Routine Pre-Treatment MRI for Breast Cancer in a Single-Payer Medical Center: Effects on Surgical Choices, Timing and...

Area of Science:

• Oncology
• Radiology
• Surgical Oncology

Background:

• Pre-operative magnetic resonance imaging (MRI) is increasingly utilized for breast cancer evaluation.
• The benefits and risks of routine pre-operative MRI remain a subject of ongoing debate.
• Standardized protocols for pre-operative MRI have been implemented at some institutions.

Purpose of the Study:

• To compare surgical choices, timing, and outcomes in breast cancer patients before and after the institution of a standardized pre-operative MRI protocol.
• To examine the impact of pre-operative MRI on initial surgical decisions, including mastectomy rates.
• To assess the effect of pre-operative MRI on the need for re-excision and time to definitive surgical management.

Main Methods:

• Retrospective review of a prospectively collected database of invasive breast cancer patients (2007-2012).
• Comparison of a control group (no MRI) with an MRI group (standardized pre-operative MRI protocol).
• Analysis of surgical choices, re-excision rates, surgical timing, and correlation between MRI findings and final pathology.

Main Results:

• The MRI group showed a significantly higher rate of initial mastectomy compared to the control group (47.1% vs 21.1%).
• The MRI group had a lower re-excision rate (15.2% vs 28.9%).
• Time to initial surgery was similar, but time to margin-negative surgery was slightly shorter in the MRI group.

Conclusions:

• Routine pre-treatment MRI in breast cancer patients is associated with increased mastectomy rates but reduced re-excision rates.
• Pre-operative MRI does not delay initial surgical therapy and may expedite margin-negative surgical management.
• Patient preference significantly influences mastectomy decisions after MRI, with MRI findings being a factor in 26% of cases, and these findings are largely pathologically confirmed.