Risk–benefit analysis of preoperative breast MRI in patients with primary breast cancer

• Published in: Clinical radiology 2009-04, Vol.64 (4), p.403-413
• Main Authors: Siegmann, K.C, Baur, A, Vogel, U, Kraemer, B, Hahn, M, Claussen, C.D
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biopsy; Breast - pathology; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - pathology; Carcinoma, Ductal, Breast - diagnostic imaging; Carcinoma, Ductal, Breast - pathology; Carcinoma, Lobular - diagnostic imaging; Carcinoma, Lobular - pathology; Carcinoma, Medullary - diagnostic imaging; Carcinoma, Medullary - pathology; Female; Gynecology. Andrology. Obstetrics; Humans; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Imaging - methods; Mammary gland diseases; Mammography; Medical sciences; Middle Aged; Needs Assessment; Neoplasm Staging; Neoplasms, Ductal, Lobular, and Medullary - diagnostic imaging; Neoplasms, Ductal, Lobular, and Medullary - pathology; Preoperative Care - methods; Prospective Studies; Radiology; Risk Assessment; Treatment Outcome; Tumors; Ultrasonography, Mammary
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/j.crad.2008.12.002

Aim To analyse and compare the risks and benefits of preoperative breast MRI (BMRI) in patients with primary breast cancer (PBC), and to determine the influence of mammographic breast density (BD) and histological tumour type (TT). Materials and Methods One hundred and nineteen patients who underwent preoperative bilateral breast MRI for staging of PBC during a 1-year period from July 2005 to August 2006 were prospectively evaluated. Changes in clinical management due to BMRI findings were recorded. MRI-detected lesions were correlated with histology. Additional MRI-detected malignant lesions and spared additional biopsies because of negative MRI in case of unclear ultrasound findings were determined as beneficial for the patient. Biopsies of benign MRI detected lesions were defined as disadvantageous. The influence of BD (ACR 1–4) and TT on the change in clinical management and patient benefit was evaluated. Results The findings of the BMRI examinations changed the clinical management in 48 patients (40.3%). Seventeen women underwent mastectomy instead of breast conservation, eight patients underwent extended excision, 21 additional lesions were clarified by MRI intervention, and two ultrasound-detected lesions were not biopsied because of negative MRI. Histologically malignant additional or extended biopsies ( n = 34) and two cases of spared biopsies resulted in 36 (30.3%) women who benefited from preoperative BMRI. Twelve patients (10.1%) had additional biopsies of MRI-detected benign lesions, and therefore, had an unfavourable outcome due to BMRI. The change in clinical management and patient benefit were independent of BD and TT ( p > 0.05). Conclusion Preoperative BMRI was beneficial for 30.3% of 119 patients with PBC. The percentage of additional biopsies of benign lesions (10.1%) seems acceptable.