Is Preoperative Magnetic Resonance Imaging Useful in Managing Premenopausal Breast Cancer?: Presented at ASBD

To print: Select File and then Print from your browser's menu
---------------------------------------------------------------------------------------
Title: Is Preoperative Magnetic Resonance Imaging Useful in Managing Premenopausal Breast Cancer?: Presented at ASBD
URL: http://www.pslgroup.com/dg/21F7BA.htm
Doctor's Guide
April 14, 2008

By Kristina Rebelo

SAN DIEGO -- April 14, 2008 -- A magnetic resonance imaging (MRI) scan may not be the best option for preoperative breast cancer management, according to a research poster presented at the American Society of Breast Disease (ASBD) 32nd Annual Symposium.

An MRI may cause a delay in surgery, may incur financial costs, and may cause psychological and physical burdens on the patient that are unwarranted, noted Anna Kundel, MD, Resident, Department of Surgery, New York Hospital Medical Center, Queens, New York.

The question of whether to use MRI in premenopausal women diagnosed with ductal carcinoma in situ (DCIS) or invasive ductal or lobular breast cancer (IDC or ILC) is "a real toss-up," co-author Dr. Kundel said here in a presentation on April 10.

Dr. Kundel and colleagues conducted the retrospective study to determine the impact of preoperative breast MRI in this population -- a population with increased breast density that may limit traditional mammography and clinical examinations.

From October 2003 to October 2007, premenopausal women were identified who had had preoperative MRI after a diagnosis of DCIS or invasive breast cancer on core-needle biopsy. Charts were reviewed to determine those patients who required additional biopsies or imaging due to new findings on MRI. Pathology results were then correlated to MRI findings, and the impact of breast MRI on the final surgical management was evaluated.

The study results identified 51 premenopausal breast cancer patients with DCIS (n = 11) or invasive breast cancer (IDC, n = 37; ILC, n = 2; mucinous, n = 1). The average age of the patients was 44 years.

MRI findings resulted in subsequent procedures in 25 (50%) of the patients. Of these, 10 patients (20%) required some 13 extra biopsies, of which 3 were positive for malignancy (2 DCIS; 1 ILC).

"Both of the patients with DCIS required mastectomies due to the advanced disease, while the patient with ILC had a wider lumpectomy performed to incorporate the additional lesion at the time of surgery for the primary tumour," the authors noted in their poster, adding that another 3 patients who chose mastectomy would have required biopsy for an additional lesion seen on MRI. An evaluation of the specimen revealed additional DCIS in 1 patient, and only primary tumour in the other 2 patients.

"All follow-ups to date have been negative in the 17 patients who had BIRADS-3 [Probably Benign Finding -- short-interval follow-up suggested] MRI results for other lesions," the authors noted.

The study found that preoperative MRI resulted in 20% of patients requiring extra biopsies, finding additional cancer in 8% and altering surgical management in 6% of patients. Dr. Kundel attributed the high number of patients with BIRADS-3 MRIs (33%) to the menstrual cycle.

"Delay in surgery should take into account the psychological, financial, and angst burden on the patient," said Dr. Kundel, suggesting that a cost-effectiveness analysis could be useful in determining the utility of preoperative MRI in breast cancer management.

Dr. Kundel concluded that the medical community must "consider all the repercussions of the preoperative breast MRI. We need more standardisation for reading MRIs, and we need additional studies."

[Presentation title: The Impact of Preoperative Breast MRI on Management of Premenopausal Breast Cancer. Poster T-29.]

http://www.docguide.com

Return to News Story Page

webmaster@pslgroup.com