Liane Elizabeth Philpotts MD, Presenter: Nothing to Disclose

Summer Herlihy MD, Abstract Co-Author: Nothing to Disclose

Kimberly Lapia RN, Abstract Co-Author: Nothing to Disclose

Regina J. Hooley MD, Abstract Co-Author: Research grant, SuperSonic Imagine

Jaime Lynn Geisel MD, Abstract Co-Author: Nothing to Disclose

Laura Jean Horvath MD, Abstract Co-Author: Nothing to Disclose

Jeffrey C. Weinreb MD, Abstract Co-Author: Research support, Bayer AG Consultant, Bayer AG Speakers Bureau, Bracco Group Speakers Bureau, Bayer AG Consultant, Boston Scientific Corporation

Baiba J. Grube MD, Abstract Co-Author: Nothing to Disclose

Brigid Killelea MD, Abstract Co-Author: Nothing to Disclose

Donald R. Lannin MD, Abstract Co-Author: Nothing to Disclose

To assess the value of pre-operative breast MRI in patients undergoing lumpectomy, by comparing positive margins and re-excision rates by lesion type, size, patient age, breast density, and surgeon.

A retrospective review of the breast imaging database and medical records identified 158 consecutive patients over a 1 year period (February 2010-February 2011) undergoing initial needle localization and lumpectomy for newly diagnosed breast cancer. Patients that received pre-operative MRI were compared to those who did not in terms of positive margins and re-excisions. Factors such as patient age (grouped by decade), cancer type, breast density, and surgeon were all compared. Imaging size and final pathological sizes were determined.

Of the 158 patients, 96 (61%) underwent pre-operative MRI. Of those, 13 (13%) had positive margins, and 9 (9%) underwent re-excision. Of 62 patients who did not undergo pre-operative MRI, 17 (27%) had positive margins and 11 (17%) underwent re-excision. The difference in positive margins is statistically significant (P=0.02). Positive margins occurred significantly more often in younger women (39-49) (p=.005) than older age groups and there was a trend for MRI to decrease the positive margin rate among these young women (30% vs 60%, p=0.1). The most common type of cancer lesions, Invasive Ductal Carcinoma with DCIS, were significantly less likely to have positive margins if MRI was performed (10% vs 31%, p=0.03). By breast density, positive margins were found in 30% fatty, 11% scattered, 26% heterogeneous, and 20% extremely dense. MRI reduced the percentage with positive margins most significantly for heterogeneous breasts (p<0.006). Utilization of MRI and positive margin rates, respectively, by surgeon were: a) 88%, 15%; b) 52%, 12%; c) 80%, 30%; d) 58%, 9%; e) 0%, 64%. The surgeon with the lowest utilization of MRI had the highest positive margin rate.

The appropriate use of pre-operative MRI in selected patients is associated with a statistically significant improved surgical outcome in terms of fewer positive margins.

The appropriate use of pre-operative MRI is associated with an improved surgical outcome.

Philpotts, L, Herlihy, S, Lapia, K, Hooley, R, Geisel, J, Horvath, L, Weinreb, J, Grube, B, Killelea, B, Lannin, D, The Effect of Pre-operative MRI on Surgical Outcomes of Patients Undergoing Initial Lumpectomy for Newly Diagnosed Breast Cancer.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11005598.html