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Sub-category:
Preoperative Study Methods
Category:
Treatment
Meeting:
2008 Breast Cancer Symposium
Session Type and Session Title:
General Poster Session D
Abstract No:
227
Author(s):
R. J. Bleicher, R. M. Ciocca, B. L. Egleston, L. Sesa, K. Evers, E. R. Sigurdson, M. Morrow
Abstract:
Background: Breast MRI is increasingly being used in newly diagnosed breast cancer patients (pts), but evidence of outcome benefit is lacking. This study was performed to characterize the population receiving MRI and examine its effect on short term surgical outcomes including time to surgery, positive margin rate, conversion from breast conservation (BCT) to mastectomy, and mastectomy rate. Methods: All pts with invasive breast cancer seen in a multidisciplinary breast clinic from 7/04-12/06 were retrospectively reviewed. MRIs obtained at our institution and prior to referral were reviewed, but MRI was not performed routinely in our practice. Pts were evaluated by a team comprised of a radiologist, pathologist, and a surgical, radiation, and medical oncologist. Results: The 577 pts had a mean age of 57.3 y, a mean tumor size of 2.1 cm, and 130 pts (22.5%) had pretreatment MRIs. MRI use increased between 2004 and 2005 (OR 2.2, p=0.014) and again in 2006 (OR 2.7, p=0.002). Pts having MRI were younger (mean 52.4 y vs. 58.8 y, p<0.001) than those who did not, but its use did not correlate with a family history of breast or ovarian cancer, presentation, or tumor features such as histology, T size, or stage. MRI was associated with a 24.6-day delay in completion of pretreatment evaluation (p=0.009). There were 419 pts who had final surgical data. BCT was attempted in 321 pts (76.6%). A preoperative MRI conferred an odds ratio for mastectomy of 1.97 after controlling for T size and stage (p=0.012). When adjusting for T size, MRI use did not decrease the likelihood of positive margins at first lumpectomy (21.6%-MRI vs. 13.9%-no MRI, p=0.10), nor did it decrease the percentage of pts requiring conversion from BCT to mastectomy (9.8%-MRI vs. 5.8%-no MRI, p=0.40). Conclusion: MRI use was not restricted to high risk pts. No benefit in avoiding positive margins or decreasing failed attempts at BCT was noted, however, MRI was associated with a treatment delay and increased mastectomy rate. In the absence of evidence that MRI decreases local recurrence after BCT, our findings suggest that MRI should not be a routine part of patient evaluation for BCT. Greater efforts to define the limitations and appropriate use of breast MRI are needed.
Abstract Disclosures
Abstracts that were granted an exception in accordance with ASCO's Conflict of Interest Policy
and are designated with a caret symbol (^) here and in the print version.
 Associated Presentation(s):
Other Abstracts in this Sub-Category:
Abstracts by R. J. Bleicher:
Presentations by R. J. Bleicher:
Educational Book Manuscripts by R. J. Bleicher:
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