Preoperative breast MRI valuable complement to mammography, ultrasound

In In The News by Barbara Jacoby

By: Mark Leiser


Preoperative MRI served as a valuable complement to conventional imaging for determining extent of breast cancer and detecting additional lesions, according to study results presented at Miami Breast Cancer Conference.

The approach appeared particularly beneficial for younger patients, results showed.

Preoperative breast MRI can be used in addition to ultrasound and mammography to help inform diagnostic and surgical management of patients with breast cancer. This strategy is especially helpful when there is concern about the potential for more extensive disease than has been indicated on prior imaging.

Christine Xue, MD, and colleagues from Lehigh Valley Health Network conducted a retrospective chart review to determine the value of preoperative MRI for characterizing the extent of cancer, identify risk factors associated with additional lesions on MRI that were not apparent on prior imaging, and evaluate the effect of this approach on patient management.

The researchers reviewed charts of 199 patients (median age, 52 years; range, 33-79) with biopsy-proven breast cancer who underwent preoperative MRI at their institution between January 2014 and February 2018.

Xue and colleagues evaluated the accuracy of MRI for predicting extent of disease, including tumor size, presence of bilateral disease and presence of multifocal multicentric disease.

They also measured frequency of additional lesions visualized on MRI, incremental cancer detection and modifications to surgical management.

Researchers calculated a 98% sensitivity with MRI for detecting breast cancer. MRI predicted tumor size within 10 mm of the pathological tumor size in 155 cases (78%).

Investigators also determined MRI had greater sensitivity than mammography and ultrasound for detecting multifocal multicentric disease (82% vs. 53%) and for detecting bilateral disease (90% vs. 33%).

Seventy-two MRIs (36%) revealed additional lesions, which helped investigators identify additional biopsy-proven cancer sites in 37 patients (19%).

The additional findings altered surgical management for 33 patients (17%), either from lumpectomy to mastectomy or from mastectomy to bilateral mastectomy.

Age younger than 50 years appeared associated with increased frequency of more lesions detected by MRI (P = .004). Other factors — such as race, histopathology, breast density, hormone receptor status and BRCA-positive status — did not appear significantly associated with frequency of additional lesions detected on MRI.