A Multi-institutional Analysis of Factors Influencing the Rate of Positive MRI Biopsy Among Women with Early-Stage Breast Cancer
Background The use of preoperative magnetic resonance imaging (MRI) for early-stage breast cancer (ESBC) is increasing, but its utility in detecting additional malignancy is unclear and delays surgical management (Jatoi and Benson in Future Oncol 9:347–353, 2013. https://doi.org/10.2217/fon.12.186, Bleicher et al. J Am Coll Surg 209:180–187, 2009. https://doi.org/10.1016/j.jamcollsurg.2009.04.010, Borowsky et al. J Surg Res 280:114–122, 2022. https://doi.org/10.1016/j.jss.2022.06.066). The present study sought to identify ESBC patients most likely to benefit from preoperative MRI by assessing the positive predictive values (PPVs) of ipsilateral and contralateral biopsies. Methods A retrospective cohort study included patients with cTis-T2N0-N1 breast cancer from two institutions during 2016–2021. A “positive” biopsy result was defined as additional cancer ($ Positive_{Cancer} $) or cancer with histology often excised ($ Positive_{Surg} $). The PPV of MRI biopsies was calculated with respect to age, family history, breast density, and histology. Uni- and multivariate logistic regression determined whether combinations of age younger than 50 years, dense breasts, family history, and pure ductal carcinoma in situ (DCIS) histology led to higher biopsy yield. Results Of the included patients, 447 received preoperative MRI and 131 underwent 149 MRI-guided biopsies (96 ipsilateral, 53 contralateral [18 bilateral]). $ Positive_{Cancer} $ for ipsilateral biopsy was 54.2%, and $ Positive_{Cancer} $ for contralateral biopsy was 17.0%. $ Positive_{Surg} $ for ipsilateral biopsy was 62.5%, and $ Positive_{Surg} $ for contralateral biopsy was 24.5%. Among the contralateral MRI biopsies, patients younger than 50 years were less likely to have $ Positive_{Surg} $ (odds ratio, 0.02; 95% confidence interval, 0.00–0.84; p = 0.041). The combinations of age, density, family history, and histology did not lead to a higher biopsy yield. Conclusion Historically accepted factors for recommending preoperative MRI did not appear to confer a higher MRI biopsy yield. To prevent delays to surgical management, MRI should be carefully selected for individual patients most likely to benefit from additional imaging..
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:31 |
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| Enthalten in: |
Annals of surgical oncology - 31(2024), 5 vom: 29. Jan., Seite 3141-3153 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Choi, Seraphina [VerfasserIn] |
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| Links: |
Volltext [lizenzpflichtig] |
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| Anmerkungen: |
© Society of Surgical Oncology 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. |
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| doi: |
10.1245/s10434-024-14954-1 |
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| 520 | |a Background The use of preoperative magnetic resonance imaging (MRI) for early-stage breast cancer (ESBC) is increasing, but its utility in detecting additional malignancy is unclear and delays surgical management (Jatoi and Benson in Future Oncol 9:347–353, 2013. https://doi.org/10.2217/fon.12.186, Bleicher et al. J Am Coll Surg 209:180–187, 2009. https://doi.org/10.1016/j.jamcollsurg.2009.04.010, Borowsky et al. J Surg Res 280:114–122, 2022. https://doi.org/10.1016/j.jss.2022.06.066). The present study sought to identify ESBC patients most likely to benefit from preoperative MRI by assessing the positive predictive values (PPVs) of ipsilateral and contralateral biopsies. Methods A retrospective cohort study included patients with cTis-T2N0-N1 breast cancer from two institutions during 2016–2021. A “positive” biopsy result was defined as additional cancer ($ Positive_{Cancer} $) or cancer with histology often excised ($ Positive_{Surg} $). The PPV of MRI biopsies was calculated with respect to age, family history, breast density, and histology. Uni- and multivariate logistic regression determined whether combinations of age younger than 50 years, dense breasts, family history, and pure ductal carcinoma in situ (DCIS) histology led to higher biopsy yield. Results Of the included patients, 447 received preoperative MRI and 131 underwent 149 MRI-guided biopsies (96 ipsilateral, 53 contralateral [18 bilateral]). $ Positive_{Cancer} $ for ipsilateral biopsy was 54.2%, and $ Positive_{Cancer} $ for contralateral biopsy was 17.0%. $ Positive_{Surg} $ for ipsilateral biopsy was 62.5%, and $ Positive_{Surg} $ for contralateral biopsy was 24.5%. Among the contralateral MRI biopsies, patients younger than 50 years were less likely to have $ Positive_{Surg} $ (odds ratio, 0.02; 95% confidence interval, 0.00–0.84; p = 0.041). The combinations of age, density, family history, and histology did not lead to a higher biopsy yield. Conclusion Historically accepted factors for recommending preoperative MRI did not appear to confer a higher MRI biopsy yield. To prevent delays to surgical management, MRI should be carefully selected for individual patients most likely to benefit from additional imaging. | ||
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