Preoperative Breast MRI Associated With Fewer Tumor Recurrences
By Norra MacReady
Medscape Medical News
May 10, 2010 (San Diego, California) — Magnetic resonance imaging (MRI) before surgery for a primary breast tumor can prevent contralateral tumors and local ipsilateral recurrences, Valeria Dominelli, MD, from the University of Rome "La Sapienza," in Italy, announced here at the American Roentgen Ray Society 2010 Annual Meeting.
In a retrospective analysis of 49 women slated for surgery to treat recurrent breast cancer, the rate of contralateral carcinoma and ipsilateral recurrent carcinoma was significantly lower among patients who had undergone preoperative contrast-enhanced MRI, said Dr. Dominelli, lead author of the study.
These findings suggest that "preoperative local MR staging allows a significant reduction in ipsilateral recurrences and contralateral cancer at follow-up," most likely because clinicians can better evaluate the extent of the disease, said Dr. Dominelli.
At least one expert not involved in this research urged a more cautious approach. "There is still a good deal of debate over whether MRI should be used in women with breast cancer," said Constance Lehman, MD, professor of radiology at the University of Washington, and director of imaging at the Seattle Cancer Care Alliance.
The patients in Dr. Dominelli's study were part of a larger group of 150 women evaluated for breast cancer recurrence between January 2007 and January 2009. In all cases, surgery had successfully removed the entire initial tumor, and histologic margins were free of disease. All of the patients underwent similar systemic treatment after surgery, and all underwent follow-up breast MRI to evaluate the extent of any relapse.
Recurrences occurred in 49 women from 7 to 47 months after treatment of the initial primary carcinoma. Of those, 10 had undergone preoperative MRI (group?A). In 3 of those cases, MRI revealed multifocal or multicentric disease not detected by other imaging modalities, Dr. Dominelli said. In 2 of the 39 women who had not undergone preoperative MRI (group?B), additional disease foci were found during surgery.
To remove the initial tumor, 6 of the women in group?A (60%) underwent mastectomy, 3 (30%) underwent quadrantectomy, and 1 (10%) underwent lumpectomy. Among women in group?B, 8 (21%) underwent mastectomy, 27 (69%) underwent quadrantectomy, and 4 (10%) underwent lumpectomy.
At follow-up, 14% of the women in group?A had developed ipsilateral local recurrences, and 12% had developed metachronous contralateral carcinoma. In contrast, local ipsilateral recurrences and metachronous contralateral carcinomas were found in 86% and 88%, respectively, of the women in group?B (P?< .001). "This suggests that initial staging probably was not correctly done," Dr. Dominelli said.
In a related study on the use of contrast-enhanced MR mammography (CE-MRM) in planning initial breast cancer surgery, Dr. Dominelli and her colleagues found that CE-MRM detected all the lesions found by other imaging methods, plus 51 additional suspicious lesions in 34 of 164 patients (21%), leading to a change in treatment for 32 of those patients (20%). All in all, said Dr. Dominelli, breast MRI "should be recommended" for more precise evaluation of disease extent in patients with breast cancer.
"Both of these studies lend support for the use of preoperative breast MRI, but we need more postoperative data about its true value in these patients," Dr. Lehman added.
Dr. Dominelli and Dr. Lehman have disclosed no relevant financial relationships.
American Roentgen Ray Society (ARRS) 2010 Annual Meeting. Presented May 6, 2010.
