학술논문
A Multi-institutional Analysis of Factors Influencing the Rate of Positive MRI Biopsy Among Women with Early-Stage Breast Cancer
Document Type
Original Paper
Author
Choi, Seraphina; Borowsky, Peter A.; Morgan, Orly; Kwon, Deukwoo; Zhao, Wei; Koru-Sengul, Tulay; Gilna, Gareth; Net, Jose; Kesmodel, Susan; Goel, Neha; Patel, Yamini; Griffiths, Alexa; Feinberg, Joshua A.; Kangas-Dick, Aeryn; Andaz, Charusheela; Giuliano, Christina; Zelenko, Natalie; Manasseh, Donna-Marie; Borgen, Patrick; Rojas, Kristin E.
Source
Annals of Surgical Oncology. 31(5):3141-3153
Subject
Language
English
ISSN
1068-9265
1534-4681
1534-4681
Abstract
Background: The use of preoperative magnetic resonance imaging (MRI) for early-stage breast cancer (ESBC) is increasing, but its utility in detecting additional malignancy is unclear and delays surgical management (Jatoi and Benson in Future Oncol 9:347–353, 2013. https://doi.org/10.2217/fon.12.186, Bleicher et al. J Am Coll Surg 209:180–187, 2009. https://doi.org/10.1016/j.jamcollsurg.2009.04.010, Borowsky et al. J Surg Res 280:114–122, 2022. https://doi.org/10.1016/j.jss.2022.06.066). The present study sought to identify ESBC patients most likely to benefit from preoperative MRI by assessing the positive predictive values (PPVs) of ipsilateral and contralateral biopsies.Methods: A retrospective cohort study included patients with cTis-T2N0-N1 breast cancer from two institutions during 2016–2021. A “positive” biopsy result was defined as additional cancer (PositiveCancer ) or cancer with histology often excised (PositiveSurg ). The PPV of MRI biopsies was calculated with respect to age, family history, breast density, and histology. Uni- and multivariate logistic regression determined whether combinations of age younger than 50 years, dense breasts, family history, and pure ductal carcinoma in situ (DCIS) histology led to higher biopsy yield.Results: Of the included patients, 447 received preoperative MRI and 131 underwent 149 MRI-guided biopsies (96 ipsilateral, 53 contralateral [18 bilateral]). PositiveCancer for ipsilateral biopsy was 54.2%, and PositiveCancer for contralateral biopsy was 17.0%. PositiveSurg for ipsilateral biopsy was 62.5%, and PositiveSurg for contralateral biopsy was 24.5%. Among the contralateral MRI biopsies, patients younger than 50 years were less likely to have PositiveSurg (odds ratio, 0.02; 95% confidence interval, 0.00–0.84; p = 0.041). The combinations of age, density, family history, and histology did not lead to a higher biopsy yield.Conclusion: Historically accepted factors for recommending preoperative MRI did not appear to confer a higher MRI biopsy yield. To prevent delays to surgical management, MRI should be carefully selected for individual patients most likely to benefit from additional imaging.