Presenter(s)
R. Shaker1, L. Spiguel2, and T. Biswas1; 1Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, 2Department of Surgery, University of Florida College of Medicine, Gainesville, FL
Purpose/Objective(s): Breast cancer remains a leading cause of cancer-related morbidity and mortality among women, making accurate imaging critical for diagnosis and treatment planning. Breast magnetic resonance imaging (MRI) is used in selected clinical scenarios to evaluate disease extent, identify multifocal or contralateral disease, and assess response to systemic therapy. However, routine use of diagnostic breast MRI remains controversial in breast cancer management. We undertook this study to examine the impact of breast MRI in management of newly diagnosed breast cancer.
Materials/Methods: We conducted a retrospective review of patients at our institution who underwent surgical evaluation for breast cancer in 2022. A total of 197 patients were included. MRI findings were correlated with pathologic outcomes, and descriptive analyses were performed. A binomial regression model was used to assess whether patient age and tumor size on mammography predicted a change in surgical planning among patients who underwent MRI.
Results: Of the 197 patients, 165 underwent preoperative breast MRI (84%) and 33 did not (16%). Median age at diagnosis was 63 years (range 27–94), and median tumor size on mammography was 15 mm (range 5–117). MRI identified additional lesions in 76 patients (46%), including nine contralateral lesions (5%). Forty-one additional biopsies were performed (25%), of which 22 (54%) were positive for carcinoma. Thirty-one MRI findings were concordant with final pathology (49%), while 32 were discordant (51%). The proportion of patients undergoing mastectomy was significantly higher among those who had MRI compared with those who did not (48% vs. 21%, p = 0.047). Binomial regression analysis demonstrated no significant association between age or tumor size and MRI-related changes in surgical planning (p = 0.46).
Conclusion: Routine use of preoperative breast MRI led to additional cancer diagnoses in approximately one in five patients and was associated with a higher rate of mastectomy. However, patient age and tumor size did not predict MRI-driven changes in surgical management. These findings highlight the diagnostic impact of MRI while underscoring the need for careful patient selection and further study to clarify its effect on clinical outcomes.