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Surgical Patterns of Care in Patients with Invasive Breast Cancer Treated with Neoadjuvant Systemic Therapy and Breast Magnetic Resonance Imaging: Results of a Secondary Analysis of TBCRC 017

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Neoadjuvant chemotherapy (NCT) downstages advanced primary tumors, with magnetic resonance imaging (MRI) being the most sensitive imaging predictor of response. However, the impact of MRI evaluation on surgical treatment decisions in the neoadjuvant setting has not been well described. We report surgical patterns of care across 8 National Cancer Institute comprehensive cancer centers in women receiving both NCT and MRI to evaluate the impact of MRI findings on surgical planning.

Methods

Seven hundred seventy women from 8 institutions received NCT with MRI obtained both before and after systemic treatment. Univariate and multivariate analyses of imaging, patient-, and tumor-related covariates associated with choice of breast surgery were conducted.

Results

MRI and surgical data were available on 759 of 770 patients. A total of 345 of 759 (45 %) patients received breast-conserving surgery and 414 of 759 (55 %) received mastectomy. Mastectomy occurred more commonly in patients with incomplete MRI response versus complete (58 vs. 43 %) (p = 0.0003). On multivariate analysis, positive estrogen receptor status (p = 0.02), incomplete MRI response (p = 0.0003), higher baseline T classification (p < 0.0001), younger age (p < 0.0006), and institution (p = 0.003) were independent predictors of mastectomy. A statistically significant trend toward increasing use of mastectomy with increasing T stage at presentation (p < 0.0001) was observed in patients with incomplete response by MRI only. Among women with complete response on MRI, 43 % underwent mastectomy.

Conclusions

Within a multi-institutional cohort of women undergoing neoadjuvant treatment for breast cancer, MRI findings were not clearly associated with extent of surgery. This study shows that receptor status, T stage at diagnosis, young age, and treating institution are more significant determinants of surgical treatment choice than MRI response data.

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Acknowledgments

We are grateful to all of the patients who were included in this study and to the Translational Breast Cancer Research Consortium investigators and data managers for their efforts. We are very appreciative of funding support from the Translational Breast Cancer Research Consortium from the AVON Foundation, the Breast Cancer Research Foundation, and Susan G. Komen for the Cure. We gratefully acknowledge the American College of Radiology Imaging Network (ACRIN) for granting permission to include patients who were treated on the ACRIN 6657/I-SPY Trial (supported by National Cancer Institute grants U01 CA079778 and U01 CA080098).

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, Magee-Womens Hospital, University of Pittsburgh, Pittsburgh, PA, USA

    Kandace P. McGuire MD

  2. Department of Surgery, Duke University, Durham, NC, USA

    E. Shelley Hwang MD

  3. Division of Biostatistics/Preventive Medicine, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL, USA

    Alan Cantor PhD

  4. Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Mehra Golshan MD

  5. Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA

    Funda Meric-Bernstam MD

  6. Department of Radiation Oncology, Duke University, Durham, NC, USA

    Janet K. Horton MD

  7. Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA

    Rita Nanda MD

  8. Department of Surgery, University of North Carolina, Chapel Hill, NC, USA

    Keith D. Amos MD

  9. Division of Hematology/Clinical Oncology, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL, USA

    Andres Forero MD

  10. Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Cliff A. Hudis MD

  11. Department of Surgical Oncology, The Vanderbilt Breast Center, Vanderbilt Ingram Cancer Center, Nashville, TN, USA

    Ingrid Meszoely MD

  12. Department of Radiation Oncology, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL, USA

    Jennifer F. De Los Santos MD

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  1. Kandace P. McGuire MD
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  2. E. Shelley Hwang MD
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  3. Alan Cantor PhD
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  4. Mehra Golshan MD
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  5. Funda Meric-Bernstam MD
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  6. Janet K. Horton MD
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  7. Rita Nanda MD
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  8. Keith D. Amos MD
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  9. Andres Forero MD
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  12. Jennifer F. De Los Santos MD
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Corresponding author

Correspondence to Kandace P. McGuire MD.

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On behalf of Translational Breast Cancer Research Consortium.

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McGuire, K.P., Hwang, E.S., Cantor, A. et al. Surgical Patterns of Care in Patients with Invasive Breast Cancer Treated with Neoadjuvant Systemic Therapy and Breast Magnetic Resonance Imaging: Results of a Secondary Analysis of TBCRC 017. Ann Surg Oncol 22, 75–81 (2015). https://doi.org/10.1245/s10434-014-3948-3

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  • DOI: https://doi.org/10.1245/s10434-014-3948-3

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