Jie Li MD, Presenter: Nothing to Disclose

Sujata Patil PhD, Abstract Co-Author: Nothing to Disclose

Kimberly J. Van Zee MD, Abstract Co-Author: Nothing to Disclose

Laura Liberman MD, Abstract Co-Author: Nothing to Disclose

D. David Dershaw MD, Abstract Co-Author: Nothing to Disclose

Elizabeth A. Morris MD, Abstract Co-Author: Nothing to Disclose

To determine impact of preoperative staging breast MRI on outcomes of early breast cancer patients (AJCC stage 0, I and II) undergoing breast conservative therapy (BCT) and radiation therapy (RT).

With IRB approval, 1224 staging breast MRI exam records from 2000-2004 were retrospectively reviewed. Among these, 174 staging MRI exams were performed in women with AJCC 0, I or II cancer diagnosed by percutaneous biopsy undergoing BCT and RT. A control group of 174 women who had BCT & RT but no MRI were identified from 3645 patients (same time period), matched by age, histopathology, staging and surgeon. Median follow-up after treatment was 5.5 (range 1.8-9.4) years. For both groups the following were compared: final margin, lymph node status, lymphovascular involvement, extensive intraductal component (EIC) status, hormone receptor status, adjuvant therapy, breast density, and whether cancer was mammographically occult. Outcomes of ipsilateral recurrence, contralateral new cancer and distant metastasis after treatment were compared using Kaplan-Meier methods and the log-rank test.

Women who underwent preoperative breast MRI, compared to those who did not, were significantly more likely to have extremely dense breasts (28% vs 6%, P<0.0001) and mammographically occult cancer (24% vs 9%, p<0.0003). The two groups had identical rates of negative final margins, positive lymph nodes, lymphovascular involvement, EIC status, hormone receptor positivity and systemic adjuvant therapy. In patients who were staged with MRI there were significantly fewer total operations following initial diagnosis (227 vs 252, p=0.04). For women undergoing preoperative MRI compared to those who did not, no significant difference in actuarial local/regional ipsilateral recurrence (3.6% vs.4.9%, p=0.4), contralateral cancer rate (2.0% vs 3.2%, p=0.6), or distant metastasis rate (2.3% vs 5.3%, p=0.8) was observed.

Preoperative staging MRI decreased total number of surgical procedures in women with early stage breast cancer undergoing BCT and RT.  Preoperative staging MRI did not decrease ipsilateral recurrence, contralateral cancer or distant metastasis rates.   

Preoperative MRI appears to be used more in extremely dense breasts and mammographically occult cancer, therefore retrospective outcome analysis is difficult. A prospective randomized trial is needed.

Li, J, Patil, S, Van Zee, K, Liberman, L, Dershaw, D, Morris, E, Preoperative Breast MRI: Outcomes in Early Stage Breast Cancer.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9012429.html