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Pan IW, Yen TW, Bedrosian I, Shih YCT. Current Trends in the Utilization of Preoperative Breast Magnetic Resonance Imaging Among Women With Newly Diagnosed Breast Cancer. JCO Oncol Pract 2023; 19:446-455. [PMID: 37071025 PMCID: PMC10337726 DOI: 10.1200/op.22.00578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 02/06/2023] [Accepted: 02/21/2023] [Indexed: 04/19/2023] Open
Abstract
PURPOSE The clinical benefit of preoperative breast magnetic resonance imaging (MRI) for early-stage breast cancer (BC) remains controversial. We examined trends and the associated factors of preoperative breast MRI use. METHODS This study cohort, constructed from Optum Clinformatics database, included women with early-stage BC who had a cancer surgery between March 1, 2008, and December 31, 2020. Preoperative breast MRI was performed between the date of BC diagnosis and index surgery. Multivariable logistic regressions, one for elderly (65 years and older) and the other for non-elderly patients (younger than 65 years), were performed to examine factors associated with the use of preoperative MRI. RESULTS Among 92,077 women with early-stage BC, the crude rate of preoperative breast MRI increased from 48% in 2008 to 60% in 2020 for nonelderly and from 27% to 34% for elderly women. For both age groups, non-Hispanic Blacks were less likely (odds ratio [OR]; 95% CI, younger than 65 years: 0.75, 0.70 to 0.81; 65 years and older: 0.77, 0.72 to 0.83) to receive preoperative MRI than non-Hispanic White patients. Across Census divisions, the highest adjusted rate was observed in Mountain division (OR compared with New England; 95% CI, younger than 65 years: 1.45, 1.27 to 1.65; 65 years and older: 2.42, 2.16 to 2.72). Other factors included younger age, fewer comorbidities, family history of BC, axillary node involvement, and neoadjuvant chemotherapy for both age groups. CONCLUSION The use of preoperative breast MRI has steadily increased. Aside from clinical factors, age, race/ethnicity, and geographic location were associated with preoperative MRI use. This information is important for future implementation or deimplementation strategies of preoperative MRI.
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Affiliation(s)
- I-Wen Pan
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tina W.F. Yen
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Isabelle Bedrosian
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
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Impact of contrast-enhanced mammography in surgical management of breast cancers for women with dense breasts: a dual-center, multi-disciplinary study in Asia. Eur Radiol 2022; 32:8226-8237. [PMID: 35788756 DOI: 10.1007/s00330-022-08906-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/14/2022] [Accepted: 05/20/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the impact of pre-operative contrast-enhanced mammography (CEM) in breast cancer patients with dense breasts. METHODS We conducted a retrospective review of 232 histologically proven breast cancers in 200 women (mean age: 53.4 years ± 10.2) who underwent pre-surgical CEM imaging across two Asian institutions (Singapore and Taiwan). Majority (95.5%) of patients had dense breast tissue (BI-RADS category C or D). Surgical decision was recorded in a simulated blinded multi-disciplinary team setting on two separate scenarios: (i) pre-CEM setting with standard imaging, and clinical and histopathological results; and (ii) post-CEM setting with new imaging and corresponding histological findings from CEM. Alterations in surgical plan (if any) because of CEM imaging were recorded. Predictors CEM of patients who benefitted from surgical plan alterations were evaluated using logistic regression. RESULTS CEM resulted in altered surgical plans in 36 (18%) of 200 patients in this study. CEM discovered clinically significant larger tumor size or extent in 24 (12%) patients and additional tumors in 12 (6%) patients. CEM also detected additional benign/false-positive lesions in 13 (6.5%) of the 200 patients. Significant predictors of patients who benefitted from surgical alterations found on multivariate analysis were pre-CEM surgical decision for upfront breast conservation (OR, 7.7; 95% CI, 1.9-32.1; p = 0.005), architectural distortion on mammograms (OR, 7.6; 95% CI, 1.3-42.9; p = .022), and tumor size of ≥ 1.5 cm (OR, 1.5; 95% CI, 1.0-2.2; p = .034). CONCLUSION CEM is an effective imaging technique for pre-surgical planning for Asian breast cancer patients with dense breasts. KEY POINTS • CEM significantly altered surgical plans in 18% (nearly 1 in 5) of this Asian study cohort with dense breasts. • Significant patient and imaging predictors for surgical plan alteration include (i) patients considered for upfront breast-conserving surgery; (ii) architectural distortion lesions; and (iii) tumor size of ≥ 1.5 cm. • Additional false-positive/benign lesions detected through CEM were uncommon, affecting only 6.5% of the study cohort.
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3
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Pak LM, Learn PA. ASO Author Reflections: Preoperative Breast MRI and Provider-Induced Demand. Ann Surg Oncol 2020; 27:3424-3425. [PMID: 32297082 DOI: 10.1245/s10434-020-08467-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Linda M Pak
- Department of Surgery, Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Brigham and Women's Hospital, Boston, MA, USA. .,Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - Peter A Learn
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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4
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Pak LM, Banaag A, Koehlmoos TP, Nguyen LL, Learn PA. Non-clinical Drivers of Variation in Preoperative MRI Utilization for Breast Cancer. Ann Surg Oncol 2020; 27:3414-3423. [PMID: 32215756 DOI: 10.1245/s10434-020-08380-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Preoperative magnetic resonance imaging (MRI) utilization in breast cancer treatment has increased significantly over the past 2 decades, but its use continues to have interprovider variability and disputed clinical indications. OBJECTIVE The aim of this study was to evaluate non-clinical factors associated with preoperative breast MRI utilization. METHODS This study utilized TRICARE claims data from 2006 to 2015. TRICARE provides health benefits for active duty service members, retirees, and their dependents at both military (direct care with salaried physicians) and civilian (purchased care under fee-for-service structure) facilities. We studied patients aged 25-64 years with a breast cancer diagnosis who had undergone mammogram/ultrasound (MMG/US) alone or with subsequent breast MRI prior to surgery. Facility characteristics included urban-rural location according to the National Center for Health Statistics classification. Adjusted multivariable logistic regression tests were used to identify independent factors associated with preoperative breast MRI utilization. RESULTS Of the 25,392 identified patients, 64.7% (n = 16,428) received preoperative MMG/US alone, while 35.3% (n = 8964) underwent additional MRI. Younger age, Charlson Comorbidity Index score ≥ 2, active duty or retired beneficiary category, officer rank (surrogate for socioeconomic status), Air Force service branch, metropolitan location, and purchased care were associated with an increased likelihood of preoperative MRI utilization. Non-metropolitan location and Navy service branch were associated with decreased MRI use. CONCLUSION After controlling for expected clinical risk factors, patients were more likely to receive additional MRI when treated at metropolitan facilities or through the fee-for-service system. Both associations may point toward non-clinical incentives to perform MRI in the treatment of breast cancer.
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Affiliation(s)
- Linda M Pak
- Department of Surgery, Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Brigham and Women's Hospital, Boston, MA, USA. .,Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - Amanda Banaag
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Tracey P Koehlmoos
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Louis L Nguyen
- Department of Surgery, Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Brigham and Women's Hospital, Boston, MA, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter A Learn
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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5
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Wang SY, Long JB, Killelea BK, Evans SB, Roberts KB, Silber AL, Davidoff AJ, Sedghi T, Gross CP. Associations of preoperative breast magnetic resonance imaging with subsequent mastectomy and breast cancer mortality. Breast Cancer Res Treat 2018; 172:453-461. [PMID: 30099634 PMCID: PMC6193824 DOI: 10.1007/s10549-018-4919-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To examine associations between pre-operative magnetic resonance imaging (MRI) use and clinical outcomes among women undergoing breast-conserving surgery (BCS) with or without radiotherapy for early-stage breast cancer. METHODS We identified women from the Surveillance, Epidemiology, and End Results-Medicare dataset aged 67-94 diagnosed during 2004-2010 with stage I/II breast cancer who received BCS. We compared subsequent mastectomy and breast cancer mortality with versus without pre-operative MRI, using Cox regression and competing risks models. We further stratified by receipt of radiotherapy for subgroup analyses. RESULTS Our sample consisted of 24,379 beneficiaries, 4691 (19.2%) of whom received pre-operative MRI. Adjusted rates of subsequent mastectomy and breast cancer mortality were not significantly different with and without MRI: 3.2 versus 4.1 per 1000 person-years [adjusted hazard ratio (AHR) 0.92; 95% confidence interval (CI) 0.70-1.19] and 5.3 versus 8.7 per 1000 person-years (AHR 0.89; 95% CI 0.73-1.08), respectively. In subgroup analyses, women receiving BCS plus radiotherapy had similar rates of subsequent mastectomy (AHR 1.17; 95% CI 0.84-1.61) and breast cancer mortality (AHR 1.00; 95% CI 0.80-1.24) with versus without MRI. However, among women receiving BCS alone, MRI use was associated with lower risks of subsequent mastectomy (AHR 0.60; 95% CI 0.37-0.98) and breast cancer mortality (AHR 0.57; 95% CI 0.36-0.92). CONCLUSIONS Pre-operative MRI was associated with improved outcomes among older women with breast cancer receiving BCS alone, but not among those receiving BCS plus radiotherapy. Further research is needed to identify appropriate settings for which MRI may be helpful.
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Affiliation(s)
- Shi-Yi Wang
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT, 06520, USA.
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA.
| | - Jessica B Long
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA
- Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Brigid K Killelea
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Suzanne B Evans
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Kenneth B Roberts
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Andrea L Silber
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA
- Section of Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Amy J Davidoff
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA
- Department of Health Policy and Management, Yale University School of Public Health, New Haven, CT, USA
| | - Tannaz Sedghi
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA
| | - Cary P Gross
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA
- Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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6
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Susnik B, Schneider L, Swenson KK, Krueger J, Braatz C, Lillemoe T, Tsai M, DeFor TE, Knaack M, Rueth N. Predictive value of breast magnetic resonance imaging in detecting mammographically occult contralateral breast cancer: Can we target women more likely to have contralateral breast cancer? J Surg Oncol 2018; 118:221-227. [PMID: 30196538 DOI: 10.1002/jso.25130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/19/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Preoperative breast magnetic resonance imaging (B-MRI) staging in newly diagnosed breast cancer increases detection of synchronous contralateral findings, but may result in false-positive outcomes. This study objective was to identify women more likely of having mammographically occult, MRI detected contralateral breast cancer (CBC). METHODS We performed a retrospective review of patients who had preoperative B-MRI prior to surgery from 2010 to 2015 and collected patient imaging and clinicopathologic data. Multivariate logistic regression was used to identify predictors of CBC. RESULTS MRI resulted in contralateral findings in 201 of 1894 patients (10.6%). Overall 3.2% (60 of 1894) had synchronous CBC detected on B-MRI. The majority of CBCs (n = 60) were stage 0 or IA (85.0%), hormone receptor positive (94.9%), human epidermal growth factor receptor 2 (HER2/neu) negative (89.7%), and low/intermediate pathological grade (87.2%). Women more likely to have CBC were older (P < .001), had lobular index cancer (P = .03), and estrogen receptor (ER)+ (P = .027) or progesterone receptor (PR)+ (P = .002) tumors. On multivariate analysis (receiver operating characteristic curve area = 0.75), PR + status (P = .022), and older age (P = .004) were predictive of CBC. CONCLUSIONS Preoperative MRI is most effective in detecting early stage, hormone receptor-positive CBC in older women.
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Affiliation(s)
| | - Lisa Schneider
- Consulting Radiologists Ltd, Piper Breast Center, Virginia Piper Cancer Institute, Minneapolis, Minnesota
| | - Karen K Swenson
- Allina Health System, Virginia Piper Cancer Institute, Minneapolis, Minnesota
| | - Janet Krueger
- Allina Health System, Virginia Piper Cancer Institute, Minneapolis, Minnesota
| | - Christina Braatz
- Consulting Radiologists Ltd, Piper Breast Center, Virginia Piper Cancer Institute, Minneapolis, Minnesota
| | | | - Michaela Tsai
- Allina Health System, Virginia Piper Cancer Institute, Minneapolis, Minnesota
| | - Todd E DeFor
- Biostatistics Core, University of Minnesota, Minneapolis, Minnesota
| | - Monica Knaack
- Allina Health System, Virginia Piper Cancer Institute, Minneapolis, Minnesota
| | - Natasha Rueth
- Allina Health System, Virginia Piper Cancer Institute, Minneapolis, Minnesota
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7
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Henderson LM, Hubbard RA, Zhu W, Weiss J, Wernli KJ, Goodrich ME, Kerlikowske K, DeMartini W, Ozanne EM, Onega T. Preoperative Breast Magnetic Resonance Imaging Use by Breast Density and Family History of Breast Cancer. J Womens Health (Larchmt) 2018; 27:987-993. [PMID: 29334616 DOI: 10.1089/jwh.2017.6428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Use of preoperative breast magnetic resonance imaging (MRI) among women with a new breast cancer has increased over the past decade. MRI use is more frequent in younger women and those with lobular carcinoma, but associations with breast density and family history of breast cancer are unknown. MATERIALS AND METHODS Data for 3075 women ages >65 years with stage 0-III breast cancer who underwent breast conserving surgery or mastectomy from 2005 to 2010 in the Breast Cancer Surveillance Consortium were linked to administrative claims data to assess associations of preoperative MRI use with mammographic breast density and first-degree family history of breast cancer. Multivariable logistic regression estimated adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for the association of MRI use with breast density and family history, adjusting for woman and tumor characteristics. RESULTS Overall, preoperative MRI use was 16.4%. The proportion of women receiving breast MRI was similar by breast density (17.6% dense, 16.9% nondense) and family history (17.1% with family history, 16.5% without family history). After adjusting for potential confounders, we found no difference in preoperative MRI use by breast density (OR = 0.95 for dense vs. nondense, 95% CI: 0.73-1.22) or family history (OR = 0.99 for family history vs. none, 95% CI: 0.73-1.32). CONCLUSIONS Among women aged >65 years with breast cancer, having dense breasts or a first-degree relative with breast cancer was not associated with greater preoperative MRI use. This utilization is in keeping with lack of evidence that MRI has higher yield of malignancy in these subgroups.
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Affiliation(s)
- Louise M Henderson
- 1 Department of Radiology, The University of North Carolina , Chapel Hill, North Carolina
| | - Rebecca A Hubbard
- 2 Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Weiwei Zhu
- 3 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Julie Weiss
- 4 Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire
| | - Karen J Wernli
- 3 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Martha E Goodrich
- 4 Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire
| | - Karla Kerlikowske
- 5 Departments of Medicine and Epidemiology and Biostatistics, University of California , San Francisco, San Francisco, California
| | - Wendy DeMartini
- 6 Department of Radiology, Stanford University , Stanford, California
| | - Elissa M Ozanne
- 7 Department of Population Health Sciences, University of Utah School of Medicine , Salt Lake City, Utah
| | - Tracy Onega
- 8 The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center , Geisel School of Medicine at Dartmouth, Lebanon , New Hampshire
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9
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Goodrich ME, Weiss J, Onega T, Balch SL, Buist DSM, Kerlikowske K, Henderson LM, Hubbard RA. The Role of Preoperative Magnetic Resonance Imaging in the Assessment and Surgical Treatment of Interval and Screen-Detected Breast Cancer in Older Women. Breast J 2016; 22:616-622. [PMID: 27550072 DOI: 10.1111/tbj.12651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
We describe the relationship between preoperative magnetic resonance imaging (MRI) and the utilization of additional imaging, biopsy, and primary surgical treatment for subgroups of women with interval versus screen-detected breast cancer. We determined the proportion of women receiving additional breast imaging or biopsy and type of primary surgical treatment, stratified by use of preoperative MRI, separately for both groups. Using Breast Cancer Surveillance Consortium (BCSC) data, we identified a cohort of women age 66 and older with an interval or screen-detected breast cancer diagnosis between 2005 and 2010. Using logistic regression, we explored associations between primary surgical treatment type and preoperative MRI use for interval and screen-detected cancers. There were 204 women with an interval cancer and 1,254 with a screen-detected cancer. The interval cancer group was more likely to receive preoperative MRI (21% versus 13%). In both groups, women receiving MRI were more likely to receive additional imaging and/or biopsy. Receipt of MRI was not associated with increased odds of mastectomy (OR = 0.99, 95% CI: 0.67-1.50), while interval cancer diagnosis was associated with significantly higher odds of mastectomy (OR = 1.64, 95% CI: 1.11-2.42). Older women with interval cancer were more likely than women with a screen-detected cancer to have preoperative MRI, however, those with an interval cancer had 64% higher odds of mastectomy regardless of receipt of MRI. Given women with interval cancer are reported to have a worse prognosis, more research is needed to understand effectiveness of imaging modalities and treatment consequences within this group.
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Affiliation(s)
- Martha E Goodrich
- Department of Biomedical Data Sciences, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Julie Weiss
- Department of Biomedical Data Sciences, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Tracy Onega
- Department of Biomedical Data Sciences, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.,The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Steve L Balch
- Group Health Research Institute, Seattle, Washington
| | | | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.,General Internal Medicine Section, Department of Veterans Affairs, University of California at San Francisco, San Francisco, California
| | - Louise M Henderson
- Department of Radiology, The University of North Carolina, Chapel Hill, North Carolina
| | - Rebecca A Hubbard
- Group Health Research Institute, Seattle, Washington.,Department of Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
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Tardivel AM, Balleyguier C, Dunant A, Delaloge S, Mazouni C, Mathieu MC, Dromain C. Added Value of Contrast-Enhanced Spectral Mammography in Postscreening Assessment. Breast J 2016; 22:520-8. [DOI: 10.1111/tbj.12627] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Corinne Balleyguier
- Radiology Department; Gustave Roussy; Villejuif France
- UMR 8081, IR4M; Paris-Sud University; Orsay France
| | - Ariane Dunant
- Department of Statstics; Gustave Roussy; Villejuif France
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11
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Wang SY, Long JB, Killelea BK, Evans SB, Roberts KB, Silber A, Gross CP. Preoperative breast magnetic resonance imaging and contralateral breast cancer occurrence among older women with ductal carcinoma in situ. Breast Cancer Res Treat 2016; 158:139-148. [PMID: 27287780 DOI: 10.1007/s10549-016-3858-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/06/2016] [Indexed: 11/24/2022]
Abstract
Although preoperative magnetic resonance imaging (MRI) can detect mammographically occult contralateral breast cancers (CBCs) among women with ductal carcinoma in situ (DCIS), the impact of MRI on the incidence of subsequent CBC events is unclear. We examined whether MRI use decreases CBC occurrences and detection of invasive disease among women who develop a CBC. Utilizing the Surveillance, Epidemiology, and End Results-Medicare dataset, we assessed overall, synchronous (<6 months after primary cancer diagnosis), and subsequent (≥6 months after diagnosis, i.e., metachronous) CBC occurrence in women aged 67-94 years diagnosed with DCIS during 2004-2009, with follow-up through 2011. We applied a matched propensity score approach to compare the stage-specific incidence rate of CBC according to MRI use. Our sample consisted of 9166 beneficiaries, 1258 (13.7 %) of whom received preoperative MRI. After propensity score matching, preoperative MRI use was significantly associated with a higher synchronous CBC detection rate (108.6 vs. 29.7 per 1000 person-years; hazard ratio [HR] = 3.65; p < .001) with no significant differences in subsequent CBC rate (6.7 vs. 6.8 per 1000 person-years; HR = 0.90; p = .71). The 6-year cumulative incidence of any CBC (in situ plus invasive) remained significantly higher among women undergoing MRI, compared with those not undergoing MRI (9 vs. 4 %, p < .001). Women undergoing MRI also had a higher incidence of invasive CBC (4 vs. 3 %, p = .04). MRI use resulted in an increased detection of synchronous CBC but did not prevent subsequent CBC occurrence, suggesting that many of the undetected CBC lesions may not become clinically evident.
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Affiliation(s)
- Shi-Yi Wang
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT, 06520, USA. .,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA.
| | - Jessica B Long
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA.,Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Brigid K Killelea
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA.,Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Suzanne B Evans
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA.,Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Kenneth B Roberts
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA.,Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Andrea Silber
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA.,Section of Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Cary P Gross
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA.,Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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Kerger AL, Stamatis TA. Contributions and Controversies of Preoperative DCE-Breast MRI. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0143-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Onega T, Tosteson ANA, Weiss J, Alford-Teaster J, Hubbard RA, Henderson LM, Kerlikowske K, Goodrich ME, O'Donoghue C, Wernli KJ, DeMartini WB, Virnig BA. Costs of diagnostic and preoperative workup with and without breast MRI in older women with a breast cancer diagnosis. BMC Health Serv Res 2016; 16:76. [PMID: 26920552 PMCID: PMC4769533 DOI: 10.1186/s12913-016-1317-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 02/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer in the U.S. - estimated at 232,670 incident cases in 2014 - has the highest aggregate economic burden of care relative to other female cancers. Yet, the amount of cost attributed to diagnostic/preoperative work up has not been characterized. We examined the costs of imaging and biopsy among women enrolled in Medicare who did and did not receive diagnostic/preoperative Magnetic Resonance Imaging (MRI). METHODS Using Surveillance, Epidemiology and End Results (SEER)- Medicare data, we compared the per capita costs (PCC) based on amount paid, between diagnosis date and primary surgical treatment for a breast cancer diagnosis (2005-2009) with and without diagnostic/preoperative MRI. We compared the groups with and without MRI using multivariable models, adjusting for woman and tumor characteristics. RESULTS Of the 53,653 women in the cohort, within the diagnostic/preoperative window, 20 % (N = 10,776) received diagnostic/preoperative MRI. Total unadjusted median costs were almost double for women with MRI vs. without ($2,251 vs. $1,152). Adjusted costs were higher among women receiving MRI, with significant differences in total costs ($1,065), imaging costs ($928), and biopsies costs ($138). CONCLUSION Costs of diagnostic/preoperative workups among women with MRI are higher than those without. Using these cost estimates in comparative effectiveness models should be considered when assessing the benefits and harms of diagnostic/preoperative MRI.
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Affiliation(s)
- Tracy Onega
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Medical Center Drive, Lebanon, NH, USA. .,Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. .,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Anna N A Tosteson
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. .,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Julie Weiss
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Medical Center Drive, Lebanon, NH, USA. .,Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Jennifer Alford-Teaster
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Medical Center Drive, Lebanon, NH, USA. .,Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Rebecca A Hubbard
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA.
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA. .,Department of Veterans Affairs, General Internal Medicine Section, University of California, San Francisco, CA, USA.
| | - Martha E Goodrich
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Medical Center Drive, Lebanon, NH, USA. .,Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | | | | | - Wendy B DeMartini
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Beth A Virnig
- School of Public Health, University of Minnesota, Minneapolis, MN, USA.
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14
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Henderson LM, Weiss J, Hubbard RA, O'Donoghue C, DeMartini WB, Buist DS, Kerlikowske K, Goodrich M, Virnig B, Tosteson AN, Lehman CD, Onega T. Factors Associated with Preoperative Magnetic Resonance Imaging Use among Medicare Beneficiaries with Nonmetastatic Breast Cancer. Breast J 2016; 22:24-34. [PMID: 26511204 PMCID: PMC4718842 DOI: 10.1111/tbj.12522] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Preoperative breast magnetic resonance imaging (MRI) use among Medicare beneficiaries with breast cancer has substantially increased from 2005 to 2009. We sought to identify factors associated with preoperative breast MRI use among women diagnosed with ductal carcinoma in situ (DCIS) or stage I-III invasive breast cancer (IBC). Using Surveillance, Epidemiology, and End Results and Medicare data from 2005 to 2009 we identified women ages 66 and older with DCIS or stage I-III IBC who underwent breast-conserving surgery or mastectomy. We compared preoperative breast MRI use by patient, tumor and hospital characteristics stratified by DCIS and IBC using multivariable logistic regression. From 2005 to 2009, preoperative breast MRI use increased from 5.9% to 22.4% of women diagnosed with DCIS and 7.0% to 24.3% of women diagnosed with IBC. Preoperative breast MRI use was more common among women who were younger, married, lived in higher median income zip codes and had no comorbidities. Among women with IBC, those with lobular disease, smaller tumors (<1 cm) and those with estrogen receptor negative tumors were more likely to receive preoperative breast MRI. Women with DCIS were more likely to receive preoperative MRI if tumors were larger (>2 cm). The likelihood of receiving preoperative breast MRI is similar for women diagnosed with DCIS and IBC. Use of MRI is more common in women with IBC for tumors that are lobular and smaller while for DCIS MRI is used for evaluation of larger lesions.
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Affiliation(s)
| | - Julie Weiss
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Rebecca A. Hubbard
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, University of Washington, Seattle, WA
| | | | | | | | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
- General Internal Medicine Section, Department of Veterans Affairs, University of California at San Francisco, San Francisco, CA
| | - Martha Goodrich
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Beth Virnig
- School of Public Health, Division of Health Policy and Management, University of Minnesota, Minneapolis, MN
| | - Anna N.A. Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Constance D. Lehman
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA
| | - Tracy Onega
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Hanover, NH
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15
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Wang SY, Long JB, Killelea BK, Evans SB, Roberts KB, Silber A, Gross CP. Preoperative Breast Magnetic Resonance Imaging and Contralateral Breast Cancer Occurrence Among Older Women With Breast Cancer. J Clin Oncol 2015; 34:321-8. [PMID: 26628465 DOI: 10.1200/jco.2015.62.9741] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Preoperative magnetic resonance imaging (MRI) detects occult contralateral breast cancers (CBCs) in women with breast cancer, but the impact of detection on long-term CBC events is unclear. We examined whether MRI use decreases the occurrence of CBCs and the detection of stages II to IV disease among women who develop a CBC. PATIENTS AND METHODS Analyzing the SEER-Medicare database, we assessed overall, synchronous (< 6 months after primary cancer diagnosis), and subsequent (ie, metachronous) stage-specific CBC occurrences in women who were diagnosed with stages I and II breast cancer during 2004-2009 and who were observed through 2011. RESULTS Among 38,971 women with breast cancer, 6,377 (16.4%) received preoperative MRI. After propensity score matching, and compared with women who did not undergo MRI, preoperative MRI use was significantly associated with a higher synchronous CBC detection rate (126.4 v 42.9 per 1,000 person-years, respectively; hazard ratio, 2.85; P < .001) but a lower subsequent CBC detection rate (3.3 v 4.5 per 1,000 person-years, respectively; hazard ratio, 0.68; P = .002). However, the 5-year cumulative incidence of CBC remained significantly higher among women undergoing MRI compared with those not undergoing MRI (7.2% v 4.0%, respectively; P < .001). The analyses of projected CBC events for 10,000 patients who receive MRI indicated that, after a 5-year follow-up, MRI use would detect an additional 192 in situ CBCs (95% CI, 125 to 279) and 120 stage I CBCs (95% CI, 62 to 193) but would not have a significant impact on stages II to IV CBC occurrences (∼ 6; 95% CI, -21 to 47). CONCLUSION An increased synchronous CBC detection rate, attributable to MRI, was not offset by a decrease of subsequent CBC occurrence among older women with early-stage breast cancer, suggesting that preoperative MRI in women with breast cancer may lead to overdiagnosis.
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Affiliation(s)
- Shi-Yi Wang
- Shi-Yi Wang, Yale University School of Public Health; and Shi-Yi Wang, Jessica B. Long, Brigid K. Killelea, Suzanne B. Evans, Kenneth B. Roberts, Andrea Silber, and Cary P. Gross, Yale Cancer Center and Yale University School of Medicine, New Haven, CT.
| | - Jessica B Long
- Shi-Yi Wang, Yale University School of Public Health; and Shi-Yi Wang, Jessica B. Long, Brigid K. Killelea, Suzanne B. Evans, Kenneth B. Roberts, Andrea Silber, and Cary P. Gross, Yale Cancer Center and Yale University School of Medicine, New Haven, CT
| | - Brigid K Killelea
- Shi-Yi Wang, Yale University School of Public Health; and Shi-Yi Wang, Jessica B. Long, Brigid K. Killelea, Suzanne B. Evans, Kenneth B. Roberts, Andrea Silber, and Cary P. Gross, Yale Cancer Center and Yale University School of Medicine, New Haven, CT
| | - Suzanne B Evans
- Shi-Yi Wang, Yale University School of Public Health; and Shi-Yi Wang, Jessica B. Long, Brigid K. Killelea, Suzanne B. Evans, Kenneth B. Roberts, Andrea Silber, and Cary P. Gross, Yale Cancer Center and Yale University School of Medicine, New Haven, CT
| | - Kenneth B Roberts
- Shi-Yi Wang, Yale University School of Public Health; and Shi-Yi Wang, Jessica B. Long, Brigid K. Killelea, Suzanne B. Evans, Kenneth B. Roberts, Andrea Silber, and Cary P. Gross, Yale Cancer Center and Yale University School of Medicine, New Haven, CT
| | - Andrea Silber
- Shi-Yi Wang, Yale University School of Public Health; and Shi-Yi Wang, Jessica B. Long, Brigid K. Killelea, Suzanne B. Evans, Kenneth B. Roberts, Andrea Silber, and Cary P. Gross, Yale Cancer Center and Yale University School of Medicine, New Haven, CT
| | - Cary P Gross
- Shi-Yi Wang, Yale University School of Public Health; and Shi-Yi Wang, Jessica B. Long, Brigid K. Killelea, Suzanne B. Evans, Kenneth B. Roberts, Andrea Silber, and Cary P. Gross, Yale Cancer Center and Yale University School of Medicine, New Haven, CT
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16
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Pellet AC, Erten MZ, James TA. Value analysis of postoperative staging imaging for asymptomatic, early-stage breast cancer: implications of clinical variation on utility and cost. Am J Surg 2015; 211:1084-8. [PMID: 26545344 DOI: 10.1016/j.amjsurg.2015.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 06/23/2015] [Accepted: 08/02/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Routine staging imaging for early-stage breast cancer is not recommended. Despite this, there is clinical practice variation with imaging studies obtained for asymptomatic patients with a positive sentinel node (SN+). We characterize the utility, cost, and clinical implications of imaging studies obtained in asymptomatic SN+ patients. METHODS A retrospective review was performed of asymptomatic, clinically node-negative patients who were found to have a positive sentinel node after surgery. The type of imaging, subsequent tests/interventions, frequency of additional malignancy detected, and costs were recorded. RESULTS From April 2009 to April 2013, a total of 50 of 113 (44%) asymptomatic patients underwent staging imaging for a positive sentinel node; 11 (22%) patients had at least 1 subsequent imaging study or diagnostic intervention. No instance of metastatic breast cancer was identified, with a total cost of imaging calculated at $116,905. CONCLUSIONS Staging imaging for asymptomatic SN+ breast cancer demonstrates clinical variation. These tests were associated with low utility, increased costs, and frequent false positives leading to subsequent testing/intervention. Evidence-based standardization may help increase quality by decreasing unnecessary variation and cost.
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Affiliation(s)
- Andrew C Pellet
- Department of Surgery, University of Vermont, 89 Beaumont Avenue, Given Building, Burlington, VT, 05405, USA
| | - Mujde Z Erten
- Department of Surgery, University of Vermont, 89 Beaumont Avenue, Given Building, Burlington, VT, 05405, USA
| | - Ted A James
- Department of Surgery, University of Vermont, 89 Beaumont Avenue, Given Building, Burlington, VT, 05405, USA.
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17
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Pilewskie M, Hirsch A, Eaton A, Stempel M, Gemignani ML. Breast Cancer in the Elderly: Is MRI Helpful? Breast J 2015; 21:651-7. [PMID: 26400412 DOI: 10.1111/tbj.12504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Appropriate use of magnetic resonance imaging (MRI) in elderly breast cancer (BC) patients remains unclear; we sought to identify the indications and implications of MRI use in our elderly BC population. Women 70 years of age or older at first BC diagnosis with an MRI performed at our institution either perioperatively or in follow-up were included from a prospectively maintained database from 2000 to 2010. Univariate logistic regression was used to test associations with disease identified by MRI only (additional ipsilateral, contralateral, or new cancer) following perioperative MRI. 305 BCs were imaged in 286 patients. 133 were imaged with MRI in the perioperative setting alone, 88 had only follow-up MRIs after BC treatment, and 65 had both. Indications for perioperative MRI include: extent of disease evaluation (181; 91%); occult primary (10; 5%); high-risk screening (5; 3%); and abnormal physical exam with negative conventional imaging (2; 1%). Disease identified by MRI only for occult primary cases was 4/10 (40%; 95% confidence interval: 12.2-73.8%) and 14/181 (7.7%; 95% confidence interval: 4.3-12.6%) for perioperative MRIs performed for extent of disease evaluation. Analysis of imaging and tumor characteristics failed to find significant predictors of disease identified by MRI only. A total of 369 post-treatment follow-up MRIs were performed in 148 patients with a median of 2 MRIs per patient (range 1-8), with seven cases of disease identified by MRI only (1.9%; 95% confidence interval: 0.8-3.9%). MRI had the greatest benefit in women presenting with an occult primary cancer and minimal additional benefit in elderly patients with BC undergoing MRI imaging for extent of disease evaluation or in post-treatment surveillance.
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Affiliation(s)
- Melissa Pilewskie
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Allison Hirsch
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anne Eaton
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michelle Stempel
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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18
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Pilewskie M, King TA. Magnetic resonance imaging in patients with newly diagnosed breast cancer: a review of the literature. Cancer 2014; 120:2080-9. [PMID: 24752817 DOI: 10.1002/cncr.28700] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/21/2014] [Accepted: 03/14/2014] [Indexed: 12/14/2022]
Abstract
The use of magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer remains controversial. Here we review the current use of breast MRI and the impact of MRI on short-term surgical outcomes and rates of local recurrence. In addition, we address the use of MRI in specific patient populations, such as those with ductal carcinoma in situ, invasive lobular carcinoma, and occult primary breast cancer, and discuss the potential role of MRI for assessing response to neoadjuvant chemotherapy. Although MRI has improved sensitivity compared with conventional imaging, this has not translated into improved short-term surgical outcomes or long-term patient benefit, such as improved local control or survival, in any patient population. MRI is an important diagnostic test in the evaluation of patients presenting with occult primary breast cancer and has shown promise in monitoring response to neoadjuvant chemotherapy; however, the data do not support the routine use of perioperative MRI in patients with newly diagnosed breast cancer. Cancer 2014;120:120:2080-2089. © 2014 American Cancer Society.
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Affiliation(s)
- Melissa Pilewskie
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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19
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Fortune-Greeley AK, Wheeler SB, Meyer AM, Reeder-Hayes KE, Biddle AK, Muss HB, Carpenter WR. Preoperative breast MRI and surgical outcomes in elderly women with invasive ductal and lobular carcinoma: a population-based study. Breast Cancer Res Treat 2014; 143:203-12. [PMID: 24305978 PMCID: PMC4093828 DOI: 10.1007/s10549-013-2787-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 11/22/2013] [Indexed: 12/29/2022]
Abstract
Existing evidence suggests that preoperative breast magnetic resonance imaging (MRI) might not improve surgical outcomes in the general breast cancer population. To determine if patients differentially benefit from breast MRI, we examined surgical outcomes-initial mastectomy, reoperation, and final mastectomy rates-among patients grouped by histologic type. We identified women diagnosed with early-stage breast cancer from 2004 to 2007 in the SEER-Medicare dataset. We classified patients as having invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), mixed ductal/lobular carcinoma (IDLC) or other histologic type. Medicare claims were used to identify breast MRI and definitive surgeries during the initial surgical treatment episode. We used propensity score methods to account for the differential likelihood of exposure to MRI. Of the 20,332 patients who met our inclusion criteria for this study, 12.2 % had a preoperative breast MRI. Patients with ILC as compared to other histologic groups were most likely to receive MRI [OR 2.32; 95 % CI (2.02-2.67)]. In the propensity score-adjusted analyses, breast MRI was associated with an increased likelihood of an initial mastectomy for all patients and among all histologic subgroups. Among patients with ILC, having a breast MRI was associated with lower odds of a reoperation [OR 0.59; 95 % CI (0.40-0.86)], and an equal likelihood of a final mastectomy compared to similar patients without a breast MRI. Overall and among patients with IDC and IDLC, breast MRI was not significantly associated with a likelihood of a reoperation but was associated with greater odds of a final mastectomy. Our study provides evidence in support of the targeted use of preoperative breast MRI among patients with ILC to improve surgical planning; it does not provide evidence for the routine use of breast MRI among all newly diagnosed breast cancer patients or among patients with IDC.
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Affiliation(s)
- Alice K Fortune-Greeley
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, CB#7411, Chapel Hill, NC, 27599, USA,
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20
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Wang SY, Kuntz KM, Tuttle TM, Jacobs DR, Kane RL, Virnig BA. The association of preoperative breast magnetic resonance imaging and multiple breast surgeries among older women with early stage breast cancer. Breast Cancer Res Treat 2013; 138:137-47. [PMID: 23354364 DOI: 10.1007/s10549-013-2420-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 01/15/2013] [Indexed: 11/26/2022]
Abstract
To evaluate the association between preoperative breast magnetic resonance imaging (MRI) utilization and the rate of multiple surgeries, and to investigate the extent of any variation of rates of multiple surgeries among physicians. We identified patients with stage 0, I, or II breast cancer diagnosed between 2002 and 2007 in the Surveillance, Epidemiology, and End Results-Medicare database. Using diagnosis and procedure codes, we defined that the initial treatment episode had ended when a gap in surgery occurred at least 90 days after primary surgery. Surgical procedures of partial mastectomy or mastectomy during the initial treatment period were calculated to identify patients who received multiple surgeries. Multilevel logistic regression models were used to identify patient- and physician-level predictors of multiple surgeries. Of 45,453 women with early stage breast cancer who were treated by 2,595 surgeons during the study period, 9,462 patients (20.8 %) received multiple breast surgeries; of these patients, 8,318 (87.9 %) underwent one additional surgery, 988 (10.4 %) received two additional surgeries, and 156 (1.6 %) received three or more additional surgeries. Among 2,997 (6.6 % of the entire cohort) women who underwent preoperative breast MRI evaluation, 770 received multiple breast surgeries. After we adjusted for patient and tumor characteristics associated with multiple surgeries, we found that the rate of multiple surgeries was not significantly different between the two groups with or without preoperative breast MRI. Furthermore, the median odds ratio of 2.0, corresponding with the median value of the relative odds of receiving multiple surgeries between two randomly chosen physicians after controlling for other confounders, indicated a large individual surgeon effect. Substantial variation was observed in the rates of multiple surgeries in women aged 66 and older with early stage breast cancer. Evidence does not support that preoperative breast MRI reduces the incidence of multiple surgeries.
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Affiliation(s)
- Shi-Yi Wang
- Division of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, Room 432, New Haven, CT 06520, USA.
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