E. Warnack1, S. Dhage1, K. P. Joseph1 1New York University School Of Medicine,Surgery,New York, NY, USA
Introduction:
Use of MRI for pre-operative evaluation of newly diagnosed breast cancer has become more common, despite questionable impact on survival outcomes. We sought to examine whether or not MRI led to further delay in definitive surgery at this public hospital, and to determine how often and in what manner pre-operative breast MRI changed surgical management. We also sought to examine characteristics of patients who received preoperative MRI.
Methods:
Our breast clinic database was used to identify patients who received surgery between January and December 2015. From this group, patients who received preoperative MRI were identified. Characteristics of patients, including ethnicity, age, tumor stage, and type of surgery, were collected for both groups. Mean time to surgery, from biopsy definitive operation, was calculated for both groups. Patients who received neoadjuvant chemotherapy were excluded. Of those who received MRI, data on whether MRI changed surgical management was abstracted.
Results:
A total of 101 patients received breast surgery at our institution over a one-year period, and 27 patients received MRI for preoperative planning purposes. There were no significant differences in the MRI and no MRI group in terms of ethnicity (p 0.227.) There were significant differences in the two groups for age, (p .002) stage (p .049,) and type of surgery received (p .005). Patients with stage 2A cancer were 5.1 times more likely (p.026) to receive MRI, and patients with stage 2B cancer were 7 times more likely (p .021) to receive MRI, compared to patients with stage 0 disease. Patients who underwent MRI were less likely to receive lumpectomy or re-excision (OR .212, p .002,) compared to mastectomy. The group of patients who did not undergo MRI experienced slightly longer mean time to surgery (38.75 days compared to 37.4 days in MRI group.) Of those who received MRI, most (22, 81.4%) had abnormal results, and 13 (48.1%) underwent biopsy as a result of MRI. MRI changed management in nine patients (33.3%,) in most cases by converting a planned lumpectomy to mastectomy.
Conclusion:
Interestingly, there was no significant difference in time to surgery between the MRI and no MRI group, suggesting that MRI did not cause substantial delay in management. Patients were more likely to receive MRI if they had advanced stages of cancer, and those that received MRI were more likely to receive mastectomy compared to lumpectomy. Considering the high rate of change in surgical management for those who received MRI, and the equivalent time to surgery in this group, it may be inferred that MRI is a helpful imaging study in select patients with breast cancer. Further studies are needed to explore long-term outcomes of those who received MRI.
