRI, and 9/38 (23.6%) patients who underwent lumpectomy without staging MRI. Conclusions: In our study, no patient with high grade DCIS had a positive sentinel node suggesting that routine sentinel node biopsy is not necessary in DCIS patients. The use of MRI changed the surgical planning in 33.3% of patients, but did not improve the surgeon's ability to achieve clear margins.

Role of preoperative MRI in improving the selection of patients with early-stage cervical cancer for fertility-sparing surgery

Role of preoperative MRI in improving the selection of patients with early-stage cervical cancer for fertility-sparing surgery

P232 The role of preoperative MRI in influencing the surgical decision making, a retrospective look at the experience of a large academic hospital in the face of a rising mastectomy rates

P232 The role of preoperative MRI in influencing the surgical decision making, a retrospective look at the experience of a large academic hospital in the face of a rising mastectomy rates

Abstract P2-02-06: Efficacy and Cost Benefit of Preoperative MRI in the Diagnostic Procedure for Operable Breast Cancer

Abstract Purpose The role of preoperative MRI for operable breast cancer is controversial. In this study, we evaluate the efficacy of preoperative MRI as a diagnostic tool to determine the most appropriate procedure (i.e; mastectomy or partial mastectomy) for operable breast cancer patients and cost saving benefit from selecting the most appropriate procedure. Patients and Methods From January 2006 to December 2007, we retrospectively studied 1149 patients. All of these patients were diagnosed with breast cancer and consequently underwent mammography (MMG), ultrasound (US) and MRI before surgery so as to determine the optimal procedure. We extracted all the cases which required changes in procedures due to the MRI findings, and compared the radiological data to the clinical and pathological outcomes. Furthermore, we studied the overall cost differences between using MRI and not using MRI. Results In seventy seven cases, 6.7% of the total, operational changes were made because of preoperative MRI findings, which resulted in better operational outcomes. The main reason for procedural changes was the MRI findings revealed more extensive lesions, which pathologically proven to be in situ lesions. In some cases, additional lesions were pointed out by the MRI, which led us to avoid undertreatment. Among 77 cases, 69 were pathologically proven to have accurate radiological diagnosis and appropriate procedural change with MRI. The positive predictive value of preoperative MRI for partial resection was 99.1% and that for total mastectomy was 97.1%. The calculated cost difference for appropriate procedural change with MRI compared with not using MRI was $4,340. From our data, in 69 cases among 1149 received this appropriate change, $260 per case would be saved, which assumed to be more than $130 million in a year. Conclusion Adding preoperative MRI in the diagnostic procedures for the accurate operation in breast cancer might be effective. Usage of MRI preoperatively also save the inappropriate cost in breast cancer operations. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-02-06.

The role of preoperative MRI in knee arthroscopy: a retrospective analysis of 2,000 patients

The aim of this study was to investigate, to what extent routine preoperative MRI scans could set the indications for knee arthroscopies and reduce the number of diagnostic arthroscopies. For this retrospective cohort study, 1,000 patients who had knee arthroscopies documented in 1994/1995 were compared with 1,000 patients that were treated in 2004/2005. The preoperative diagnoses that gave indications for knee arthroscopy were compared with the intraoperative findings. The congruence of preoperative diagnosis with the intraoperative findings was evaluated comparing both study populations. The number of patients who were referred to orthopaedic trauma surgeons with MRI increased from 24% to 56%. A high congruence of preoperative diagnosis and intraoperative findings was found in 49% in 1994/1995 and 55% in 2004/2005. However, regarding the most important outcome parameter, the number of diagnostic arthroscopies, no improvement was found (3% in both periods). The presented data suggests that MRI scans are not routinely necessary as an indication for knee arthroscopy, as clinical examination and plain radiograph are sufficient. However, MRI scans do allow a more detailed characterization of the expected findings and can therefore be helpful in therapy planning.