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Title: Effect of Preoperative Breast MRI on Surgical Management of Breast Cancer: Does It Offer a Benefit? Presented at ASBD
URL: http://www.pslgroup.com/dg/21F772.htm
Doctor's Guide
April 14, 2008

By Kristina Rebelo

SAN DIEGO -- April 14, 2008 -- A significant number of patients undergo a change in surgical strategy based on preoperative magnetic resonance imaging (MRI) findings, and some may have additional but inappropriately more aggressive surgery, according to a study presented here in a poster session at the 32nd Annual Symposium of the American Society of Breast Disease (ASBD).

MRI has increasingly been utilised as an imaging tool for detection of mammographically occult breast cancer. "Because of its low specificity, which can lead to a high false-positive rate, preoperative breast MRI has the potential to either positively or negatively influence surgical management of invasive cancer," the study said.

Co-author Christopher Menendez, MD, Surgeon, University of Texas Southwestern Medical Center, Dallas, Texas, said the study was conducted to determine the impact of MRI on surgical decisions for patients with breast cancer.

Dr. Menendez and colleagues conducted a retrospective review of breast cancer screening of 94 patients with breast cancer who had undergone bilateral breast MRI in the preoperative setting. The primary endpoint was adjustment of the original surgical plan elucidated by the preoperative MRI findings. Findings were classified as beneficial, harmful (over or under treatment), or neutral, based on concordance between the preoperative MRI and the final pathology reports.

Results showed that in 29.7% of patients, the MRI had prompted an adjustment in the original surgical plan; additional surgery was planned for 27, patients and less surgery was planned for 1 patient. The final pathology report confirmed resection of true occult disease in 59.3% of the 27 who were judged to require more extensive surgery, and did not confirm the extent of the disease suggested by the MRI in 18.5%.

Overall, the concordance between MRI and final pathology, with respect to extent of disease, was 64.9%; preoperative MRI was judged to provide a benefit in 19.1% of the 94 patients, the researchers said.

"Some patients just want a mastectomy," said Dr. Menendez. "They refuse the work-up even if they don't know what the lesion is. However, inherently, we're scientists and we want to know."

Dr. Menendez noted that the decision to have the mastectomy was primarily made by women who previously had a cancer diagnosed in one breast and then a spot was found in the other breast.

In a poster presentation on April 10, Dr. Menendez said that MRI offers a benefit to the patient in finding disease, "but at times, it might find more disease that is not actually malignant."

The study's conclusions were that a significant number of patients undergo a change in surgical strategy based on the preoperative MRI findings, but for the most part, the technique increases the recognition and resection of occult disease. However, it can still prompt more aggressive surgery in 5% of patients.

"MRI can help in select cases but at times it can tell you too much and leave the patient in a quandary," said Dr. Menendez.


[Presentation title: The Effect of Preoperative Breast MRI on the Surgical Management of Breast Cancer: Does it Offer a Benefit. Poster T-31]

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