TY - JOUR
T1 - Preoperative breast MRI positively impacts surgical outcomes of needle biopsy-diagnosed pure DCIS
T2 - a patient-matched analysis from the MIPA study
AU - Cozzi, Andrea
AU - Di Leo, Giovanni
AU - Houssami, Nehmat
AU - Gilbert, Fiona J
AU - Helbich, Thomas H
AU - Álvarez Benito, Marina
AU - Balleyguier, Corinne
AU - Bazzocchi, Massimo
AU - Bult, Peter
AU - Calabrese, Massimo
AU - Camps Herrero, Julia
AU - Cartia, Francesco
AU - Cassano, Enrico
AU - Clauser, Paola
AU - de Lima Docema, Marcos F
AU - Depretto, Catherine
AU - Dominelli, Valeria
AU - Forrai, Gábor
AU - Girometti, Rossano
AU - Harms, Steven E
AU - Hilborne, Sarah
AU - Ienzi, Raffaele
AU - Lobbes, Marc B I
AU - Losio, Claudio
AU - Mann, Ritse M
AU - Montemezzi, Stefania
AU - Obdeijn, Inge-Marie
AU - Aksoy Ozcan, Umit
AU - Pediconi, Federica
AU - Pinker, Katja
AU - Preibsch, Heike
AU - Raya Povedano, José L
AU - Rossi Saccarelli, Carolina
AU - Sacchetto, Daniela
AU - Scaperrotta, Gianfranco P
AU - Schlooz, Margrethe
AU - Szabó, Botond K
AU - Taylor, Donna B
AU - Ulus, Sila Ö
AU - Van Goethem, Mireille
AU - Veltman, Jeroen
AU - Weigel, Stefanie
AU - Wenkel, Evelyn
AU - Zuiani, Chiara
AU - Sardanelli, Francesco
PY - 2024/6
Y1 - 2024/6
N2 - Objectives: To investigate the influence of preoperative breast MRI on mastectomy and reoperation rates in patients with pure ductal carcinoma in situ (DCIS). Methods: The MIPA observational study database (7245 patients) was searched for patients aged 18–80 years with pure unilateral DCIS diagnosed at core needle or vacuum-assisted biopsy (CNB/VAB) and planned for primary surgery. Patients who underwent preoperative MRI (MRI group) were matched (1:1) to those who did not receive MRI (noMRI group) according to 8 confounding covariates that drive referral to MRI (age; hormonal status; familial risk; posterior-to-nipple diameter; BI-RADS category; lesion diameter; lesion presentation; surgical planning at conventional imaging). Surgical outcomes were compared between the matched groups with nonparametric statistics after calculating odds ratios (ORs). Results: Of 1005 women with pure unilateral DCIS at CNB/VAB (507 MRI group, 498 noMRI group), 309 remained in each group after matching. First-line mastectomy rate in the MRI group was 20.1% (62/309 patients, OR 2.03) compared to 11.0% in the noMRI group (34/309 patients, p = 0.003). The reoperation rate was 10.0% in the MRI group (31/309, OR for reoperation 0.40) and 22.0% in the noMRI group (68/309, p < 0.001), with a 2.53 OR of avoiding reoperation in the MRI group. The overall mastectomy rate was 23.3% in the MRI group (72/309, OR 1.40) and 17.8% in the noMRI group (55/309, p = 0.111). Conclusions: Compared to those going directly to surgery, patients with pure DCIS at CNB/VAB who underwent preoperative MRI had a higher OR for first-line mastectomy but a substantially lower OR for reoperation. Clinical relevance statement: When confounding factors behind MRI referral are accounted for in the comparison of patients with CNB/VAB-diagnosed pure unilateral DCIS, preoperative MRI yields a reduction of reoperations that is more than twice as high as the increase in overall mastectomies. Key Points: • Confounding factors cause imbalance when investigating the influence of preoperative MRI on surgical outcomes of pure DCIS. • When patient matching is applied to women with pure unilateral DCIS, reoperation rates are significantly reduced in women who underwent preoperative MRI. • The reduction of reoperations brought about by preoperative MRI is more than double the increase in overall mastectomies.
AB - Objectives: To investigate the influence of preoperative breast MRI on mastectomy and reoperation rates in patients with pure ductal carcinoma in situ (DCIS). Methods: The MIPA observational study database (7245 patients) was searched for patients aged 18–80 years with pure unilateral DCIS diagnosed at core needle or vacuum-assisted biopsy (CNB/VAB) and planned for primary surgery. Patients who underwent preoperative MRI (MRI group) were matched (1:1) to those who did not receive MRI (noMRI group) according to 8 confounding covariates that drive referral to MRI (age; hormonal status; familial risk; posterior-to-nipple diameter; BI-RADS category; lesion diameter; lesion presentation; surgical planning at conventional imaging). Surgical outcomes were compared between the matched groups with nonparametric statistics after calculating odds ratios (ORs). Results: Of 1005 women with pure unilateral DCIS at CNB/VAB (507 MRI group, 498 noMRI group), 309 remained in each group after matching. First-line mastectomy rate in the MRI group was 20.1% (62/309 patients, OR 2.03) compared to 11.0% in the noMRI group (34/309 patients, p = 0.003). The reoperation rate was 10.0% in the MRI group (31/309, OR for reoperation 0.40) and 22.0% in the noMRI group (68/309, p < 0.001), with a 2.53 OR of avoiding reoperation in the MRI group. The overall mastectomy rate was 23.3% in the MRI group (72/309, OR 1.40) and 17.8% in the noMRI group (55/309, p = 0.111). Conclusions: Compared to those going directly to surgery, patients with pure DCIS at CNB/VAB who underwent preoperative MRI had a higher OR for first-line mastectomy but a substantially lower OR for reoperation. Clinical relevance statement: When confounding factors behind MRI referral are accounted for in the comparison of patients with CNB/VAB-diagnosed pure unilateral DCIS, preoperative MRI yields a reduction of reoperations that is more than twice as high as the increase in overall mastectomies. Key Points: • Confounding factors cause imbalance when investigating the influence of preoperative MRI on surgical outcomes of pure DCIS. • When patient matching is applied to women with pure unilateral DCIS, reoperation rates are significantly reduced in women who underwent preoperative MRI. • The reduction of reoperations brought about by preoperative MRI is more than double the increase in overall mastectomies.
KW - Breast neoplasms (biopsy, needle)
KW - Carcinoma (intraductal, noninfiltrating)
KW - Magnetic resonance imaging
KW - Mastectomy
KW - Reoperation
U2 - 10.1007/s00330-023-10409-5
DO - 10.1007/s00330-023-10409-5
M3 - Article
SN - 0938-7994
VL - 34
SP - 3970
EP - 3980
JO - European Radiology
JF - European Radiology
IS - 6
ER -