Comparison of Clinical Breast Exam to Breast MRI Surveillance in Patients Following Nipple-Sparing Mastectomy

Area of Science:

• Oncology
• Breast Surgery
• Radiology

Background:

• Nipple sparing mastectomy (NSM) is increasingly utilized for breast cancer treatment.
• Optimal postoperative surveillance strategies following NSM remain undefined.

Purpose of the Study:

• To compare the efficacy of magnetic resonance imaging (MRI) surveillance versus clinical breast exam (CBE) alone after NSM.
• To evaluate recurrence rates and survival outcomes based on surveillance method.

Main Methods:

• A prospectively maintained database identified patients who underwent NSM between 2007-2021.
• Clinical data on postoperative surveillance and interventions were collected.
• Patients were stratified into MRI surveillance or CBE alone groups for comparison.

Main Results:

• Of 399 patients (483 NSMs), 66.4% had CBE alone and 33.6% had MRI surveillance.
• At 33 months median follow-up, 5.0% experienced in-breast recurrence, 1.5% axillary, and 7.0% distant recurrence.
• MRI surveillance led to higher biopsy rates (15.8% vs. 7.8%) but showed no significant difference in local recurrence or overall survival (99%) compared to CBE alone.

Conclusions:

• Screening MRI following NSM increases biopsy rates compared to CBE alone.
• There is no demonstrable difference in overall survival between MRI and CBE surveillance after NSM.