Magnetic resonance imaging before breast cancer surgery: results of an observational multicenter international prospective analysis (MIPA).
Authors
Trimboli, Rubina M
Houssami, Nehmat
Gilbert, Fiona J
Helbich, Thomas H
Álvarez Benito, Marina
Balleyguier, Corinne
Bazzocchi, Massimo
Bult, Peter
Calabrese, Massimo
Camps Herrero, Julia
Cartia, Francesco
Cassano, Enrico
Clauser, Paola
Cozzi, Andrea
de Andrade, Danúbia A
de Lima Docema, Marcos F
Depretto, Catherine
Dominelli, Valeria
Forrai, Gábor
Girometti, Rossano
Harms, Steven E
Hilborne, Sarah
Ienzi, Raffaele
Lobbes, Marc BI
Losio, Claudio
Mann, Ritse M
Montemezzi, Stefania
Obdeijn, Inge-Marie
Ozcan, Umit A
Pediconi, Federica
Pinker, Katja
Preibsch, Heike
Raya Povedano, José L
Sacchetto, Daniela
Scaperrotta, Gianfranco P
Schiaffino, Simone
Schlooz, Margrethe
Szabó, Botond K
Taylor, Donna B
Ulus, Özden S
Van Goethem, Mireille
Veltman, Jeroen
Weigel, Stefanie
Wenkel, Evelyn
Zuiani, Chiara
Di Leo, Giovanni
Publication Date
2022-03Journal Title
Eur Radiol
ISSN
0938-7994
Publisher
Springer Science and Business Media LLC
Volume
32
Issue
3
Pages
1611-1623
Language
en
Type
Article
This Version
VoR
Metadata
Show full item recordCitation
Sardanelli, F., Trimboli, R. M., Houssami, N., Gilbert, F. J., Helbich, T. H., Álvarez Benito, M., Balleyguier, C., et al. (2022). Magnetic resonance imaging before breast cancer surgery: results of an observational multicenter international prospective analysis (MIPA).. Eur Radiol, 32 (3), 1611-1623. https://doi.org/10.1007/s00330-021-08240-x
Description
Funder: Bayer AG
Funder: Università degli Studi di Milano
Abstract
OBJECTIVES: Preoperative breast magnetic resonance imaging (MRI) can inform surgical planning but might cause overtreatment by increasing the mastectomy rate. The Multicenter International Prospective Analysis (MIPA) study investigated this controversial issue. METHODS: This observational study enrolled women aged 18-80 years with biopsy-proven breast cancer, who underwent MRI in addition to conventional imaging (mammography and/or breast ultrasonography) or conventional imaging alone before surgery as routine practice at 27 centers. Exclusion criteria included planned neoadjuvant therapy, pregnancy, personal history of any cancer, and distant metastases. RESULTS: Of 5896 analyzed patients, 2763 (46.9%) had conventional imaging only (noMRI group), and 3133 (53.1%) underwent MRI that was performed for diagnosis, screening, or unknown purposes in 692/3133 women (22.1%), with preoperative intent in 2441/3133 women (77.9%, MRI group). Patients in the MRI group were younger, had denser breasts, more cancers ≥ 20 mm, and a higher rate of invasive lobular histology than patients who underwent conventional imaging alone (p < 0.001 for all comparisons). Mastectomy was planned based on conventional imaging in 22.4% (MRI group) versus 14.4% (noMRI group) (p < 0.001). The additional planned mastectomy rate in the MRI group was 11.3%. The overall performed first- plus second-line mastectomy rate was 36.3% (MRI group) versus 18.0% (noMRI group) (p < 0.001). In women receiving conserving surgery, MRI group had a significantly lower reoperation rate (8.5% versus 11.7%, p < 0.001). CONCLUSIONS: Clinicians requested breast MRI for women with a higher a priori probability of receiving mastectomy. MRI was associated with 11.3% more mastectomies, and with 3.2% fewer reoperations in the breast conservation subgroup. KEY POINTS: • In 19% of patients of the MIPA study, breast MRI was performed for screening or diagnostic purposes. • The current patient selection to preoperative breast MRI implies an 11% increase in mastectomies, counterbalanced by a 3% reduction of the reoperation rate. • Data from the MIPA study can support discussion in tumor boards when preoperative MRI is under consideration and should be shared with patients to achieve informed decision-making.
Keywords
Breast, Breast cancer, Magnetic resonance imaging, Mastectomy, Breast-conserving surgery, Reoperation
Sponsorship
National Institute for Health Research (IS-BRC-1215-20014)
Identifiers
s00330-021-08240-x, 8240
External DOI: https://doi.org/10.1007/s00330-021-08240-x
This record's URL: https://www.repository.cam.ac.uk/handle/1810/334322
Rights
Licence:
http://creativecommons.org/licenses/by/4.0/
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