BreastMRI￼

Breast MRI:
- Can be a very useful tool in both the diagnosis and staging of breast cancer
Based on the Surveillance, Epidemiology, and End Results (SEER) Program database and Medicare data pre-operative breast MRI use:
- Has increased from:
  - 5.9% to 22.4% for ductal carcinoma in situ (DCIS)
  - 7.0% to 24.3% for invasive cancer
In cases such as invasive lobular disease:
- Pre-operative MRI has been shown to decrease the rate of re-excision:
  - However, data on the benefit of routine pre-operative breast MRI are mixed:
    - With some studies showing an increase in mastectomy rate:
      - While other studies have not shown an increase in mastectomy rate
    - Contralateral mastectomy has also been shown to be higher in those with pre-operative MRI
When all tumor types were considered:
- There was consistently no difference in the rate of re-excision in those undergoing pre-operative MRI vs. no MRI
A recent meta-analysis showed that pre-operative MRI:
- Was associated with increased odds of receiving ipsilateral mastectomy and contralateral prophylactic mastectomy with no difference in rates of re-excision, re-operation, or positive margins:
  - Therefore, use of MRI should be an individualized decision, and routine use in all patients is not appropriate

References
Henderson LM, Weiss J, Hubbard RA, O’Donoghue C, DeMartini WB, Buist DS, Kerlikowske K, Goodrich M, Virnig B, Tosteson AN, Lehman CD, Onega T. Factors Associated with Preoperative Magnetic Resonance Imaging Use among Medicare Beneficiaries with Nonmetastatic Breast Cancer. Breast J. 2016 Jan-Feb;22(1):24-34. doi: 10.1111/tbj.12522. Epub 2015 Oct 28.
Mann RM, Loo CE, Wobbes T, Bult P, Barentsz JO, Gilhuijs KG, Boetes C. The impact of preoperative breast MRI on the re-excision rate in invasive lobular carcinoma of the breast. Breast Cancer Res Treat. 2010 Jan;119(2):415-22. doi: 10.1007/s10549-009-0616-6.
Houssami N, Turner RM, Morrow M. Meta-analysis of pre-operative magnetic resonance imaging (MRI) and surgical treatment for breast cancer. Breast Cancer Res Treat. 2017;165(2):273-283.
Fancellu A, Soro D, Castiglia P, Marras V, Melis M, Cottu P, et al. Usefulness of magnetic resonance in patients with invasive cancer eligible for breast conservation: a comparative study. Clin Breast Cancer. 2014;14(2):114-121.
Fancellu A, Turner RM, Dixon JM, Pinna A, Cottu P, Houssami N. Meta-analysis of the effect of preoperative breast MRI on the surgical management of ductal carcinoma in situ. Br J Surg. 2015;102(8):883-893.
Parsyan A, Moldoveanu D, Balram B, Wong S, Zhang DD, Svadzian A, et al. Influence of preoperative magnetic resonance imaging on the surgical management of breast cancer patients. Am J Surg. 2016;211(6):1089-1094.

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BreastMRI