Influence of preoperative MRI on the surgical management of patients with operable breast cancer.

Abstract

PURPOSE: Evaluation of the impact of preoperative magnetic resonance imaging (MRI) of the breast on the clinical management of patients with operable breast cancer (BC). METHODS: Retrospective analysis of 160 patients with operable breast cancer (stages Tis through T4), treated from 2002 through 2004. All patients underwent a full mammographic assessment, high frequency breast ultrasound, and breast MRI. The impact of preoperative MRI was evaluated for each patient with regard to changes in the therapeutic procedure. Patient and tumor characteristics were analyzed to identify possible patient subgroups that predominantly would benefit from preoperative MRI. RESULTS: Preoperative MRI affected the clinical management in 44 of 160 patients (27.5%). In 30 cases (18.75%) additional in situ or invasive cancers or a more widespread tumor extent were diagnosed correctly which went undetected by clinical palpation, mammography, and breast ultrasound. In 14 cases (8.75%) additional surgical procedures were performed based on suspicious MRI findings that turned out to be benign in final pathology. Age, menopausal status, breast density, tumor characteristics (type, tumor size, grading), ER-, PR- and HER2-receptor features did not significantly differ between patients in which breast MRI affected the clinical management and patients that experienced no additional information from MRI. CONCLUSIONS: Preoperative breast MRI changes surgical management of patients with operable breast cancer. MRI detects additional invasive carcinoma and proves to be a powerful supplement to the conventional work-up in the clinical management of breast cancer. This advantage is independent from patients- and tumor-specific characteristics.