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Preoperative MRI of the Breast (POMB) Influences Primary Treatment in Breast Cancer: A Prospective, Randomized, Multicenter Study

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Abstract

Background

Breast magnetic resonance imaging (MRI) has shown high sensitivity in determining tumor extent, multifocality, and occult contralateral breast cancer. Low specificity, unnecessary mastectomies, and costs are arguments against MRI. The purpose of this study was to determine whether preoperative breast MRI would affect primary surgical management, reduce reexcision/reoperation procedures, and influence the choice of neoadjuvant treatment in patients with newly diagnosed breast cancer.

Methods

This prospective, randomized, multicenter study included 440 breast cancer patients younger than aged 56 years from three, Swedish, large-volume breast units. Patients were randomly allocated on a 1:1 basis to either preoperative staging with breast MRI (n = 220) or no breast MRI (n = 220) (control group). Treatment planning of all patients was discussed at multidisciplinary team conferences.

Results

In patients randomized to the MRI group, who had an observed higher percentage of planned breast-conserving surgery (BCS) compared with the control group, a change from suggested breast conservation to mastectomy occurred in 23 of 153 (15 %) patients. Breast MRI provided additional information in 83 of 220 (38 %) patients, which caused a change in treatment plan in 40 (18 %). The breast reoperation rate was significantly lower in the MRI group: 11 of 220 (5 %) versus 33 of 220 (15 %) in the control group (p < 0.001). The number of mastectomies, axillary reoperations, and the number of patients receiving neoadjuvant chemotherapy after definitive treatment did not differ significantly between the groups.

Conclusions

Preoperative staging with breast MRI in women younger than age 56 years altered the treatment plan in 18 % of the patients. Although a higher MRI-related conversion rate from breast conservation to mastectomy was found, the final numbers of mastectomies did not differ between the two groups. The breast reoperation rate in the MRI group was significantly reduced.

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Acknowledgments

The authors thank the medical staff and surgeons at the breast units for the inclusion of patients. Particular thanks to: Anders Adolfsson, Åsa Aspelin, Jan Frisell, Eva Frodis, Eva Hagel, Henry Letocha, Katrina Thingvall, and Birgitte Wilczek. The work was supported by stipends and Grants from, Capio St Göran´s Hospital Research Foundation, Center for Clinical Research, CKF, Uppsala University, Västerås, Johan & Jakob Söderberg Foundation, King Gustaf V’s Jubilee Foundation, Paula Brunetti Jacovone Foundation, Independent Order of Odd Fellow Stockholm, Percy Falk Foundation, Stockholm County Council, Swedish Surgical Society, The Swedish Breast Cancer Association (BRO), Västmanland County Council

Conflict of interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, Västmanland County Hospital, 721 89, Västerås, Sweden

    Virginia Gonzalez & Staffan Eriksson

  2. Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76, Stockholm, Sweden

    Kerstin Sandelin & Wiveca Åberg

  3. Department of Radiology, Capio St Göran’s Hospital, 112 81, Stockholm, Sweden

    Anders Karlsson

  4. Department of Surgery, Capio St Göran’s Hospital, 112 81, Stockholm, Sweden

    Lars Löfgren

  5. Department of Radiology, Karolinska University Hospital, 171 76, Stockholm, Sweden

    Gabriela Iliescu

  6. Department of Oncology and Pathology, Karolinska Institutet, 171 76, Stockholm, Sweden

    Brita Arver

Authors
  1. Virginia Gonzalez
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  2. Kerstin Sandelin
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  3. Anders Karlsson
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  4. Wiveca Åberg
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  7. Staffan Eriksson
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  8. Brita Arver
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Corresponding author

Correspondence to Virginia Gonzalez.

Appendix

Appendix

See Fig. 2.

Fig. 2
figure 2

Mastectomy at different time points

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Gonzalez, V., Sandelin, K., Karlsson, A. et al. Preoperative MRI of the Breast (POMB) Influences Primary Treatment in Breast Cancer: A Prospective, Randomized, Multicenter Study. World J Surg 38, 1685–1693 (2014). https://doi.org/10.1007/s00268-014-2605-0

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  • DOI: https://doi.org/10.1007/s00268-014-2605-0

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