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Li Y, Zhang Y, Tian L, Li J, Li H, Wang X, Wang C. 3D amide proton transfer-weighted imaging may be useful for diagnosing early-stage breast cancer: a prospective monocentric study. Eur Radiol Exp 2024; 8:41. [PMID: 38584248 PMCID: PMC10999404 DOI: 10.1186/s41747-024-00439-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/17/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND We investigated the value of three-dimensional amide proton transfer-weighted imaging (3D-APTWI) in the diagnosis of early-stage breast cancer (BC) and its correlation with the immunohistochemical characteristics of malignant lesions. METHODS Seventy-eight women underwent APTWI and dynamic contrast-enhanced (DCE)-MRI. Pathological results were categorized as either benign (n = 43) or malignant (n = 37) lesions. The parameters of APTWI and DCE-MRI were compared between the benign and malignant groups. The diagnostic value of 3D-APTWI was evaluated using the area under the receiver operating characteristic curve (ROC-AUC) to establish a diagnostic threshold. Pearson's correlation was used to analyze the correlation between the magnetization transfer asymmetry (MTRasym) and immunohistochemical characteristics. RESULTS The MTRasym and time-to-peak of malignancies were significantly lower than those of benign lesions (all p < 0.010). The volume transfer constant, rate constant, and wash-in and wash-out rates of malignancies were all significantly greater than those of benign lesions (all p < 0.010). ROC-AUCs of 3D-APTWI, DCE-MRI, and 3D-APTWI+DCE to differential diagnosis between early-stage BC and benign lesions were 0.816, 0.745, and 0.858, respectively. Only the difference between AUCAPT+DCE and AUCDCE was significant (p < 0.010). When a threshold of MTRasym for malignancy for 2.42%, the sensitivity and specificity of 3D-APTWI for BC diagnosis were 86.5% and 67.6%, respectively; MTRasym was modestly positively correlated with pathological grade (r = 0.476, p = 0.003) and Ki-67 (r = 0.419, p = 0.020). CONCLUSIONS 3D-APTWI may be used as a supplementary method for patients with contraindications of DCE-MRI. MTRasym can imply the proliferation activities of early-stage BC. RELEVANCE STATEMENT 3D-APTWI can be an alternative diagnostic method for patients with early-stage BC who are not suitable for contrast injection. KEY POINTS • 3D-APTWI reflects the changes in the microenvironment of early-stage breast cancer. • Combined 3D-APTWI is superior to DCE-MRI alone for early-stage breast cancer diagnosis. • 3D-APTWI improves the diagnostic accuracy of early-stage breast cancer.
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Affiliation(s)
- Yeqin Li
- Department of Radiology, Shandong Province Hospital of Traditional Chinese Medicine, Jinan, 250014, China
| | - Yan Zhang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medcial University, Jinan, 250021, China
| | - Liwen Tian
- Department of Radiology, Shandong Public Health Clinical Center, Jinan, 250100, China
| | - Ju Li
- Department of Radiology, Shandong Public Health Clinical Center, Jinan, 250100, China
- Binzhou Medical University, Yantai, 264003, China
| | - Huihua Li
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medcial University, Jinan, 250021, China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medcial University, Jinan, 250021, China
| | - Cuiyan Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medcial University, Jinan, 250021, China.
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Wernli KJ, Smith RE, Henderson LM, Zhao W, Durham DD, Schifferdecker K, Kaplan C, Buist DSM, Kerlikowske K, Miglioretti DL, Onega T, Alsheik NH, Sprague BL, Jackson-Nefertiti G, Budesky J, Johnson D, Tosteson ANA. Decision quality and regret with treatment decisions in women with breast cancer: Pre-operative breast MRI and breast density. Breast Cancer Res Treat 2022; 194:607-616. [PMID: 35723793 PMCID: PMC9642106 DOI: 10.1007/s10549-022-06648-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/01/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE We evaluated self-report of decision quality and regret with breast cancer surgical treatment by pre-operative breast MRI use in women recently diagnosed with breast cancer. METHODS We conducted a survey with 957 women aged 18 + with stage 0-III breast cancer identified in the Breast Cancer Surveillance Consortium. Participants self-reported receipt of pre-operative breast MRI. Primary outcomes were process measures in the Breast Cancer Surgery Decision Quality Instrument (BCS-DQI) (continuous outcome) and Decision Regret Scale (dichotomized outcome as any/none). Generalized estimating equations with linear and logit link were used to estimate adjusted associations between breast MRI and primary outcomes. All analyses were also stratified by breast density. RESULTS Survey participation rate was 27.9% (957/3430). Study population was primarily > 60 years, White, college educated, and diagnosed with early-stage breast cancer. Pre-operative breast MRI was reported in 46% of women. A higher proportion of women who were younger age (< 50 years), commercially insured, and self-detected their breast cancer reported pre-operative breast MRI use. In adjusted analysis, pre-operative breast MRI use compared with no use was associated with a small but statistically significantly higher decision quality scores (69.5 vs 64.7, p-value = 0.043). Decision regret did not significantly differ in women who reported pre-operative breast MRI use compared with no use (54.2% v. 48.7%, respectively, p-value = 0.11). Study results did not vary when stratified by breast density for either primary outcome. CONCLUSIONS AND RELEVANCE Breast MRI use in the diagnostic work-up of breast cancer does not negatively alter women's perceptions of surgical treatment decisions in early survivorship. CLINICAL TRIALS REGISTRATION NUMBER NCT03029286.
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Affiliation(s)
- Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA.
| | - Rebecca E Smith
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | | | - Wenyan Zhao
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | | | - Karen Schifferdecker
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Celia Kaplan
- University of California-San Francisco, San Francisco, CA, USA
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA
| | | | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA
- University of California-Davis, Davis, CA, USA
| | | | | | | | | | | | | | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
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3
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Tannenbaum SS, Soulos PR, Herrin J, Pollack CE, Xu X, Christakis NA, Forman HP, Yu JB, Killelea BK, Wang SY, Gross CP. Surgeon peer network characteristics and adoption of new imaging techniques in breast cancer: A study of perioperative MRI. Cancer Med 2018; 7:5901-5909. [PMID: 30444005 PMCID: PMC6308117 DOI: 10.1002/cam4.1821] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 11/28/2022] Open
Abstract
Background Perioperative MRI has disseminated into breast cancer practice despite equivocal evidence. We used a novel social network approach to assess the relationship between the characteristics of surgeons’ patient‐sharing networks and subsequent use of MRI. Methods We identified a cohort of female patients with stage 0‐III breast cancer from the Surveillance, Epidemiology, and End Results (SEER)‐Medicare database. We used claims data from these patients and non‐cancer patients from the 5% Medicare sample to identify peer groups of physicians who shared patients during 2004‐2006 (T1). We used a multivariable hierarchical model to identify peer group characteristics associated with uptake of MRI in T2 (2007‐2009) by surgeons who had not used MRI in T1. Results Our T1 sample included 15 149 patients with breast cancer, treated by 2439 surgeons in 390 physician groups. During T1, 9.1% of patients received an MRI; the use of MRI varied from 0% to 100% (IQR 0%, 8.5%) across peer groups. After adjusting for clinical characteristics, patients treated by surgeons in groups with a higher proportion of primary care physicians (PCPs) in T1 were less likely to receive MRI in T2 (OR = 0.81 for 10% increase in PCPs, 95% CI = 0.71, 0.93). Surgeon transitivity (ie, clustering of surgeons) was significantly associated with MRI receipt (P = 0.013); patients whose surgeons were in groups with higher transitivity in T1 were more likely to receive MRI in T2 (OR = 1.29 for 10% increase in clustering, 95% CI = 1.06, 1.58). Conclusion The characteristics of a surgeon's peer network are associated with their patients’ subsequent receipt of perioperative MRI.
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Affiliation(s)
| | - Pamela R Soulos
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, Connecticut.,Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jeph Herrin
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, Connecticut.,Section of Cardiology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Health Research & Educational Trust, Chicago, Illinois
| | - Craig E Pollack
- Johns Hopkins School of Medicine, Baltimore, Maryland.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Xiao Xu
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, Connecticut.,Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Nicholas A Christakis
- Department of Sociology, Yale University, New Haven, Connecticut.,Yale Institute for Network Science and Human Nature Lab, Yale University, New Haven, Connecticut
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - James B Yu
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, Connecticut.,Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Brigid K Killelea
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, Connecticut.,Department of Surgery, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Shi-Yi Wang
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, Connecticut.,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Cary P Gross
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, Connecticut.,Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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Pollack CE, Soulos PR, Herrin J, Xu X, Christakis NA, Forman HP, Yu JB, Killelea BK, Wang SY, Gross CP. The Impact of Social Contagion on Physician Adoption of Advanced Imaging Tests in Breast Cancer. J Natl Cancer Inst 2017; 109:3071265. [PMID: 28376191 DOI: 10.1093/jnci/djw330] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/13/2016] [Indexed: 12/31/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) and positron emission tomography (PET) scans are widely used in breast cancer practice despite unproven benefits. We examined the extent to which social contagion is associated with adoption of these imaging modalities. Methods We used Surveillance, Epidemiology, and End Results-Medicare to construct peer groups of physicians who shared patients during a baseline period when these imaging modalities were starting to disseminate into practice (2004-2006) and determined the potential impact of these peer groups during a follow-up period (2007-2009). For non-early-adopting surgeons (whose patients did not receive MRI/PET during baseline), we used hierarchical logistic regression models to examine the effect of their peer group's baseline use on their use of MRI/PET during the follow-up period, adjusting for patient characteristics and hospital MRI/PET use. Results For MRI, there were 6424 women diagnosed in the follow-up period assigned to 986 non-early-adopting surgeons. During baseline, 9.3% of women received an MRI, varying across peer groups from 0% to 81%. Women assigned to surgeons whose peers had the highest rate of baseline MRI use were more likely to receive MRI compared with women whose surgeons' peers did not use MRI (24.9% vs 10.1%, adjusted odds ratio [OR] = 2.47, 95% confidence interval [CI] = 1.39 to 4.39). Physician peers were associated with uptake of PET imaging (OR for highest vs lowest baseline peer group PET use = 2.04, 95% CI = 1.24 to 3.36). Conclusions The phenomenon of social contagion may offer opportunities to better understand how new approaches to cancer care disseminate into clinical practice.
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Affiliation(s)
- Craig E Pollack
- Johns Hopkins School of Medicine, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Pamela R Soulos
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, CT, USA.,Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jeph Herrin
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, CT, USA.,Section of Cardiology, Yale School of Medicine, New Haven, CT, USA.,Health Research and Educational Trust, Chicago, Illinois, USA
| | - Xiao Xu
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, CT, USA.,Department of Internal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Nicholas A Christakis
- Department of Sociology and Yale Institute for Network Science and Human Nature Lab Yale University, New Haven, CT, USA
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - James B Yu
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, CT, USA.,Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA
| | - Brigid K Killelea
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, CT, USA.,Department of Surgery, Yale School of Medicine, New Haven, CT, USA.,Yale Cancer Center, New Haven, CT, USA
| | - Shi-Yi Wang
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, CT, USA.,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Cary P Gross
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale School of Medicine, New Haven, CT, USA.,Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Loggers ET, Gao H, Gold LS, Kessler L, Etzioni R, Buist DSM. Predictors of preoperative MRI for breast cancer: differences by data source. J Comp Eff Res 2015; 4:215-226. [PMID: 25960128 PMCID: PMC4641841 DOI: 10.2217/cer.15.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
AIM Investigate how the results of predictive models of preoperative MRI for breast cancer change based on available data. MATERIALS & METHODS A total of 1919 insured women aged ≥18 with stage 0-III breast cancer diagnosed 2002-2009. Four models were compared using nested multivariable logistic, backwards stepwise regression; model fit was assessed via area under the curve (AUC), R2. RESULTS MRI recipients (n = 245) were more recently diagnosed, younger, less comorbid, with higher stage disease. Significant variables included: Model 1/Claims (AUC = 0.76, R2 = 0.10): year, age, location, income; Model 2/Cancer Registry (AUC = 0.78, R2 = 0.12): stage, breast density, imaging indication; Model 3/Medical Record (AUC = 0.80, R2 = 0.13): radiologic recommendations; Model 4/Risk Factor Survey (AUC = 0.81, R2 = 0.14): procedure count. CONCLUSION Clinical variables accounted for little of the observed variability compared with claims data.
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Affiliation(s)
| | | | | | - Larry Kessler
- University of Washington, Department of Health Services, School of Public Health
- Fred Hutchinson Cancer Research Center, Public Health Sciences Division
| | - Ruth Etzioni
- University of Washington, Department of Health Services, School of Public Health
- Fred Hutchinson Cancer Research Center, Public Health Sciences Division
| | - Diana S. M. Buist
- Group Health Research Institute
- University of Washington, Department of Health Services, School of Public Health
- Fred Hutchinson Cancer Research Center, Public Health Sciences Division
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6
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Grimm LJ, Johnson KS, Marcom PK, Baker JA, Soo MS. Can breast cancer molecular subtype help to select patients for preoperative MR imaging? Radiology 2014; 274:352-8. [PMID: 25325325 DOI: 10.1148/radiol.14140594] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To assess whether breast cancer molecular subtype classified by surrogate markers can be used to predict the extent of clinically relevant disease with preoperative breast magnetic resonance (MR) imaging. MATERIALS AND METHODS In this HIPAA-compliant, institutional review board-approved study, informed consent was waived. Preoperative breast MR imaging reports from 441 patients were reviewed for multicentric and/or multifocal disease, lymph node involvement, skin and/or nipple invasion, chest wall and/or pectoralis muscle invasion, or contralateral disease. Pathologic reports were reviewed to confirm the MR imaging findings and for hormone receptors (estrogen and progesterone subtypes), human epidermal growth factor receptor type 2 (HER2 subtype), tumor size, and tumor grade. Surrogates were used to categorize tumors by molecular subtype: hormone receptor positive and HER2 negative (luminal A subtype); hormone receptor positive and HER2 positive (luminal B subtype); hormone receptor negative and HER2 positive (HER2 subtype); hormone receptor negative and HER2 negative (basal subtype). All patients included in the study had a histologic correlation with MR imaging findings or they were excluded. χ(2) analysis was used to compare differences between subtypes, with multivariate logistic regression analysis used to assess for variable independence. RESULTS Identified were 289 (65.5%) luminal A, 45 (10.2%) luminal B, 26 (5.9%) HER2, and 81 (18.4%) basal subtypes. Among subtypes, significant differences were found in the frequency of multicentric and/or multifocal disease (luminal A, 27.3% [79 of 289]; luminal B, 53.3% [24 of 45]; HER2, 65.4% [17 of 26]; basal, 27.2% [22 of 81]; P < .001) and lymph node involvement (luminal A, 17.3% [50 of 289]; luminal B, 35.6% [26 of 45]; HER2, 34.6% [nine of 26]; basal 24.7% [20 of 81]; P = .014). Multivariate analysis showed that molecular subtype was independently predictive of multifocal and/or multicentric disease. CONCLUSION Preoperative breast MR imaging is significantly more likely to help detect multifocal and/or multicentric disease and lymph node involvement in luminal B and HER2 molecular subtype breast cancers. Molecular subtype may help to select patients for preoperative breast MR imaging.
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Affiliation(s)
- Lars J Grimm
- From the Departments of Radiology (L.J.G., K.S.J., J.A.B., M.S.S.) and Medicine-Oncology (P.K.M.), Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710
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Tsina G, Simon P. Breast magnetic resonance imaging and its impact on the surgical treatment of breast cancer. Obstet Gynecol Int 2014; 2014:632074. [PMID: 24864145 PMCID: PMC4016890 DOI: 10.1155/2014/632074] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 02/11/2014] [Accepted: 03/12/2014] [Indexed: 11/17/2022] Open
Abstract
Breast MRI focuses on the detection of multifocality, multicentricity, and bilaterality of newly diagnosed breast cancer. A retrospective study was carried out on 833 patients that were diagnosed and treated for breast cancer between January 2002 and December 2011. Patients were divided into two groups: those that had a presurgery breast MRI and those that did not. The two groups were compared on the basis of the several parameters. The aim of the study was to determine whether the use of MRI in breast cancer screening changes the initial treatment decision. In 18% of the patients, MRI revealed a multifocal or a multicentric unilateral breast cancer, a bilateral tumour, or a larger cancer than initially diagnosed. Most of these patients underwent a second-look breast ultrasound, with or without an additional biopsy. The percentage of mastectomies did not increase as a result of an MRI exam. Neoadjuvant chemotherapy was used more often and the percentage of reoperations decreased when an MRI was performed.
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Affiliation(s)
- Georgia Tsina
- Hôpital Erasme, Université Libre de Bruxelles (ULB), Belgium Route de Lennik Lennikse Baan 808, 1070 Anderlecht, Belgium
| | - Philippe Simon
- Hôpital Erasme, Université Libre de Bruxelles (ULB), Belgium Route de Lennik Lennikse Baan 808, 1070 Anderlecht, Belgium
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8
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Houssami N, Turner R, Macaskill P, Turnbull LW, McCready DR, Tuttle TM, Vapiwala N, Solin LJ. An Individual Person Data Meta-Analysis of Preoperative Magnetic Resonance Imaging and Breast Cancer Recurrence. J Clin Oncol 2014; 32:392-401. [DOI: 10.1200/jco.2013.52.7515] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose There is little consensus regarding preoperative magnetic resonance imaging (MRI) in breast cancer (BC). We examined the association between preoperative MRI and local recurrence (LR) as primary outcome, as well as distant recurrence (DR), in patients with BC. Methods An individual person data (IPD) meta-analysis, based on preoperative MRI studies that met predefined eligibility criteria, was performed. Survival analysis (Cox proportional hazards modeling) was used to investigate time to recurrence and to estimate the hazard ratio (HR) for MRI. We modeled the univariable association between LR (or DR) and MRI, and covariates, and fitted multivariable models to estimate adjusted HRs. Sensitivity analysis was based on women who had breast conservation with radiotherapy. Results Four eligible studies contributed IPD on 3,180 affected breasts in 3,169 subjects (median age, 56.2 years). Eight-year LR-free survival did not differ between the MRI (97%) and no-MRI (95%) goups (P = .87), and the multivariable model showed no significant effect of MRI on LR-free survival: HR for MRI (versus no-MRI) was 0.88 (95% CI, 0.52 to 1.51; P = .65); age, margin status, and tumor grade were associated with LR-free survival (all P < .05). HR for MRI was 0.96 (95% CI, 0.52 to 1.77; P = .90) in sensitivity analysis. Eight-year DR-free survival did not differ between the MRI (89%) and no-MRI (93%) groups (P = .37), and the multivariable model showed no significant effect of MRI on DR-free survival: HR for MRI (v no-MRI) was 1.18 (95% CI, 0.76 to 2.27; P = .48) or 1.31 (95% CI, 0.76 to 2.27; P = .34) in sensitivity analysis. Conclusion Preoperative MRI for staging the cancerous breast does not reduce the risk of LR or DR.
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Affiliation(s)
- Nehmat Houssami
- Nehmat Houssami, Robin Turner, Petra Macaskill, the Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Lindsay W. Turnbull, Centre for Magnetic Resonance Investigations, Hull York Medical School in association with University of Hull, Hull, United Kingdom; David R. McCready, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Todd M. Tuttle, University of Minnesota, Minneapolis, MN; Neha Vapiwala and Lawrence J. Solin, University of Pennsylvania
| | - Robin Turner
- Nehmat Houssami, Robin Turner, Petra Macaskill, the Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Lindsay W. Turnbull, Centre for Magnetic Resonance Investigations, Hull York Medical School in association with University of Hull, Hull, United Kingdom; David R. McCready, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Todd M. Tuttle, University of Minnesota, Minneapolis, MN; Neha Vapiwala and Lawrence J. Solin, University of Pennsylvania
| | - Petra Macaskill
- Nehmat Houssami, Robin Turner, Petra Macaskill, the Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Lindsay W. Turnbull, Centre for Magnetic Resonance Investigations, Hull York Medical School in association with University of Hull, Hull, United Kingdom; David R. McCready, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Todd M. Tuttle, University of Minnesota, Minneapolis, MN; Neha Vapiwala and Lawrence J. Solin, University of Pennsylvania
| | - Lindsay W. Turnbull
- Nehmat Houssami, Robin Turner, Petra Macaskill, the Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Lindsay W. Turnbull, Centre for Magnetic Resonance Investigations, Hull York Medical School in association with University of Hull, Hull, United Kingdom; David R. McCready, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Todd M. Tuttle, University of Minnesota, Minneapolis, MN; Neha Vapiwala and Lawrence J. Solin, University of Pennsylvania
| | - David R. McCready
- Nehmat Houssami, Robin Turner, Petra Macaskill, the Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Lindsay W. Turnbull, Centre for Magnetic Resonance Investigations, Hull York Medical School in association with University of Hull, Hull, United Kingdom; David R. McCready, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Todd M. Tuttle, University of Minnesota, Minneapolis, MN; Neha Vapiwala and Lawrence J. Solin, University of Pennsylvania
| | - Todd M. Tuttle
- Nehmat Houssami, Robin Turner, Petra Macaskill, the Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Lindsay W. Turnbull, Centre for Magnetic Resonance Investigations, Hull York Medical School in association with University of Hull, Hull, United Kingdom; David R. McCready, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Todd M. Tuttle, University of Minnesota, Minneapolis, MN; Neha Vapiwala and Lawrence J. Solin, University of Pennsylvania
| | - Neha Vapiwala
- Nehmat Houssami, Robin Turner, Petra Macaskill, the Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Lindsay W. Turnbull, Centre for Magnetic Resonance Investigations, Hull York Medical School in association with University of Hull, Hull, United Kingdom; David R. McCready, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Todd M. Tuttle, University of Minnesota, Minneapolis, MN; Neha Vapiwala and Lawrence J. Solin, University of Pennsylvania
| | - Lawrence J. Solin
- Nehmat Houssami, Robin Turner, Petra Macaskill, the Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Lindsay W. Turnbull, Centre for Magnetic Resonance Investigations, Hull York Medical School in association with University of Hull, Hull, United Kingdom; David R. McCready, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Todd M. Tuttle, University of Minnesota, Minneapolis, MN; Neha Vapiwala and Lawrence J. Solin, University of Pennsylvania
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Fancellu A, Soro D, Castiglia P, Marras V, Melis M, Cottu P, Cherchi A, Spanu A, Mulas S, Pusceddu C, Simbula L, Meloni GB. Usefulness of magnetic resonance in patients with invasive cancer eligible for breast conservation: a comparative study. Clin Breast Cancer 2013; 14:114-21. [PMID: 24321101 DOI: 10.1016/j.clbc.2013.10.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 10/02/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND The role of magnetic resonance imaging (MRI) in newly detected breast cancer remains controversial. We investigated the impact of preoperative MRI on surgical management of infiltrating breast carcinoma (IBC). METHODS We reviewed data of 237 patients with IBC who were suitable for breast-conserving surgery (BCS) between 2009 and 2011. Of these patients, 109 underwent preoperative MRI (46%; MRI group) and 128 did not (54%; no-MRI group). We analyzed MRI-triggered changes in surgical plan and compared differences in rates of positive margins and mastectomy. RESULTS Tumor size was larger in the MRI group (16.8 mm vs. 13.9 mm; P < .001). MRI changed the initial surgical planning in 18 of 109 patients (16.5%) because of detection of larger tumor diameter requiring wider resection (8 patients [7.3%]) or additional malignant lesions in the ipsilateral (9 patients [8.2%]) or contralateral breast (1 patient [0.9%]). MRI-triggered treatment changes included mastectomy (n = 12), wider excision (n = 5), and contralateral BCS (n = 1). Reoperation rates for positive margins after BCS appeared higher in the no-MRI group (4.1% vs. 8.6%), but the difference missed statistical significance (P = .9). Overall mastectomy rates were higher in the MRI group (13.7% vs. 7.0%; P < .05). The likelihood of having a change of treatment resulting from MRI was significantly higher for patients with tumors > 15 mm and for those with positive lymph nodes. CONCLUSION Lymph node positivity and tumor size > 15 mm may predict an MRI-triggered change in surgical plan. Preoperative MRI resulted in higher mastectomy rates justified by biopsy-proven additional foci of carcinoma and did not significantly reduce reoperation rates for positive margins.
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Affiliation(s)
- Alessandro Fancellu
- Unit of General Surgery II, Clinica Chirurgica, University of Sassari, Sassari, Italy.
| | - Daniela Soro
- Department of Radiology, University of Sassari, Sassari, Italy
| | - Paolo Castiglia
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Vincenzo Marras
- Department of Pathology, University of Sassari, Sassari, Italy
| | - Marcovalerio Melis
- New York University School of Medicine and Department of Surgery, NY Harbor Healthcare System VAMC, New York, NY
| | - Pietrina Cottu
- Unit of General Surgery II, Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Alessandra Cherchi
- Unit of General Surgery II, Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Angela Spanu
- Department of Nuclear Medicine, University of Sassari, Sassari, Italy
| | - Silvia Mulas
- Unit of General Surgery II, Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Claudio Pusceddu
- Department of Radio-oncology, Oncological Hospital of Cagliari, Cagliari, Italy
| | - Luca Simbula
- Department of Radiology, University of Sassari, Sassari, Italy
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10
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Killelea BK, Long JB, Chagpar AB, Ma X, Soulos PR, Ross JS, Gross CP. Trends and clinical implications of preoperative breast MRI in Medicare beneficiaries with breast cancer. Breast Cancer Res Treat 2013; 141:155-63. [PMID: 23942872 DOI: 10.1007/s10549-013-2656-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 07/28/2013] [Indexed: 01/12/2023]
Abstract
While there has been increasing interest in the use of preoperative breast magnetic resonance imaging (MRI) for women with breast cancer, little is known about trends in MRI use, or the association of MRI with surgical approach among older women. Using the Surveillance, Epidemiology and End Results-Medicare database, we identified a cohort of women diagnosed with breast cancer from 2000 to 2009 who underwent surgery. We used Medicare claims to identify preoperative breast MRI and surgical approach. We evaluated temporal trends in MRI use according to age and type of surgery, and identified factors associated with MRI. We assessed the association between MRI and surgical approach: breast-conserving surgery (BCS) versus mastectomy, bilateral versus unilateral mastectomy, and use of contralateral prophylactic mastectomy. Among the 72,461 women in our cohort, 10.1 % underwent breast MRI. Preoperative MRI use increased from 0.8 % in 2000-2001 to 25.2 % in 2008-2009 (p < 0.001). Overall, 43.3 % received mastectomy and 56.7 % received BCS. After adjustment for clinical and demographic factors, MRI was associated with an increased likelihood of having a mastectomy compared to BCS (adjusted odds ratio = 1.21, 95 % CI 1.14-1.28). Among women who underwent mastectomy, MRI was significantly associated with an increased likelihood of having bilateral cancer diagnosed (9.7 %) and undergoing bilateral mastectomy (12.5 %) compared to women without MRI (3.7 and 4.1 %, respectively, p < 0.001 for both). In conclusion, the use of preoperative breast MRI has increased substantially among older women with breast cancer and is associated with an increased likelihood of being diagnosed with bilateral cancer, and more invasive surgery.
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Affiliation(s)
- Brigid K Killelea
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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11
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Houssami N, Morrow M. Does preoperative MRI improve clinical outcomes in breast cancer? BREAST CANCER MANAGEMENT 2013. [DOI: 10.2217/bmt.13.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY There is little consensus regarding the use of preoperative MRI in newly diagnosed breast cancer. Although preoperative breast MRI detects additional disease (relative to conventional assessment) in the ipsilateral or contralateral breast of breast cancer patients, this does not translate into improved treatment or patient outcomes. Two randomized trials have reported that preoperative MRI does not reduce re-excision surgery. Meta-analysis of controlled studies provides strong evidence that preoperative MRI significantly increases the odds of having a mastectomy without significantly reducing re-excision rates. The role of MRI in patients with invasive lobular cancer is uncertain; there is a suggestion of decreased re-excisions at the expense of an increase in mastectomy. Although data on long-term outcomes are limited to three observational studies, the two larger and adequately adjusted studies have found that preoperative MRI does not reduce ipsilateral breast tumor recurrence. Routine use of preoperative MRI in breast cancer should be discouraged, except in the context of research studies.
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Affiliation(s)
- Nehmat Houssami
- Screening & Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan–Kettering Cancer Center, New York, NY, USA
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