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Breast. 2014 Aug;23(4):341-5. doi: 10.1016/j.breast.2014.01.005. Epub 2014 Feb 14.

Evaluation of expert criteria for preoperative magnetic resonance imaging of newly diagnosed breast cancer.

Author information

1
Biostatistics, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA. Electronic address: cbehrendt@coh.org.
2
Diagnostic Radiology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA.
3
General Surgery, University of California San Francisco, Fresno Campus/Community Regional Medical Center, 2823 Fresno St., Fresno, CA 93721, USA.
4
Surgical Oncology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA.
5
Surgical Oncology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA. Electronic address: jyim@coh.org.

Abstract

Despite 2 randomized trials reporting no reduction in operations or local recurrence at 1 year, preoperative magnetic resonance imaging (MRI) is increasingly used in diagnostic workup of breast cancer. We evaluated 5 utilization criteria recently proposed by experts. Of women (n = 340) newly diagnosed with unilateral breast cancer who underwent bilateral MRI, most (69.4%) met at least 1 criterion before MRI: mammographic density (44.4%), under consideration for partial breast irradiation (PBI) (19.7%), genetic-familial risk (12.9%), invasive lobular carcinoma (11.8%), and multifocal/multicentric disease (10.6%). MRI detected occult malignant lesion or extension of index lesion in 21.2% of index, 3.3% of contralateral, breasts. No expert criterion was associated with MRI-detected malignant lesion, which associated instead with pre-MRI plan of lumpectomy without PBI (48.2% of subjects): Odds Ratio 3.05, 95% CI 1.57-5.91 (p adjusted for multiple hypothesis testing = 0.007, adjusted for index-vs-contralateral breast and covariates). The expert guidelines were not confirmed by clinical evidence.

KEYWORDS:

Background parenchymal enhancement; Breast cancer; Hormone replacement; Magnetic resonance imaging; Mammographic density; Partial breast irradiation; Practice guidelines; Preoperative screening; Smoking

PMID:
24530008
PMCID:
PMC4074599
DOI:
10.1016/j.breast.2014.01.005
[Indexed for MEDLINE]
Free PMC Article

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