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A Multi-institutional Analysis of Factors Influencing the Rate of Positive MRI Biopsy Among Women with Early-Stage Breast Cancer

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

Abstract

Background

The use of preoperative magnetic resonance imaging (MRI) for early-stage breast cancer (ESBC) is increasing, but its utility in detecting additional malignancy is unclear and delays surgical management (Jatoi and Benson in Future Oncol 9:347–353, 2013. https://doi.org/10.2217/fon.12.186, Bleicher et al. J Am Coll Surg 209:180–187, 2009. https://doi.org/10.1016/j.jamcollsurg.2009.04.010, Borowsky et al. J Surg Res 280:114–122, 2022. https://doi.org/10.1016/j.jss.2022.06.066). The present study sought to identify ESBC patients most likely to benefit from preoperative MRI by assessing the positive predictive values (PPVs) of ipsilateral and contralateral biopsies.

Methods

A retrospective cohort study included patients with cTis-T2N0-N1 breast cancer from two institutions during 2016–2021. A “positive” biopsy result was defined as additional cancer (PositiveCancer) or cancer with histology often excised (PositiveSurg). The PPV of MRI biopsies was calculated with respect to age, family history, breast density, and histology. Uni- and multivariate logistic regression determined whether combinations of age younger than 50 years, dense breasts, family history, and pure ductal carcinoma in situ (DCIS) histology led to higher biopsy yield.

Results

Of the included patients, 447 received preoperative MRI and 131 underwent 149 MRI-guided biopsies (96 ipsilateral, 53 contralateral [18 bilateral]). PositiveCancer for ipsilateral biopsy was 54.2%, and PositiveCancer for contralateral biopsy was 17.0%. PositiveSurg for ipsilateral biopsy was 62.5%, and PositiveSurg for contralateral biopsy was 24.5%. Among the contralateral MRI biopsies, patients younger than 50 years were less likely to have PositiveSurg (odds ratio, 0.02; 95% confidence interval, 0.00–0.84; p = 0.041). The combinations of age, density, family history, and histology did not lead to a higher biopsy yield.

Conclusion

Historically accepted factors for recommending preoperative MRI did not appear to confer a higher MRI biopsy yield. To prevent delays to surgical management, MRI should be carefully selected for individual patients most likely to benefit from additional imaging.

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Authors and Affiliations

  1. Division of Surgical Oncology, Dewitt Daughtry Department of Surgery, University of Miami, Miami, FL, USA

    Seraphina Choi BA, Peter A. Borowsky MD, Orly Morgan BA, Gareth Gilna MD, Susan Kesmodel MD, Neha Goel MD & Kristin E. Rojas MD

  2. Division of Biostatistics, Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA

    Deukwoo Kwon PhD, Wei Zhao MD & Tulay Koru-Sengul PhD

  3. Division of Breast Imaging, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA

    Jose Net MD

  4. Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA

    Susan Kesmodel MD, Neha Goel MD & Kristin E. Rojas MD

  5. Wright Center for Graduate Medical Education, Scranton, PA, USA

    Yamini Patel MD

  6. Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA

    Alexa Griffiths MD, Joshua A. Feinberg MD, Aeryn Kangas-Dick MD, Charusheela Andaz MD, Donna-Marie Manasseh MD & Patrick Borgen MD

  7. Department of Radiology, Maimonides Medical Center, Brooklyn, NY, USA

    Christina Giuliano MD & Natalie Zelenko MD

Authors
  1. Seraphina Choi BA
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  2. Peter A. Borowsky MD
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Corresponding author

Correspondence to Kristin E. Rojas MD.

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Disclosure

Dr. Kristin Rojas received speaker’s honoraria from Pacira Pharmaceuticals, served on the advisory board for Merck, and was a consultant for Roche Diagnostic Solutions. Dr. Patrick Borgen received honoraria from Pacira Pharmaceuticals. The remaining authors had no conflicts of interest.

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Choi, S., Borowsky, P.A., Morgan, O. et al. A Multi-institutional Analysis of Factors Influencing the Rate of Positive MRI Biopsy Among Women with Early-Stage Breast Cancer. Ann Surg Oncol 31, 3141–3153 (2024). https://doi.org/10.1245/s10434-024-14954-1

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