Magnetic resonance imaging before breast cancer surgery: results of an observational multicenter international prospective analysis (MIPA)

Abstract Objectives Preoperative 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. Methods This 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. Results Of 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). Conclusions Clinicians 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.

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Role of magnetic resonance imaging in the planning of breast cancer treatment strategies: comparison with conventional imaging techniques

Radiologia Brasileira ◽

10.1590/0100-3984.2015.0124 ◽

2017 ◽

Vol 50 (2) ◽

pp. 76-81 ◽

Cited By ~ 10

Author(s):

Luciana Karla Lira França ◽

Almir Galvão Vieira Bitencourt ◽

Hugo Lamartine Souza Paiva ◽

Caroline Baptista Silva ◽

Nara Pacheco Pereira ◽

...

Keyword(s):

Breast Cancer ◽

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Treatment Strategies ◽

Breast Mri ◽

Breast Cancer Treatment ◽

Pathological Examination ◽

Conventional Imaging ◽

Resonance Imaging

Abstract Objective: To assess the role of magnetic resonance imaging (MRI) in the planning of breast cancer treatment strategies. Materials and Methods: The study included 160 women diagnosed with breast cancer, who underwent breast MRI for preoperative staging. Using Pearson's correlation coefficient (r), we compared the size of the primary tumor, as determined by MRI, by conventional imaging (mammography and ultrasound), and in the pathological examination (gold standard). The identification of lesions not identified in previous examinations was also evaluated, as was its influence on treatment planning. Results: The mean age of the patients was 52.2 years (range, 30-81 years), and the most common histological type was invasive ductal carcinoma (in 60.6% of the patients). In terms of the tumor size determined, MRI correlated better with the pathological examination than did mammography (r = 0.872 vs. 0.710) or ultrasound (r = 0.836 vs. 0.704). MRI identified additional lesions in 53 patients (33.1%), including malignant lesions in 20 (12.5%), which led to change in the therapeutic planning in 23 patients (14.4%). Conclusion: Breast MRI proved to be more accurate than conventional imaging in determining the dimensions of the main tumor and was able to identify lesions not identified by other methods evaluated, which altered the therapeutic planning in a significant proportion of cases.

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The Impact of Preoperative Breast Magnetic Resonance Imaging on Surgical Management in Symptomatic Patients With Invasive Lobular Carcinoma

Breast Cancer Basic and Clinical Research ◽

10.1177/1178223420948477 ◽

2020 ◽

Vol 14 ◽

pp. 117822342094847

Author(s):

Brian M Moloney ◽

Peter F McAnena ◽

Éanna J Ryan ◽

Ellen O Beirn ◽

Ronan M Waldron ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Lobular Carcinoma ◽

Multivariable Analysis ◽

Breast Mri ◽

Breast Conserving Surgery ◽

Conventional Imaging ◽

Resonance Imaging ◽

Tertiary Centre ◽

The Impact

Objective: Due to an insidious proliferative pattern, invasive lobular breast cancer (ILC) often fails to form a defined radiological or palpable lesion and accurate diagnosis remains challenging. This study aimed to determine the value of preoperative magnetic resonance imaging (MRI) for ILC and its impact on surgical outcomes. Methods: Consecutive symptomatic patients diagnosed with ILC in a tertiary centre over a 9-year period were reviewed. The time from diagnosis until surgery, initial type of surgery/index operation (breast-conserving surgery [BCS]/mastectomy) and the rates of reoperation (re-excision/completion mastectomy) were recorded. Patients were grouped into those who received conventional imaging and preoperative MRI (MR+) and those who received conventional imaging alone (MR–). Results: There were 218 cases of ILC, and 32.1% (n = 70) had preoperative MRI. Time from diagnosis to surgery was longer in the MR+ than the MR– group (32.5 vs 21.1 days, P < .001) even when adjusting for age and breast density. Initial BCS was performed on 71.4% (n = 50) of MR+ patients and 72.3% (n = 107) of the MR– group. While the rate of completion mastectomy following initial BCS was higher in the MR+ group (30.0%, n = 15 vs 14.0%, n = 15; χ2 = 5.63; P = .018), this association was not maintained in multivariable analysis. No difference was recorded in overall (initial and completion) mastectomy rate between the MR+ and MR– group (50.0%, n = 35 vs 37.8%, n = 56; χ2 = 2.89; P = .089). Margin re-excision following BCS was comparable between groups (8.0%, n =4, vs 9.3%, n = 10; χ2 = 0.076, P = .783) despite the selection bias for borderline conservable cases in the MR+ group. The rate of usage of MRI for ILC cases declined over the study period. Conclusion: While MRI was associated with minor delays in treatment and did not reduce overall rates of margin re-excision or completion mastectomy, it altered the choice of surgical procedure in almost a quarter of MR+ cases. The benefit of preoperative breast MRI appears to be confined to select (younger, dense breast, borderline conservable) cases in symptomatic ILC.

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Magnetic Resonance Imaging of the Breast

Cancer Control ◽

10.1177/107327480100800502 ◽

2001 ◽

Vol 8 (5) ◽

pp. 399-406 ◽

Cited By ~ 17

Author(s):

Christopher P. Goscin ◽

Claudia G. Berman ◽

Robert A. Clark

Keyword(s):

Breast Cancer ◽

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Clinical Studies ◽

Breast Imaging ◽

Breast Mri ◽

Resonance Imaging ◽

Valuable Adjunct ◽

Interpretation Criteria ◽

Contrast Enhanced

Background Magnetic resonance imaging (MRI) has the potential to become a useful adjunct in breast imaging. Contrast-enhanced breast MRI has demonstrated a high sensitivity in the detection of invasive breast cancer. In clinical studies, breast MRI has often altered the course of patient care. Although promising results have been generated, MRI of the breast is currently in a development stage. Methods The authors reviewed the literature on the potential indications, sensitivity, specificity, and limitations of MRI of the breast. Results Reported advantages of MRI of the breast over conventional imaging techniques include improved staging and treatment planning, enhanced evaluation of the augmented breast, better detection of recurrence, and improved screening of high-risk women. Contrast-enhanced breast MRI is a sensitive modality for detecting breast cancer, but its variable specificity is a major limitation. Conclusions MRI of the breast is emerging as a valuable adjunct to mammography and sonography for specific clinical indications. Additional clinical studies that define indications, interpretation criteria, imaging parameters, and cost effectiveness are needed. A multi-institutional study designed to address these issues is in progress.

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Indications for breast magnetic resonance imaging at a referral center for the diagnosis and treatment of breast cancer in Brazil

Radiologia Brasileira ◽

10.1590/0100-3984.2019.0114 ◽

2021 ◽

Vol 54 (2) ◽

pp. 83-86

Author(s):

Samuel Silva Ferreira ◽

Adriene Moraes Campos ◽

Patrícia Lima Fernandes ◽

Izabela Machado Pereira ◽

Flavia Maria Rodrigues ◽

...

Keyword(s):

Breast Cancer ◽

Magnetic Resonance Imaging ◽

High Risk ◽

Magnetic Resonance ◽

Breast Magnetic Resonance Imaging ◽

Breast Mri ◽

Diagnosis And Treatment ◽

Resonance Imaging ◽

Referral Center ◽

Breast Magnetic Resonance

Abstract Objective: To describe the indications for breast magnetic resonance imaging (MRI) at a referral center for breast cancer in Brazil. Materials and Methods: This was a retrospective study in which we reviewed the clinical records, including physician requests and patient questionnaires, of women who underwent breast MRI between 2014 and 2018 at a referral center for the diagnosis and treatment of breast cancer in the city of Belo Horizonte, Brazil. Results: The most common indication for breast MRI was as a complement to mammography/ultrasonography (in 43.6% of cases), followed by breast cancer staging (in 25.1%), the screening of patients at high risk (in 17.4%), the evaluation of breast implants (in 10.1%), and the evaluation of the response to neoadjuvant chemotherapy (in 3.8%). Conclusion: Although there is strong evidence supporting the use of breast MRI, mainly for the screening of high-risk patients, the imaging method is underutilized in Brazil.

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Breast Magnetic Resonance Imaging of Multicentric, Multifocal and Bilateral Cancer — A Case-based Review

European Oncology & Haematology ◽

10.17925/eoh.2011.07.01.24 ◽

2011 ◽

Vol 07 (01) ◽

pp. 24

Author(s):

Virginia Pérez Dueñas ◽

María Ruíz de Gopegui Andreu ◽

Sara Morón Hodge ◽

Asunción Suárez Manrique ◽

◽

...

Keyword(s):

Breast Cancer ◽

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

False Positive ◽

Breast Magnetic Resonance Imaging ◽

Breast Mri ◽

Resonance Imaging ◽

Mri Findings ◽

Mri Features ◽

Breast Magnetic Resonance

Multifocal or multicentric breast cancer can be difficult to detect on mammography or ultrasound, particularly in patients with dense breast tissue. A multimodality approach that includes breast magnetic resonance imaging (MRI) is indicated, particularly when conservative surgery is being considered as it is the most sensitive technique for identifying additional sites of disease. However, its influence on recurrence and survival rates has yet not been clearly established, and false-positive cases may lead to more aggressive management and treatment. Radiologists should therefore be aware of relevant breast MRI findings. Infiltrating carcinomas, contralateral unsuspected carcinomas, occult carcinomas, false-positive cases and post-chemotherapy changes. Several cases of multiple-site breast carcinomas and their corresponding mammographic, ultrasound and MRI features have been reviewed for this article, in which the definition and differences between multifocal, multicentric and contralateral breast carcinoma are explained and the most relevant imaging findings on MRI are illustrated and correlated with mammogram and ultrasound findings. Finally, the role of breast MRI in the pre-operative assessment of breast cancer is discussed.

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Four magnetic resonance imaging surveillance-detected breast cancer cases in cancer-free BRCA1/2 mutation carriers

Surgical Case Reports ◽

10.1186/s40792-021-01313-5 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Megumi Takaoka ◽

Shozo Ohsumi ◽

Yuichiro Miyoshi ◽

Mina Takahashi ◽

Seiki Takashima ◽

...

Keyword(s):

Breast Cancer ◽

Magnetic Resonance Imaging ◽

Ovarian Cancer ◽

Magnetic Resonance ◽

Breast Mri ◽

Resonance Imaging ◽

Breast And Ovarian Cancer ◽

Guided Biopsy ◽

Mutation Carriers ◽

Mri Surveillance

Abstract Background Hereditary breast and ovarian cancer (HBOC) syndrome is a susceptibility syndrome for cancers, such as breast and ovarian cancer, and BRCA1/2 are its causative genes. Annual breast-enhanced magnetic resonance imaging (MRI) is recommended for BRCA1/2 mutation carriers aged over 25 years as a secondary prevention of breast cancer. However, breast MRI surveillance is rarely performed in Japan, and only four cases of breast cancer diagnosis triggered by MRI surveillance have been reported. Case presentation At our hospital, MRI triggered the diagnosis of breast cancer in four cancer-free BRCA1/2 mutation carriers. In one of our four cases, although MRI showed only a 3-mm focus, we could diagnose breast cancer by shortening the surveillance interval considering the patient’s high-risk for developing breast cancer. Conclusions Image-guided biopsy, including MRI-guided biopsy, depending on the size of the lesion, and shorter surveillance intervals are useful when there are potentially malignant findings on breast MRI surveillance for cancer-free patients with HBOC.

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The Role of Preoperative Bilateral Breast Magnetic Resonance Imaging in Patient Selection for Partial Breast Irradiation in Ductal CarcinomaIn Situ

International Journal of Surgical Oncology ◽

10.1155/2012/206342 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6

Author(s):

Kristin V. Kowalchik ◽

Laura A. Vallow ◽

Michelle McDonough ◽

Colleen S. Thomas ◽

Michael G. Heckman ◽

...

Keyword(s):

Breast Cancer ◽

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Breast Magnetic Resonance Imaging ◽

Breast Mri ◽

Partial Breast Irradiation ◽

Breast Irradiation ◽

Resonance Imaging ◽

Ipsilateral Breast ◽

Breast Magnetic Resonance

Purpose. Women with ductal carcinomain situ(DCIS) are often candidates for breast-conserving therapy, and one option for radiation treatment is partial breast irradiation (PBI). This study evaluates the use of preoperative breast magnetic resonance imaging (MRI) for PBI selection in DCIS patients.Methods. Between 2002 and 2009, 136 women with newly diagnosed DCIS underwent a preoperative bilateral breast MRI at Mayo Clinic in Florida. One hundred seventeen women were deemed eligible for PBI by the NSABP B-39 (National Surgical Adjuvant Breast and Bowel Project, Protocol B-39) inclusion criteria using physical examination, mammogram, and/or ultrasound. MRIs were reviewed for their impact on patient eligibility, and findings were pathologically confirmed.Results. Of the 117 patients, 23 (20%) were found ineligible because of pathologically proven MRI findings. MRI detected additional ipsilateral breast cancer in 21 (18%) patients. Of these women, 15 (13%) had more extensive disease than originally noted before MRI, and 6 (5%) had multicentric disease in the ipsilateral breast. In addition, contralateral breast cancer was detected in 4 (4%).Conclusions. Preoperative breast MRI altered the PBI recommendations for 20% of women. Bilateral breast MRI should be an integral part of the preoperative evaluation of all patients with DCIS being considered for PBI.

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Inter-Reader Agreement of Diffusion-Weighted Magnetic Resonance Imaging for Breast Cancer Detection: A Multi-Reader Retrospective Study

Cancers ◽

10.3390/cancers13081978 ◽

2021 ◽

Vol 13 (8) ◽

pp. 1978

Author(s):

Filippo Pesapane ◽

Anna Rotili ◽

Silvia Penco ◽

Marta Montesano ◽

Giorgio Maria Agazzi ◽

...

Keyword(s):

Breast Cancer ◽

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Pairwise Comparison ◽

Breast Mri ◽

Surgical Excision ◽

Wald Test ◽

Resonance Imaging ◽

Diffusion Weighted ◽

The Difference

Purpose: In order to evaluate the use of un-enhanced magnetic resonance imaging (MRI) for detecting breast cancer, we evaluated the accuracy and the agreement of diffusion-weighted imaging (DWI) through the inter-reader reproducibility between expert and non-expert readers. Material and Methods: Consecutive breast MRI performed in a single centre were retrospectively evaluated by four radiologists with different levels of experience. The per-breast standard of reference was the histological diagnosis from needle biopsy or surgical excision, or at least one-year negative follow-up on imaging. The agreement across readers (by inter-reader reproducibility) was examined for each breast examined using Cohen’s and Fleiss’ kappa (κ) statistics. The Wald test was used to test the difference in inter-reader agreement between expert and non-expert readers. Results: Of 1131 examinations, according to our inclusion and exclusion criteria, 382 women were included (49.5 ± 12 years old), 40 of them with unilateral mastectomy, totaling 724 breasts. Overall inter-reader reproducibility was substantial (κ = 0.74) for expert readers and poor (κ = 0.37) for non- expert readers. Pairwise agreement between expert readers and non-expert readers was moderate (κ = 0.60) and showed a statistically superior agreement of the expert readers over the non-expert readers (p = 0.003). Conclusions: DWI showed substantial inter-reader reproducibility among expert-level readers. Pairwise comparison showed superior agreement of the expert readers over the non-expert readers, with the expert readers having higher inter-reader reproducibility than the non-expert readers. These findings open new perspectives for prospective studies investigating the actual role of DWI as a stand-alone method for un-enhanced breast MRI.

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Diagnostic performance of mammography and magnetic resonance imaging for evaluating mammographically visible breast masses

Journal of International Medical Research ◽

10.1177/0300060520973092 ◽

2021 ◽

Vol 49 (9) ◽

pp. 030006052097309

Author(s):

Xueli Zhu ◽

Yi Cao ◽

Ruidie Li ◽

Mingxia Zhu ◽

Xin Chen

Keyword(s):

Breast Cancer ◽

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Breast Mri ◽

Resonance Imaging ◽

Predictive Values ◽

Breast Masses ◽

Significant Difference ◽

Diagnostic Values ◽

Magnetic Resonance Imaging Mri

Objective We compared the diagnostic values of mammography and magnetic resonance imaging (MRI) for evaluating breast masses. Methods We retrospectively analyzed mammography, MRI, and histopathological data for 377 patients with breast masses on mammography, including 73 benign and 304 malignant masses. Results The sensitivities and negative predictive values (NPVs) were significantly higher for MRI compared with mammography for detecting breast cancer (98.4% vs. 89.8% and 87.8% vs. 46.6%, respectively). The specificity and positive predictive values (PPV) were similar for both techniques. Compared with mammography alone, mammography plus MRI improved the specificity (67.1% vs. 37.0%) and PPV (91.8% vs. 85.6%), but there was no significant difference in sensitivity or NPV. Compared with MRI alone, the combination significantly improved the specificity (67.1% vs. 49.3%), but the sensitivity (88.5% vs. 98.4%) and NPV (58.3% vs. 87.8%) were reduced, and the PPV was similar in both groups. There was no significant difference between mammography and MRI in terms of sensitivity or specificity among 81 patients with breast masses with calcification. Conclusion Breast MRI improved the sensitivity and NPV for breast cancer detection. Combining MRI and mammography improved the specificity and PPV, but MRI offered no advantage in patients with breast masses with calcification.

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Impact of breast magnetic resonance imaging on the locoregional staging and management of breast cancer

Radiologia Brasileira ◽

10.1590/0100-3984.2018.0064 ◽

2019 ◽

Vol 52 (4) ◽

pp. 211-216 ◽

Cited By ~ 1

Author(s):

Luciana Karla Lira França ◽

Almir Galvão Vieira Bitencourt ◽

Fabiana Baroni Alves Makdissi ◽

Carla Curi ◽

Juliana Alves de Souza ◽

...

Keyword(s):

Breast Cancer ◽

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Positive Impact ◽

Breast Mri ◽

Patient Treatment ◽

Treatment Recommendation ◽

Resonance Imaging ◽

The Impact ◽

Locoregional Staging

Abstract Objective: To assess the impact of magnetic resonance imaging (MRI) on the locoregional staging of breast cancer. Materials and Methods: We evaluated 61 patients with breast cancer who underwent pre-treatment breast MRI, between August 2015 and April 2016. An experienced breast surgeon determined the surgical treatment, on the basis of the findings of conventional imaging examinations, and made a subsequent treatment recommendation based on the MRI findings, then determining whether the MRI changed the approach, as well as whether it had a positive or negative impact on the treatment. Results: The mean age was 50.8 years (standard deviation, 12.0 years). The most common histological type was invasive breast carcinoma of no special type (in 68.9%), and the most common molecular subtype was luminal B (in 45.9%). Breast MRI modified the therapeutic management in 23.0% of the cases evaluated, having a positive impact in 82.7%. Conclusion: Breast MRI is an useful tool for the locoregional staging of breast cancer, because it provides useful information that can have a positive impact on patient treatment.

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