TY - JOUR
T1 - Is staging breast magnetic resonance imaging prompted upgrade to mastectomy appropriate?
AU - Jayaratne, Thilina
AU - Huang, Yang Yang
AU - Jacques, Angela
AU - Dhillon, Ravinder
AU - Porter, Gareth
AU - Bose, Sharmistha
AU - Bourke, Anita
AU - Dessauvagie, Ben
AU - Lo, Glen
PY - 2021/9
Y1 - 2021/9
N2 - Background: Breast magnetic resonance imaging (MRI) use for surgical staging is increasing, though remains controversial. We aimed to evaluate the accuracy of MRI in surgical decision-making to determine if mastectomy prompted by MRI was appropriate. Methods: A single-centre observational study in Perth, Western Australia, with the inclusion of all preoperative and postoperative studies (e.g. involved margins after breast-conserving surgery) undergoing staging breast MRI from 1 January 2015 to 26 August 2019. A standard protocol using gadolinium contrast was used. The reference standard was postoperative histopathology or, for studies without additional surgery after MRI following breast-conserving surgery, the next and subsequent annual screening episodes. By reviewing the final histopathology, the medical case notes and multidisciplinary team decision process, we evaluated whether the reported MRI disease extent was accurate in prompting an appropriate upgrade to mastectomy. Outcomes are reported with descriptive statistics. Results: Of 130 cancers staged with MRI; seven were excluded as information was incomplete, 104 were performed preoperatively and 19 postoperatively. The majority (60%) staged lobular carcinoma (invasive 59%, in situ 1%) compared to ductal carcinoma (invasive 31%, in situ 8%). For preoperative MRI, half (54% – 56/104) underwent subsequent mastectomy. Of these, MRI prompted mastectomy in 45% (25/56), all appropriate for disease extent. In the postoperative staging group, two mastectomies were performed, one planned before imaging, the other prompted when MRI diagnosed residual disease and confirmed on histopathology. No false-negative staging MRI was identified. Conclusions: In our cohort, MRI prompted an upgrade to mastectomy in 21% (26/123), appropriate for cancer extent.
AB - Background: Breast magnetic resonance imaging (MRI) use for surgical staging is increasing, though remains controversial. We aimed to evaluate the accuracy of MRI in surgical decision-making to determine if mastectomy prompted by MRI was appropriate. Methods: A single-centre observational study in Perth, Western Australia, with the inclusion of all preoperative and postoperative studies (e.g. involved margins after breast-conserving surgery) undergoing staging breast MRI from 1 January 2015 to 26 August 2019. A standard protocol using gadolinium contrast was used. The reference standard was postoperative histopathology or, for studies without additional surgery after MRI following breast-conserving surgery, the next and subsequent annual screening episodes. By reviewing the final histopathology, the medical case notes and multidisciplinary team decision process, we evaluated whether the reported MRI disease extent was accurate in prompting an appropriate upgrade to mastectomy. Outcomes are reported with descriptive statistics. Results: Of 130 cancers staged with MRI; seven were excluded as information was incomplete, 104 were performed preoperatively and 19 postoperatively. The majority (60%) staged lobular carcinoma (invasive 59%, in situ 1%) compared to ductal carcinoma (invasive 31%, in situ 8%). For preoperative MRI, half (54% – 56/104) underwent subsequent mastectomy. Of these, MRI prompted mastectomy in 45% (25/56), all appropriate for disease extent. In the postoperative staging group, two mastectomies were performed, one planned before imaging, the other prompted when MRI diagnosed residual disease and confirmed on histopathology. No false-negative staging MRI was identified. Conclusions: In our cohort, MRI prompted an upgrade to mastectomy in 21% (26/123), appropriate for cancer extent.
KW - breast
KW - cancer
KW - magnetic resonance imaging
KW - mastectomy
KW - staging
UR - http://www.scopus.com/inward/record.url?scp=85114656392&partnerID=8YFLogxK
U2 - 10.1111/ans.16887
DO - 10.1111/ans.16887
M3 - Article
C2 - 33908181
AN - SCOPUS:85114656392
SN - 1445-1433
VL - 91
SP - 1772
EP - 1778
JO - ANZ Journal of Surgery
JF - ANZ Journal of Surgery
IS - 9
ER -