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Preoperative breast MRI in early-stage breast cancer

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Abstract

Rapid uptake of new imaging technology is a major contributor to rising healthcare costs. Preoperative breast magnetic resonance imaging (MRI) for patients with early-stage breast cancer has dramatically increased in use without the evidence of improved outcomes compared to standard assessment and is associated with higher rates of mastectomy. A decision analytic model was developed to evaluate the impact of adding breast MRI to the preoperative evaluation of women with early-stage breast cancer who were candidates for breast-conserving therapy on patient outcomes measured in quality-adjusted life years (QALYs). Model inputs, including survival, recurrence rates, and health utilities, were obtained from a comprehensive literature review. One-way sensitivity analyses were performed to estimate threshold values for key parameters at which adding MRI would become the optimal imaging strategy over standard assessment. Preoperative MRI resulted in 17.77 QALYs compared to 17.86 QALYs with standard assessment, a decrease of 0.09 QALYs or 34 days. In sensitivity analyses, standard assessment was associated with better patient outcomes than preoperative breast MRI across all plausible probabilities for mastectomy, local recurrence, and health utilities. For routine preoperative breast MRI to become the optimal strategy, the conversion rate to mastectomy after preoperative MRI would need to be <1 % (versus the range of 3.6–33 % reported in the literature). Routine preoperative breast MRI appears to confer no advantage over the standard diagnostic evaluations for early-stage breast cancer and may lead to worse patient outcomes.

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References

  1. Hackbarth GM (2009) Report to the Congress: medicare payment policy. Medicare Advisory Payment Commission, Washington, DC. http://www.medpac.gov/documents/Mar09_EntireReport.pdf. Accessed 19 Mar 2011

  2. Baker LC, Atlas SW, Afendulis CC (2008) Expanded use of imaging technology and the challenge of measure value. Health Aff (Millwood) 27:1467–1478

    Article  Google Scholar 

  3. Dinan MA, Curtis LH, Hammill BG et al (2010) Changes in the use and costs of diagnostic imaging among Medicare beneficiaries with cancer, 1996–2006. JAMA 303:1625–1631

    Article  PubMed  CAS  Google Scholar 

  4. Houssami N, Hayes DF (2009) Review of preoperative magnetic resonance imaging (MRI) in breast cancer: should MRI be performed on all women with newly diagnosed, early stage breast cancer? CA Cancer J Clin 59:290–302

    Article  PubMed  Google Scholar 

  5. Bilimoria KY, Cambic A, Hansen NM et al (2007) Evaluating the impact of preoperative breast magnetic imaging on the surgical management of newly diagnosed breast cancers. Arch Surg 142:441–445

    Article  PubMed  Google Scholar 

  6. Deurloo EE, Peterse JL, Rutgers EJ et al (2005) 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 41:1393–1401

    Article  PubMed  Google Scholar 

  7. Berg WA, Gutierrez L, NessAiver MS et al (2004) Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology 233:830–849

    Article  PubMed  Google Scholar 

  8. Bagley FH (2004) The role of magnetic resonance imaging mammography in the surgical management of the index breast cancer. Arch Surg 139:380–383

    Article  PubMed  Google Scholar 

  9. Zhang Y, Fukatsu H, Naganawa S et al (2002) The role of contrast-enhanced MR mammography for determining candidates for breast conservation surgery. Breast Cancer 9:231–239

    Article  PubMed  Google Scholar 

  10. Tan JE, Orel SG, Schnall MD et al (1999) Role of magnetic resonance imaging and magnetic resonance imaging-guided surgery in the evaluation of patients with early-stage breast cancer for breast conservation. Am J Clin Oncol 22:414–418

    Article  PubMed  CAS  Google Scholar 

  11. Hollingsworth AB, Stough RG (2006) Preoperative breast MRI for locoregional staging. J Okla Stage Med Assoc 99:505–515

    Google Scholar 

  12. Schelfout K, Van Goethem M, Kersschot E et al (2004) Contrast-enhanced MR imaging of breast lesions and effect on treatment. Eur J Surg Oncol 30:501–507

    Article  PubMed  CAS  Google Scholar 

  13. Bedrosian I, Mick R, Orel SG et al (2003) Changes in the surgical management of patients with breast carcinoma based on preoperative magnetic resonance imaging. Cancer 98:468–473

    Article  PubMed  Google Scholar 

  14. Hlawatsch A, Teifke A, Schmidt M et al (2002) Preoperative assessment of breast cancer: sonography versus MR imaging. AJR Am J Roentgenol 179:1493–1501

    PubMed  Google Scholar 

  15. Fischer U, Kopka L, Grabbe E (1999) Breast carcinoma: effect of preoperative contrast-enhanced MR imaging on the therapeutic approach. Radiology 213:881–888

    PubMed  CAS  Google Scholar 

  16. Orel SG, Schnall MD, Powell CM et al (1995) Staging of suspected breast cancer: effect o MR imaging and MR-guided biopsy. Radiology 196:115–122

    PubMed  CAS  Google Scholar 

  17. Katipamula R, Degnim AC, Hoskin T et al (2009) Trends in mastectomy rates at the Mayo Clinic Rochester: effect of surgical year and preoperative magnetic resonance imaging. J Clin Oncol 27:4082–4088

    Article  PubMed  Google Scholar 

  18. Hede K (2009) Preoperative MRI in breast cancer grows contentious. J Natl Cancer Inst 10:1667–1669

    Article  Google Scholar 

  19. Center for Evaluation of Value and Risk in Health (2010) The cost-effectiveness analysis registry. Institute for Clinical Research Health Policy Studies, Tufts Medical Center, Boston. www.cearegistry.org. Accessed 8 June 2010

  20. Turnbull LW, Brown SR, Olivier C et al (2010) Multicenter randomised controlled trial examining the cost-effectiveness of contrast-enhanced high field magnetic resonance imaging in women with primary breast cancer scheduled for wide local excision (COMICE). Health Technol Assess 14:1–182

    PubMed  CAS  Google Scholar 

  21. Turnbull LW, Brown SR, Harvey I et al (2010) Comparative effectiveness of MRI in breast cancer (COMICE) trial: a randomised controlled trial. Lancet 375:563–571

    Article  PubMed  Google Scholar 

  22. Veronesi U, Cascinelli N, Mariani L et al (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347:1227–1232

    Article  PubMed  Google Scholar 

  23. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomized trials. Lancet 366:2087–2106

    Google Scholar 

  24. Dowsett M, Cuzick J, Ingle J et al (2010) Meta-analysis of breast cancer outcomes in adjuvant trials of aromatase inhibitors versus tamoxifen. J Clin Oncol 28:509–518

    Article  PubMed  CAS  Google Scholar 

  25. Norum J, Olsen JA, Wist EA (1997) Lumpectomy or mastectomy? Is breast conserving surgery too expensive? Breast Cancer Res Treat 45:7–14

    Article  PubMed  CAS  Google Scholar 

  26. Hayman JA, Harris JR, Hillner BE et al (1998) Cost-effectiveness of routine radiation therapy following conservative surgery for early-stage breast cancer. J Clin Oncol 16:1022–1029

    PubMed  CAS  Google Scholar 

  27. de Koning HJ, Collette HJ, de Haes JC et al (1991) Breast cancer screening and cost-effectiveness; policy alternatives, quality of life considerations and the possible impact of uncertain factors. Int J Cancer 49:531–537

    Article  PubMed  Google Scholar 

  28. Hayman JA, Hillner BE, Haris JR et al (2000) Cost-effectiveness of adding an electron-beam boost to tangential radiation therapy in patients with negative margins after conservative surgery for early-stage breast cancer. J Clin Oncol 18:287–295

    PubMed  CAS  Google Scholar 

  29. Suh WW, Hillner BE, Pierce LJ et al (2005) Cost-effectiveness of radiation therapy following conservative surgery for ductal carcinoma in situ of the breast. Int J Radiat Oncol Biol Phys 61:1054–1061

    Article  PubMed  Google Scholar 

  30. Holland ML, Huston A, Noyes K (2009) Cost-effectiveness of testing for breast cancer susceptibility genes. Value Health 12:207–216

    Article  PubMed  Google Scholar 

  31. Lee JH, Glick HA, Hayman JA et al (2002) Decision-analytic model and cost-effectiveness of evaluation of postmastectomy radiation therapy in high-risk premenopausal breast cancer patients. J Clin Oncol 20:2713–2725

    Article  PubMed  Google Scholar 

  32. Tengs TO (2000) The cost effectiveness of testing for the BRCA1 and BRCA2 breast-ovarian cancer susceptibility genes. Dis Manag Clin Outcomes 1:15–24

    Google Scholar 

  33. Sher DJ, Wittenberg E, Suh WW et al (2009) Partial-breast irradiation versus whole-breast irradiation for early-stage breast cancer: a cost-effectiveness analysis. Int J Radiat Oncol Biol Phys 74:440–446

    Article  PubMed  Google Scholar 

  34. Lehman CD, Gatsonis C, Kuhl CK et al (2007) MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med 356:1295–1303

    Article  PubMed  CAS  Google Scholar 

  35. Bleicher RJ, Ciocca RM, Egleston BL et al (2009) Association of routine pretreatment magnetic resonance imaging with time to surgery, mastectomy rate, and margin status. J Am Coll Surg 209:180–187

    Article  PubMed  Google Scholar 

  36. Lohrisch C, Paltiel C, Gelmon K et al (2006) Impact on survival of time from definitive surgery to initiation of adjuvant chemotherapy for early-stage. J Clin Oncol 24:4888–4894

    Article  PubMed  Google Scholar 

  37. OM (Institute of Medicine) (2009) Initial national priorities for comparative effectiveness research. The National Academies Press, Washington, DC

    Google Scholar 

  38. Bartelink H, Horiot JC, Poortmans P et al (2001) Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Engl J Med 345:1378–1387

    Article  PubMed  CAS  Google Scholar 

  39. Baer A, Bechar N, Coehn G et al (2010) Basic steps to building a research program. J Oncol Pract 6:45–47

    Article  PubMed  Google Scholar 

  40. Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357:2277–2284

    Article  PubMed  CAS  Google Scholar 

  41. Bailey SR (2001) Past and present attempts to prevent radiocontrast nephropathy. Rev Cardiovasc Med 2(supp 1):S14–S18

    PubMed  Google Scholar 

  42. Fisher B, Anderson S, Bryant J et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Cedars Sinai Medical Center, 8700 Beverly Blvd Suite 5512, Los Angeles, CA, 90048, USA

    Patricia Young

  2. VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA

    Patricia Young & Jennifer L. Malin

  3. Division of Hematology/Oncology, Department of Medicine, UCSF School of Medicine, San Francisco, CA, USA

    Benjamin Kim

  4. RAND Corporation, Santa Monica, CA, USA

    Benjamin Kim & Jennifer L. Malin

  5. Jonsson Comprehensive Cancer Center and David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Jennifer L. Malin

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  1. Patricia Young
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  2. Benjamin Kim
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Correspondence to Patricia Young.

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Young, P., Kim, B. & Malin, J.L. Preoperative breast MRI in early-stage breast cancer. Breast Cancer Res Treat 135, 907–912 (2012). https://doi.org/10.1007/s10549-012-2207-1

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  • DOI: https://doi.org/10.1007/s10549-012-2207-1

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