Heike Preibsch, Presenter: Nothing to Disclose

Laura Kathrin Wanner, Abstract Co-Author: Nothing to Disclose

Sonja Dorothea Bahrs, Abstract Co-Author: Nothing to Disclose

Ernst Oberlechner, Abstract Co-Author: Nothing to Disclose

Annette Staebler, Abstract Co-Author: Nothing to Disclose

Claus Detlef Claussen MD, Abstract Co-Author: Nothing to Disclose

Konstantin Nikolaou MD, Abstract Co-Author: Speakers Bureau, Siemens AG Speakers Bureau, Bracco Group Speakers Bureau, Bayer AG

Katja Claudia Siegmann-Luz, Abstract Co-Author: Nothing to Disclose

Preoperative breast MR Imaging is not routinely obtained in the assessment of primary breast cancer. German guidelines recommend MRI in individual cases, such as invasive lobular carcinoma, to optimize local staging and therapy. The impact of preoperative MRI on re-excision and mastectomy rate is discussed controversially in the literature. The aim of this study was to evaluate the effect of preoperative breast MRI on surgical procedure and re-excision rate.  

After institutional review board approval, a retrospective analysis of 991 consecutive patients with 1036 primary breast cancers was performed. Of these 991 patients, in a total of 599 patients with 626 breast cancers, preoperative breast MRI was obtained. Planned surgical procedure before and after MRI was compared. Also, the number of re-excisions in patients with preoperative MRI and in patients who had no preoperative MRI was compared.

In 26% (164/626) of the cases with preoperative MRI, the result of MRI changed the surgical procedure (wider local excision (n=52), local excision to a lesser extent (n=5), excision of a contralateral carcinoma (n=7), or mastectomy (n=100). In 82% of those cases (134/164), MRI was beneficial for the patients, as a wider surgical excision or the excision of an MRI-detected contralateral carcinoma removed otherwise occult carcinomas (n=129) or further biopsy or removal of benign tissue could be prevented (n=5). In 30 cases, the carcinomas were overdiagnosed by MRI as the histopathologic size after extended excision showed a better correlation in size with mammography and ultrasound than with MRI. Patients with and without preoperative MRI showed no difference in mastectomy rates (39% vs. 39%). Without reaching statistical significance, patients with preoperative breast MRI showed a lower re-excision rate in case of tumor stages pTis, pT1 and pT3, and an elevated re-excision rate in case of tumor stages pT2 and pT4, if compared to patients who did not undergo preoperative MRI.

In the present cohort and retrospective analysis, in 21% of primary breast cancers (134/626), patients had a clear benefit from preoperative breast MRI, due to the removal of otherwise not detected carcinomas. Also, preoperative breast MRI did not increase the rate of mastectomy.

Preoperative breast MRI is helpful to optimize surgical therapy in patients with primary breast cancer.

Preibsch, H, Wanner, L, Bahrs, S, Oberlechner, E, Staebler, A, Claussen, C, Nikolaou, K, Siegmann-Luz, K, Preoperative Breast MR Imaging in the Assessment of Primary Breast Cancer: Impact on Surgical Procedure and Re-excision Rate.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14008626.html