Screening and diagnostic breast MRI: how do they impact surgical treatment? Insights from the MIPA study

Andrea Cozzi, Giovanni Di Leo, Nehmat Houssami, Fiona J. Gilbert, Thomas H. Helbich, Marina Álvarez Benito, Corinne Balleyguier, Massimo Bazzocchi, Peter Bult, Massimo Calabrese, Julia Camps Herrero, Francesco Cartia, Enrico Cassano, Paola Clauser, Marcos F. de Lima Docema, Catherine Depretto, Valeria Dominelli, Gábor Forrai, Rossano Girometti, Steven E. HarmsSarah Hilborne, Raffaele Ienzi, Marc B.I. Lobbes, Claudio Losio, Ritse M. Mann, Stefania Montemezzi, Inge Marie Obdeijn, Umit A. Ozcan, Federica Pediconi, Katja Pinker, Heike Preibsch, José L. Raya Povedano, Carolina Rossi Saccarelli, Daniela Sacchetto, Gianfranco P. Scaperrotta, Margrethe Schlooz, Botond K. Szabó, Donna B. Taylor, Özden S. Ulus, Mireille Van Goethem, Jeroen Veltman, Stefanie Weigel, Evelyn Wenkel, Chiara Zuiani, Francesco Sardanelli*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Objectives: To report mastectomy and reoperation rates in women who had breast MRI for screening (S-MRI subgroup) or diagnostic (D-MRI subgroup) purposes, using multivariable analysis for investigating the role of MRI referral/nonreferral and other covariates in driving surgical outcomes. Methods: The MIPA observational study enrolled women aged 18–80 years with newly diagnosed breast cancer destined to have surgery as the primary treatment, in 27 centres worldwide. Mastectomy and reoperation rates were compared using non-parametric tests and multivariable analysis. Results: A total of 5828 patients entered analysis, 2763 (47.4%) did not undergo MRI (noMRI subgroup) and 3065 underwent MRI (52.6%); of the latter, 2441/3065 (79.7%) underwent MRI with preoperative intent (P-MRI subgroup), 510/3065 (16.6%) D-MRI, and 114/3065 S-MRI (3.7%). The reoperation rate was 10.5% for S-MRI, 8.2% for D-MRI, and 8.5% for P-MRI, while it was 11.7% for noMRI (p ≤ 0.023 for comparisons with D-MRI and P-MRI). The overall mastectomy rate (first-line mastectomy plus conversions from conserving surgery to mastectomy) was 39.5% for S-MRI, 36.2% for P-MRI, 24.1% for D-MRI, and 18.0% for noMRI. At multivariable analysis, using noMRI as reference, the odds ratios for overall mastectomy were 2.4 (p < 0.001) for S-MRI, 1.0 (p = 0.957) for D-MRI, and 1.9 (p < 0.001) for P-MRI. Conclusions: Patients from the D-MRI subgroup had the lowest overall mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). This analysis offers an insight into how the initial indication for MRI affects the subsequent surgical treatment of breast cancer. Key Points: • Of 3065 breast MRI examinations, 79.7% were performed with preoperative intent (P-MRI), 16.6% were diagnostic (D-MRI), and 3.7% were screening (S-MRI) examinations. • The D-MRI subgroup had the lowest mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). • The S-MRI subgroup had the highest mastectomy rate (39.5%) which aligns with higher-than-average risk in this subgroup, with a reoperation rate (10.5%) not significantly different to that of all other subgroups.

Original languageEnglish
Pages (from-to)6213-6225
Number of pages13
JournalEuropean radiology
Volume33
Issue number9
Early online date3 May 2023
DOIs
Publication statusPublished - Sept 2023
Externally publishedYes

Keywords

  • Breast neoplasms
  • Breast-conserving surgery
  • Magnetic resonance imaging
  • Mastectomy
  • Reoperation

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