Breast MRI vs traditional triple assessment in the preoperative assessment of breast cancer patients. Does MRI affect correctly the decision about the extent of the surgery? A study based on the final histology specimen

54 Background: In breast cancer patients, the use of preoperative MRI is increasing. A change in the operative plan due to MRI findings occurs in 8%-20% of cases. Preoperative MRI is used routinely by many surgeons and radiologists, but debate persists with regard to its indications. We evaluated whether mammographic breast density affected MRI findings. We also examined whether the number of MRI detected synchronous cancers were affected by breast density. Methods: A retrospective chart review was performed of newly diagnosed breast cancer patients who underwent preoperative MRI from 2008-2011. There were three categories of breast density: fat-replaced, scattered fibroglandular densities, and dense. We determined the number of patients in each group who underwent biopsies based on MRI findings, and evaluated the number of occult cancers diagnosed as a result of these biopsies. Results: 301 patients were included. Overall, 64 patients (21%) who underwent an image guided biopsy based on pre-operative breast MRI were diagnosed with an additional focus of cancer. Of the 17 patients with fat-replaced breasts, 4 underwent additional biopsy, and carcinoma was identified in all patients. 149 patients had scattered fibroglandular densities; 53 (36%) underwent additional biopsies. New cancers were diagnosed in 28 patients (19%). Of 135 patients with dense breasts, 61 patients (45%) had additional biopsies, and new cancers were diagnosed in 24 % of these patients. Conclusions: MRI detected additional cancer in 21% of patients in this study. MRI is sensitive and specific in patients with fat-replaced breasts (100%), but due to the small number of patients in this group, additional studies must be done to evaluate the usefulness in this group of patients. We conclude that MRI is useful for detecting additional cancers in patients of all breast densities, and may change the surgical options of the patient when multicentric or contralateral disease is diagnosed.[Table: see text]

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Who is ordering breast MRIs in newly diagnosed breast cancer patients?

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.26_suppl.24 ◽

2014 ◽

Vol 32 (26_suppl) ◽

pp. 24-24

Author(s):

Anya Romanoff ◽

Matthew McMurray ◽

Hank Schmidt ◽

Parissa Tabrizian ◽

Christina Weltz ◽

...

Keyword(s):

Breast Cancer ◽

Primary Care ◽

Cancer Patients ◽

Breast Mri ◽

Primary Care Providers ◽

Newly Diagnosed ◽

Care Providers ◽

Breast Cancer Patients ◽

Breast Center ◽

Breast Surgeon

24 Background: Utilization of breast MRI has increased dramatically in recent years, and there is ongoing debate regarding the role of MRI in patients with breast cancer. Guidelines for MRI use in newly diagnosed breast cancer patients have not been established; therefore, provider ordering of MRI in this population is variable. We investigated patterns of MRI ordering by healthcare providers in the setting of newly diagnosed breast cancer and analyzed predictors of MRI utilization. Methods: All newly diagnosed breast cancer patients presenting for surgical management at a single tertiary care breast center from January 2011 through December 2013 were reviewed. Cases were evaluated for the use of preoperative MRI, and medical specialty of the ordering provider was determined. Patients who presented to a specialized breast center with MRI already completed were compared to those who had MRIs ordered by their treating breast surgeon. Results: A total of 423 women with newly diagnosed breast cancer underwent MRI during the study period. In this group, 253/423 patients (60%) presented to our institution with an MRI already completed. Of MRIs performed prior to presentation, 73% were ordered by a primary care provider, and 27% were ordered by a breast specialist seen previously. Race was a significant predictor of having an MRI before presentation to a breast center (64% of white patients, 41% of black patients, 25% of Asians, and 65% of Hispanic patients, p < .001). Women with commercial insurance were significantly more likely to have an MRI completed before presentation than those with Medicaid (62% versus 37%, p = .002). Age, family history of breast cancer, genetic testing, breast density, mode of diagnosis, and biopsy pathology were not significant factors in determining whether a patient underwent MRI prior to presentation to a breast surgeon. Conclusions: In our experience, the majority of MRIs performed in newly diagnosed patients with breast cancer were ordered by primary care providers as part of their patient’s initial workup. Patient race and insurance status were significant predictors of having an MRI ordered prior to seeing a breast specialist. Further research is needed to develop guidelines for breast MRI use in newly diagnosed cancer patients.

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