TY - JOUR
T1 - Screening and diagnostic breast MRI: how do they impact surgical treatment? Insights from the MIPA study
AU - Cozzi, Andrea
AU - Di Leo, Giovanni
AU - Houssami, Nehmat
AU - Gilbert, Fiona J.
AU - Helbich, Thomas H.
AU - Benito, Marina Alvarez
AU - Balleyguier, Corinne
AU - Bazzocchi, Massimo
AU - Bult, Peter
AU - Calabrese, Massimo
AU - Herrero, Julia Camps
AU - Cartia, Francesco
AU - Cassano, Enrico
AU - Clauser, Paola
AU - Docema, Marcos de Lima F.
AU - Depretto, Catherine
AU - Dominelli, Valeria
AU - Forrai, Gabor
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 - Ozcan, Umit A.
AU - Pediconi, Federica
AU - Pinker, Katja
AU - Preibsch, Heike
AU - Povedano, Jose L. Raya
AU - Saccarelli, Carolina Rossi
AU - Sacchetto, Daniela
AU - Scaperrotta, Gianfranco P.
AU - Schlooz, Margrethe
AU - Szabo, Botond K.
AU - Taylor, Donna B.
AU - Ulus, Ozden S.
AU - Van Goethem, Mireille
AU - Veltman, Jeroen
AU - Weigel, Stefanie
AU - Wenkel, Evelyn
AU - Zuiani, Chiara
AU - Sardanelli, Francesco
PY - 2023/9
Y1 - 2023/9
N2 - 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.
AB - 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.
KW - Breast-conserving surgery
KW - Breast neoplasms
KW - Magnetic resonance imaging
KW - Mastectomy
KW - Reoperation
KW - CONTRAST-ENHANCED MAMMOGRAPHY
KW - PREOPERATIVE MRI
KW - CONTRALATERAL BREAST
KW - CANCER
KW - WOMEN
KW - METAANALYSIS
KW - RECOMMENDATIONS
KW - MANAGEMENT
U2 - 10.1007/s00330-023-09600-5
DO - 10.1007/s00330-023-09600-5
M3 - Article
C2 - 37138190
SN - 0938-7994
VL - 33
SP - 6213
EP - 6225
JO - European Radiology
JF - European Radiology
IS - 9
ER -