Skip to main content
SpringerLink
Log in

Impact of Preoperative Breast MRIs on Timing of Surgery and Type of Intervention in Newly Diagnosed Breast Cancer Patients

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

Abstract

Background

We sought to evaluate the effect of preoperative breast magnetic resonance imaging (BMRI) on the wait time to surgery and to what extent it affects the surgical management plan initially considered.

Methods

From April 2007 to April 2009, a total of 147 newly diagnosed breast cancer patients who underwent surgery as initial treatment at Marvelle Koffler Breast Centre at Mount Sinai Hospital, Toronto, Ontario, Canada, met the inclusion criteria and were divided into two groups: those who had BMRI (n = 71) and those who did not (n = 76). Time to surgery was calculated from the day core biopsy result was available to the date surgery was carried out. Time span between initial surgical consult and the day of the surgery day was also calculated. Change was defined as conversion from conservative to radical surgery and/or unilateral to bilateral procedures.

Results

Overall waiting period between histologic diagnosis and treatment was 34.2 days (BMRI group 36.0 days vs. non-BMRI group 32.3 days, P = 0.15); and between date surgical management was propose and date of surgery (BMRI group 24.2 days vs. non-BMRI group 22.5 days, P = 0.38). Additional workup resulted in seven otherwise occult malignant lesions that required change. Ten percent of patients who underwent BMRI had change in surgical management. The mastectomy rate was higher among those with preoperative BMRI (initial 12% vs. final 26%, P = 0.8), but this was not statistically significant.

Conclusions

Preoperative BMRI did not delay surgical treatment or correlate with a higher rate of radical treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Dummin LJ, Cox M, Plant L. Prediction of breast tumor size by mammography and sonography—a breast screen experience. Breast. 2007;16:38–46.

    Article  CAS  PubMed  Google Scholar 

  2. Heusinger K, Lohberg C, Lux MP, et al. Assessment of breast cancer tumor size depends on method, histopathology and tumor size itself. Breast Cancer Res Treat. 2005;94:17–23.

    Article  CAS  PubMed  Google Scholar 

  3. Lagios MD, Westdahl PR, Rose MR. The concept and implications of multicentricity in breast carcinoma. Pathol annu. 1981;16(Pt 2):83–102.

    CAS  PubMed  Google Scholar 

  4. Holland R, Veling SHJ, Mravunc M, et al. Histologic multifocality of Tis, T1–2 breast carcinomas: implications for clinical trials of breast-conserving surgery. Cancer. 1985:56:979–90.

    Article  CAS  PubMed  Google Scholar 

  5. Vaidya JS, Vyas JJ, Chinoy RF, et al. Multicentricity of breast cancer: whole-organ analysis and clinical implications. Br J Cancer. 1996;74:820–4.

    CAS  PubMed  Google Scholar 

  6. Kurtz JM, Jacquemier J, Amatric R, et al. Breast conserving therapy for macroscopically multiple cancer. Ann Surg. 1990;212:38–44.

    Article  CAS  PubMed  Google Scholar 

  7. Wilson LD, Beinfield M, McKhan CF, et al. Conservative surgery and radiation in treatment of synchronous ipsilateral breast cancers. Cancer. 1993 72:137–42.

    Article  CAS  PubMed  Google Scholar 

  8. Esserman L, Hylton N, Yassa L, et al. Utility of magnetic resonance imaging in the management of breast cancer: evidence for improved preoperative staging. J Clin Oncol. 1999;17:110–9.

    CAS  PubMed  Google Scholar 

  9. Fischer U, Zachariae O, Baum F, et al. The influence of preoperative MRI of the breasts on recurrence rate in patients with breast cancer. Eur Radiol. 2004;14:1725–31.

    PubMed  Google Scholar 

  10. Sardanelli F, Giuseppetti GM, Panizza P, et al. Sensitivity of MRI versus mammography for detecting foci of multifocal, multicentric breast cancer in fatty and dense breasts using the wholebreast pathologic examination as a gold standard. AJR Am J Roentgenol. 2004;183:1149–57.

    PubMed  Google Scholar 

  11. Deurloo E, Deterse JL, Rutgers E, et al. Additional breast lesions in patients eligible for breast-conserving therapy by MRI: impact on preoperative management and potential benefit of computerized analysis. Eur J Cancer. 2005;41:1393–401.

    Article  PubMed  Google Scholar 

  12. Fischer U, Baum F, Luftner-Nagel S. Preoperative MR imaging in patients with breast cancer: preoperative staging, effects on recurrence rates, and outcome analysis. Magn Reson Imaging Clin N Am. 2006;14:351–62.

    Article  PubMed  Google Scholar 

  13. Lehman CD, Gatsonis C, Kuhl CK, et al. MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med. 2007;356:1295–303.

    Article  CAS  PubMed  Google Scholar 

  14. Van Goethem M, Schelfout K, Dijckmans L, et al. MR mammography in the pre-operative staging of breast cancer in patients with dense breast tissue: comparison with mammography and ultrasound. Eur Radiol. 2004;14:809–16.

    Article  PubMed  Google Scholar 

  15. Tozaki M, Fukuma E, Kawano N, et al. Bilateral breast MR imaging: is it superior to conventional methods for the detection of contralateral breast cancer? Breast Cancer. 2008;15:169–74.

    Article  PubMed  Google Scholar 

  16. Houssami N, Ciatto S, Macaskill P, et al. Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol. 2008;26:3248–58.

    Article  PubMed  Google Scholar 

  17. Liberman L, Morris EA, Kim CM, et al. MR imaging findings in the contralateral breast of women with recently diagnosed breast cancer. AJR Am J Roentgenl. 2003;180:333–41.

    Google Scholar 

  18. Lee SG, Orel SG, Woo IJ, et al. MR imaging screening of the contralateral breast in patients with newly diagnosed breast cancer: preliminary results. Radiology. 2003;226:773–8.

    Article  PubMed  Google Scholar 

  19. ACR practice guideline for the performance of contrast-enhanced magnetic resonance imaging (MRI) of the breast. 2002, amended 2006, revised 2008 (Res 19), pp 561–7. Available at: http://www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/dx/head-neck/mr_spectroscopy.aspx. Accessed August 17, 2009.

  20. Bevers TB, Anderson BO, Bonaccio E, et al. NCCN clinical practice guidelines in oncology: breast cancer screening and diagnosis. J Natl Compr Canc Netw. 2009;7:1060–96.

    PubMed  Google Scholar 

  21. Bleicher RJ, Ciocca RM, Egleston BL, et al. Association of routine pretreatment magnetic resonance imaging with time to surgery, mastectomy rate, and margin status. J Am Coll Surg. 2009;209:180–7.

    Article  PubMed  Google Scholar 

  22. Ontario Ministry of Health and Long-Term Care. About wait times data. Available at: http://www.health.gov.on.ca/transformation/wait_times/providers/wt_data.html#1. Accessed August 17, 2009.

  23. Canadian Society for Surgical Oncology. CSSO position statement. 2009. Available at: http://www.cos.ca/csso/. Accessed August 17, 2009.

  24. Lehman CD, DeMartini W, Anderson BO, et al. Indications for breast MRI in the patient with newly diagnosed breast cancer. J Natl Compr Canc Netw. 2009;792:193–201.

    Google Scholar 

  25. Kuhl CK, Bieling HB, Gieseke J, et al. Healthy premenopausal breast parenchyma in dynamic contrastenhanced MR imaging of the breast: normal contrast medium enhancement and cyclical-phase dependency. Radiology. 1997;203:137–44.

    CAS  PubMed  Google Scholar 

  26. Muller-Schimpfle M, Ohmenhauser K, Stoll P, et al. Menstrual cycle and age: influence on parenchymal contrast medium enhancement in MR imaging of the breast. Radiology. 1997;203:145–9.

    CAS  PubMed  Google Scholar 

  27. Bedrosian I, Mick R, Orel SG, et al. Changes in the surgical management of patients with breast carcinoma based on preoperative magnetic resonance imaging. Cancer. 2003;98:468–73.

    Article  PubMed  Google Scholar 

  28. Sardanelli F. Overview of the role of pre-operative breast MRI in the absence of evidence on patient outcomes. Breast. 2010 Feb;19:3–6.

    Article  PubMed  Google Scholar 

  29. Krishnan M, Thorsteinsson D, Horowitz N, et al. The influence of preoperative MRI in the timing and type of therapy in women newly diagnosed with breast cancer. AJR Am J Roentgenol. 2008;190:A31–4.

    Google Scholar 

  30. Ontario Ministry of Health and Long-Term Care. MRI and CT expert panel phase I report. 2005. Available at: http://www.health.gov.on.ca/transformation/wait_times/providers/reports/mri_ct.pdf. Accessed August 17, 2009.

  31. Richards MA, Westcombe AM, Love SB, et al. Influence of delay on survival in patients with breast cancer: a systematic review. Lancet. 1999;353:1119–26.

    Article  CAS  PubMed  Google Scholar 

  32. Colbert K. The longer the delay, the greater the anxiety. Delay in treatment for breast cancer. Prof Nurse. 1994;9:517–20.

    CAS  PubMed  Google Scholar 

  33. Hollingsworth AB, Stough RG. Preoperative breast MRI for locoregional staging. J Okla State Med Assoc. 2006;99:505–15.

    PubMed  Google Scholar 

  34. Schnall MD, Blume J, Bluemke DA, et al. MRI detection of distinct incidental cancer in women with primary breast cancer studied in IBMC 6883. J Surg Oncol. 2005;92:32–8.

    Article  PubMed  Google Scholar 

  35. Fischer U, Kopka L, Grabbe E. Breast carcinoma: effect of preoperative contrast-enhanced MR imaging on the therapeutic approach. Radiology. 1999;213:881–8.

    CAS  PubMed  Google Scholar 

  36. Lehman CD, Blume JD, Thickman D, et al. Added cancer yield of MRI in screening the contralateral breast of women recently diagnosed with breast cancer: results from the International Breast Magnetic Resonance Consortium (IBMC) trial. J Surg Oncol. 2005;92:9–15.

    Article  PubMed  Google Scholar 

  37. Morrow M. Magnetic resonance imaging in the preoperative evaluation of breast cancer: primum non nocere. J Am Coll Surg. 2004;198:240–1.

    Article  PubMed  Google Scholar 

  38. Turnbull L, Brown S, Harvey I, et al. Comparative Effectiveness of MRI in Breast Cancer (COMICE) trial: a randomised controlled trial. Lancet. 2010;375:528–30.

    Article  Google Scholar 

  39. Clemons M, Danson S, Hamilton T, et al. Locoregionally recurrent breast cancer: incidence, risk factors and survival. Cancer Treat Rev. 2001;27:67–82.

    Article  CAS  PubMed  Google Scholar 

  40. Punglia R, Morrow M, Winer E, et al. Local therapy and survival in breast cancer. N Engl J Med. 2007;356:2399–405.

    Article  CAS  PubMed  Google Scholar 

  41. Liberman L, Morris EA, Dershaw DD, et al. MR imaging of the ipsilateral breast in women with percutaneously proven breast cancer. AJR Am J Roentgenol. 2003;180:901–10.

    PubMed  Google Scholar 

  42. Lim HI, Choi JH, Yan JH, et al. Does pre-operative breast magnetic resonance imaging in addition to mammography and breast ultrasonography change the operative management of breast carcinoma? Breast Cancer Res Treat. 2010;119:163–7.

    Article  PubMed  Google Scholar 

  43. Bilimoria KY, Cambic A, Hansen NM, et al. Evaluating the impact of preoperative breast magnetic resonance imaging on the surgical management of newly diagnosed breast cancers. Arch Surg. 2007;142:441–5.

    Article  PubMed  Google Scholar 

  44. Berg WA, Gutierrez L, NessAiver MS, et al. Diagnostic accuracy of mammography, linical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology. 2004;233:830–49.

    Article  PubMed  Google Scholar 

  45. Bagley FH. The role of magnetic resonance imaging mammography in the surgical management of the index breast cancer. Arch Surg. 2004;139:380–3.

    Article  PubMed  Google Scholar 

  46. Zhang Y, Fukatsu H, Naganawa S, et al. The role of contrast-enhanced MR mammography for determining candidates for breast conservation surgery. Breast Cancer. 2002;9:231–9.

    Article  PubMed  Google Scholar 

  47. Orel SG, Schnall MD, Powell CM, et al. Staging of suspected breast cancer: effect of MR imaging and MR-guided biopsy. Radiology. 1995;196:115–22.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgment

We thank Alvaro J. Ruiz, MD, MSc, FACP, Department of Epidemiology, Pontificia Universidad Javeriana, Bogota, Colombia, for help with revision and editing.

Conflict of Interest

None.

Author information

Authors and Affiliations

  1. Division of Experimental Therapeutics, Toronto General Research Institute, Toronto, ON, Canada

    Fernando A. Angarita MD

  2. Peter A. Silverman Centre for International Health, Mount Sinai Hospital, Toronto, ON, Canada

    Sergio A. Acuna MD

  3. Department of Surgical Oncology, Princess Margaret Hospital, Toronto, ON, Canada

    Adriana Fonseca MD

  4. Department of Medical Imaging, Mount Sinai Hospital, Toronto, ON, Canada

    Pavel Crystal MD

  5. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Jaime Escallon MD, FRCS(C), FACS

Authors
  1. Fernando A. Angarita MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sergio A. Acuna MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Adriana Fonseca MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pavel Crystal MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jaime Escallon MD, FRCS(C), FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jaime Escallon MD, FRCS(C), FACS.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Angarita, F.A., Acuna, S.A., Fonseca, A. et al. Impact of Preoperative Breast MRIs on Timing of Surgery and Type of Intervention in Newly Diagnosed Breast Cancer Patients. Ann Surg Oncol 17 (Suppl 3), 273–279 (2010). https://doi.org/10.1245/s10434-010-1239-1

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-010-1239-1

Keywords

Search

Navigation