Breast MRI increases the number of mastectomies for ductal cancers, but decreases them for lobular cancers

Marc B.I. Lobbes, Ingeborg J.H. Vriens, Annelotte C.M. van Bommel, Grard A.P. Nieuwenhuijzen, Marjolein L. Smidt, Liesbeth J. Boersma, Thijs van Dalen, Carolien Smorenburg, Henk Struikmans, Sabine Siesling, Adri C. Voogd, Vivianne C.G. Tjan-Heijnen

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Abstract

Purpose In this retrospective population-based cohort study, we analyzed breast MRI use and its impact on type of surgery, surgical margin involvement, and the diagnosis of contralateral breast cancer. Methods All Dutch patients with cT1–4N0–3M0 breast cancer diagnosed in 2011–2013 and treated with primary surgery were eligible for inclusion. Using multivariable analyses, we analyzed in different categories whether MRI use was related to surgery type, margin involvement, and diagnosis of contralateral breast cancer (CBC). Results MRI was performed in 10,740 out of 36,050 patients (29.8%). Patients with invasive ductal cancer undergoing MRI were more likely to undergo primary mastectomy than those without MRI (OR 1.30, 95% confidence interval (CI) 1.22–1.39, p < 0.0001). Patients with invasive lobular cancer undergoing MRI were less likely to undergo primary mastectomy than those without MRI (OR 0.86, 95% CI 0.76–0.99, p = 0.0303). A significantly lower risk of positive surgical margins after breast-conserving surgery was only seen in patients with lobular cancer who had undergone MRI as compared to those without MRI (OR 0.59, 95% CI 0.44–0.79, p = 0.0003) and, consequently, a lower risk of secondary mastectomy (OR 0.61, 95% CI 0.42–0.88, p = 0.0088). Patients who underwent MRI were almost four times more likely to be diagnosed with CBC (OR 3.55, 95% CI 3.01–4.17, p < 0.0001). Conclusions Breast MRI use was associated with a reduced number of mastectomies and less positive surgical margins in invasive lobular cancer, but with an increased number of mastectomies in ductal cancers. Breast MRI use was associated with a fourfold higher incidence of CBC.
Original languageEnglish
Pages (from-to)353-364
JournalBreast cancer research and treatment
Volume162
Issue number2
DOIs
Publication statusPublished - 28 Jan 2017

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Mastectomy
Breast
Confidence Intervals
Breast Neoplasms
Neoplasms
Segmental Mastectomy
Cohort Studies
Incidence
Population
Margins of Excision

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Lobbes, M. B. I., Vriens, I. J. H., van Bommel, A. C. M., Nieuwenhuijzen, G. A. P., Smidt, M. L., Boersma, L. J., ... Tjan-Heijnen, V. C. G. (2017). Breast MRI increases the number of mastectomies for ductal cancers, but decreases them for lobular cancers. Breast cancer research and treatment, 162(2), 353-364. https://doi.org/10.1007/s10549-017-4117-8
Lobbes, Marc B.I. ; Vriens, Ingeborg J.H. ; van Bommel, Annelotte C.M. ; Nieuwenhuijzen, Grard A.P. ; Smidt, Marjolein L. ; Boersma, Liesbeth J. ; van Dalen, Thijs ; Smorenburg, Carolien ; Struikmans, Henk ; Siesling, Sabine ; Voogd, Adri C. ; Tjan-Heijnen, Vivianne C.G. / Breast MRI increases the number of mastectomies for ductal cancers, but decreases them for lobular cancers. In: Breast cancer research and treatment. 2017 ; Vol. 162, No. 2. pp. 353-364.
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title = "Breast MRI increases the number of mastectomies for ductal cancers, but decreases them for lobular cancers",
abstract = "Purpose In this retrospective population-based cohort study, we analyzed breast MRI use and its impact on type of surgery, surgical margin involvement, and the diagnosis of contralateral breast cancer. Methods All Dutch patients with cT1–4N0–3M0 breast cancer diagnosed in 2011–2013 and treated with primary surgery were eligible for inclusion. Using multivariable analyses, we analyzed in different categories whether MRI use was related to surgery type, margin involvement, and diagnosis of contralateral breast cancer (CBC). Results MRI was performed in 10,740 out of 36,050 patients (29.8{\%}). Patients with invasive ductal cancer undergoing MRI were more likely to undergo primary mastectomy than those without MRI (OR 1.30, 95{\%} confidence interval (CI) 1.22–1.39, p < 0.0001). Patients with invasive lobular cancer undergoing MRI were less likely to undergo primary mastectomy than those without MRI (OR 0.86, 95{\%} CI 0.76–0.99, p = 0.0303). A significantly lower risk of positive surgical margins after breast-conserving surgery was only seen in patients with lobular cancer who had undergone MRI as compared to those without MRI (OR 0.59, 95{\%} CI 0.44–0.79, p = 0.0003) and, consequently, a lower risk of secondary mastectomy (OR 0.61, 95{\%} CI 0.42–0.88, p = 0.0088). Patients who underwent MRI were almost four times more likely to be diagnosed with CBC (OR 3.55, 95{\%} CI 3.01–4.17, p < 0.0001). Conclusions Breast MRI use was associated with a reduced number of mastectomies and less positive surgical margins in invasive lobular cancer, but with an increased number of mastectomies in ductal cancers. Breast MRI use was associated with a fourfold higher incidence of CBC.",
author = "Lobbes, {Marc B.I.} and Vriens, {Ingeborg J.H.} and {van Bommel}, {Annelotte C.M.} and Nieuwenhuijzen, {Grard A.P.} and Smidt, {Marjolein L.} and Boersma, {Liesbeth J.} and {van Dalen}, Thijs and Carolien Smorenburg and Henk Struikmans and Sabine Siesling and Voogd, {Adri C.} and Tjan-Heijnen, {Vivianne C.G.}",
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Lobbes, MBI, Vriens, IJH, van Bommel, ACM, Nieuwenhuijzen, GAP, Smidt, ML, Boersma, LJ, van Dalen, T, Smorenburg, C, Struikmans, H, Siesling, S, Voogd, AC & Tjan-Heijnen, VCG 2017, 'Breast MRI increases the number of mastectomies for ductal cancers, but decreases them for lobular cancers', Breast cancer research and treatment, vol. 162, no. 2, pp. 353-364. https://doi.org/10.1007/s10549-017-4117-8

Breast MRI increases the number of mastectomies for ductal cancers, but decreases them for lobular cancers. / Lobbes, Marc B.I.; Vriens, Ingeborg J.H.; van Bommel, Annelotte C.M.; Nieuwenhuijzen, Grard A.P.; Smidt, Marjolein L.; Boersma, Liesbeth J.; van Dalen, Thijs; Smorenburg, Carolien; Struikmans, Henk; Siesling, Sabine ; Voogd, Adri C.; Tjan-Heijnen, Vivianne C.G.

In: Breast cancer research and treatment, Vol. 162, No. 2, 28.01.2017, p. 353-364.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Breast MRI increases the number of mastectomies for ductal cancers, but decreases them for lobular cancers

AU - Lobbes, Marc B.I.

AU - Vriens, Ingeborg J.H.

AU - van Bommel, Annelotte C.M.

AU - Nieuwenhuijzen, Grard A.P.

AU - Smidt, Marjolein L.

AU - Boersma, Liesbeth J.

AU - van Dalen, Thijs

AU - Smorenburg, Carolien

AU - Struikmans, Henk

AU - Siesling, Sabine

AU - Voogd, Adri C.

AU - Tjan-Heijnen, Vivianne C.G.

PY - 2017/1/28

Y1 - 2017/1/28

N2 - Purpose In this retrospective population-based cohort study, we analyzed breast MRI use and its impact on type of surgery, surgical margin involvement, and the diagnosis of contralateral breast cancer. Methods All Dutch patients with cT1–4N0–3M0 breast cancer diagnosed in 2011–2013 and treated with primary surgery were eligible for inclusion. Using multivariable analyses, we analyzed in different categories whether MRI use was related to surgery type, margin involvement, and diagnosis of contralateral breast cancer (CBC). Results MRI was performed in 10,740 out of 36,050 patients (29.8%). Patients with invasive ductal cancer undergoing MRI were more likely to undergo primary mastectomy than those without MRI (OR 1.30, 95% confidence interval (CI) 1.22–1.39, p < 0.0001). Patients with invasive lobular cancer undergoing MRI were less likely to undergo primary mastectomy than those without MRI (OR 0.86, 95% CI 0.76–0.99, p = 0.0303). A significantly lower risk of positive surgical margins after breast-conserving surgery was only seen in patients with lobular cancer who had undergone MRI as compared to those without MRI (OR 0.59, 95% CI 0.44–0.79, p = 0.0003) and, consequently, a lower risk of secondary mastectomy (OR 0.61, 95% CI 0.42–0.88, p = 0.0088). Patients who underwent MRI were almost four times more likely to be diagnosed with CBC (OR 3.55, 95% CI 3.01–4.17, p < 0.0001). Conclusions Breast MRI use was associated with a reduced number of mastectomies and less positive surgical margins in invasive lobular cancer, but with an increased number of mastectomies in ductal cancers. Breast MRI use was associated with a fourfold higher incidence of CBC.

AB - Purpose In this retrospective population-based cohort study, we analyzed breast MRI use and its impact on type of surgery, surgical margin involvement, and the diagnosis of contralateral breast cancer. Methods All Dutch patients with cT1–4N0–3M0 breast cancer diagnosed in 2011–2013 and treated with primary surgery were eligible for inclusion. Using multivariable analyses, we analyzed in different categories whether MRI use was related to surgery type, margin involvement, and diagnosis of contralateral breast cancer (CBC). Results MRI was performed in 10,740 out of 36,050 patients (29.8%). Patients with invasive ductal cancer undergoing MRI were more likely to undergo primary mastectomy than those without MRI (OR 1.30, 95% confidence interval (CI) 1.22–1.39, p < 0.0001). Patients with invasive lobular cancer undergoing MRI were less likely to undergo primary mastectomy than those without MRI (OR 0.86, 95% CI 0.76–0.99, p = 0.0303). A significantly lower risk of positive surgical margins after breast-conserving surgery was only seen in patients with lobular cancer who had undergone MRI as compared to those without MRI (OR 0.59, 95% CI 0.44–0.79, p = 0.0003) and, consequently, a lower risk of secondary mastectomy (OR 0.61, 95% CI 0.42–0.88, p = 0.0088). Patients who underwent MRI were almost four times more likely to be diagnosed with CBC (OR 3.55, 95% CI 3.01–4.17, p < 0.0001). Conclusions Breast MRI use was associated with a reduced number of mastectomies and less positive surgical margins in invasive lobular cancer, but with an increased number of mastectomies in ductal cancers. Breast MRI use was associated with a fourfold higher incidence of CBC.

U2 - 10.1007/s10549-017-4117-8

DO - 10.1007/s10549-017-4117-8

M3 - Article

VL - 162

SP - 353

EP - 364

JO - Breast cancer research and treatment

JF - Breast cancer research and treatment

SN - 0167-6806

IS - 2

ER -