Bhavika Kantilal Patel MD, Presenter: Nothing to Disclose

Samuel J. Galgano MD, Abstract Co-Author: Nothing to Disclose

Zhibo Wang MS, Abstract Co-Author: Nothing to Disclose

Zhengjia Chen PhD, Abstract Co-Author: Nothing to Disclose

Carl Joseph D'Orsi MD, Abstract Co-Author: Consultant, Hologic, Inc Stock options, Hologic, Inc Consultant, Koninklijke Philips Electronics NV

The purpose of this study is to determine whether including a breast MRI in the pre-operative workup has an impact on the re-excision and/or mastectomy rates in breast cancer patients.

This is an Institutional Review Board-approved retrospective study of comparing the impact MRI has on the mastectomy and re-excision rates in patients diagnosed with breast cancer at Emory Winship Cancer Institute. Our patient populations include 163 breast cancer patients, serving as a control group, who are in the pre-MRI era (2002-2005) and did not receive a pre-operative breast MRI and a second study cohort of 163 patients representing the post MRI era (2006-2009) who did receive pre-operative breast MRI. Chi-square and Wilcoxon tests were used to compare the demographics differences between them. The breast surgical staff was stable for both time periods. Logistic regression models were used to investigate surgical procedure differences and determine statistical significance. Odds ratios (OR) were calculated for comparisons that were statistically significant at a p-value ≤ 0.05.

The race and age composition of the women in control and study populations was not significantly different and did not have a significant impact on the MRI outcome. Additionally, the mastectomy rate between the pre-MRI and post-MRI populations was not statistically significant. The re-excision rates between the two populations, however, were significant (p < .0001) with woman in the pre-MRI era having a higher re-excision rate than those in the post-MRI era. Women in the pre-MRI era were 4.33 times more likely to undergo re-excision (OR= 4.33; CI (2.01, 9.35)). The difference between involved and clear margins was significant as well (p = 0.0067). Patients who did have pre-operative MRI were more likely to have negative margins (OR = 3.3003; CI (1.32, 8.20)) or close margins (OR = 4.5662; CI (1,73, 12.05)).  

Preoperative breast MRI does not result in a statistically significant difference in mastectomy rates. In fact, breast MRI is not an explanatory variable in determining the patient’s mastectomy or lumpectomy rates. Preoperative breast MRI, however, does significantly decrease the likelihood of involved margins as well as the need for surgical re-excision.

Preoperative MRI allows for a decrease in re-excision rates with no significant difference in mastectomy rates or cancer detection.

Patel, B, Galgano, S, Wang, Z, Chen, Z, D'Orsi, C, Does Preoperative MRI Workup Affect Mastectomy Rates and/or Re-excision Rate in Patients with Diagnosed Breast Carcinoma? A Retrospective Review.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12021737.html