Preoperative MRI useful for detecting additional disease in Node-positive Breast Cancer

Preoperative MRI may be especially useful in finding extra illnesses that might change surgical therapy in individuals with node-positive disease, says an article published in Annals of Surgical Oncology. Patients who had nodal disease discovered during their examination are more probable to have new multifocal, multicentric, or contralateral illness detected on MRI. 

Breast magnetic resonance imaging is the most efficient means of detecting breast cancer. However, the use of preoperative breast MRI varies greatly. It has been proposed that using MRI in the preoperative context can change surgical decision making and lower reoperation rates by detecting new disease prior to the initial surgery. Recent investigations, however, indicated that MRI did not reduce reoperation rates and instead exaggerated the amount of illness in certain patients.

While these recommendations and studies call into doubt the efficacy of preoperative MRI, other research has revealed that the apparent advantage may be limited to select patient categories. This study by Kaitlyn Kennard and team in order to find out what characteristics assist predict the usefulness of preoperative MRI with respect to breast cancer.

Researchers conducted an IRB-approved retrospective assessment of breast cancer patients who received preoperative MRI from 2018 to 2021. Patients were separated into two groups: those who had no new illness found on MRI and those who had new disease discovered.

The key findings of this study were:

Preoperative MRI revealed new multicentric, multifocal, or contralateral illness in 17% of 420 patients with a new diagnosis of breast cancer.

There was no difference in age, race, breast density, family history, or hormone status between the two groups.

Age, race, breast density, family history, tumour size, grade, and use of neoadjuvant treatment were not predictive with the identification of further new disease in multivariate analysis.

Positive nodes on ultrasonography or mammography were linked to new or multifocal illness on MRI.

Positive pre-MRI nodes enhance the chance of detecting new illness.

For 22.2% of the no new illness found cohort and 6.9% of the new multicentric disease cohort, preoperative MRI led to more extensive surgery than suggested.

Reference:

Kennard, K., Israel, I., Naaseh, A., Saini, R., Rajapakse, K., Kirsten, J., Trivedi, A., Tao, J., Luo, J., Ahmad, T., & Margenthaler, J. (2023). Lymph Node Positivity: Indication for Preoperative MRI? In Annals of Surgical Oncology. Springer Science and Business Media LLC. https://doi.org/10.1245/s10434-023-13891-9