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Choi S, Borowsky PA, Morgan O, Kwon D, Zhao W, Koru-Sengul T, Gilna G, Net J, Kesmodel S, Goel N, Patel Y, Griffiths A, Feinberg JA, Kangas-Dick A, Andaz C, Giuliano C, Zelenko N, Manasseh DM, Borgen P, Rojas KE. A Multi-institutional Analysis of Factors Influencing the Rate of Positive MRI Biopsy Among Women with Early-Stage Breast Cancer. Ann Surg Oncol 2024; 31:3141-3153. [PMID: 38286883 DOI: 10.1245/s10434-024-14954-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/09/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND The use of preoperative magnetic resonance imaging (MRI) for early-stage breast cancer (ESBC) is increasing, but its utility in detecting additional malignancy is unclear and delays surgical management (Jatoi and Benson in Future Oncol 9:347-353, 2013. https://doi.org/10.2217/fon.12.186 , Bleicher et al. J Am Coll Surg 209:180-187, 2009. https://doi.org/10.1016/j.jamcollsurg.2009.04.010 , Borowsky et al. J Surg Res 280:114-122, 2022. https://doi.org/10.1016/j.jss.2022.06.066 ). The present study sought to identify ESBC patients most likely to benefit from preoperative MRI by assessing the positive predictive values (PPVs) of ipsilateral and contralateral biopsies. METHODS A retrospective cohort study included patients with cTis-T2N0-N1 breast cancer from two institutions during 2016-2021. A "positive" biopsy result was defined as additional cancer (PositiveCancer) or cancer with histology often excised (PositiveSurg). The PPV of MRI biopsies was calculated with respect to age, family history, breast density, and histology. Uni- and multivariate logistic regression determined whether combinations of age younger than 50 years, dense breasts, family history, and pure ductal carcinoma in situ (DCIS) histology led to higher biopsy yield. RESULTS Of the included patients, 447 received preoperative MRI and 131 underwent 149 MRI-guided biopsies (96 ipsilateral, 53 contralateral [18 bilateral]). PositiveCancer for ipsilateral biopsy was 54.2%, and PositiveCancer for contralateral biopsy was 17.0%. PositiveSurg for ipsilateral biopsy was 62.5%, and PositiveSurg for contralateral biopsy was 24.5%. Among the contralateral MRI biopsies, patients younger than 50 years were less likely to have PositiveSurg (odds ratio, 0.02; 95% confidence interval, 0.00-0.84; p = 0.041). The combinations of age, density, family history, and histology did not lead to a higher biopsy yield. CONCLUSION Historically accepted factors for recommending preoperative MRI did not appear to confer a higher MRI biopsy yield. To prevent delays to surgical management, MRI should be carefully selected for individual patients most likely to benefit from additional imaging.
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Affiliation(s)
- Seraphina Choi
- Division of Surgical Oncology, Dewitt Daughtry Department of Surgery, University of Miami, Miami, FL, USA
| | - Peter A Borowsky
- Division of Surgical Oncology, Dewitt Daughtry Department of Surgery, University of Miami, Miami, FL, USA
| | - Orly Morgan
- Division of Surgical Oncology, Dewitt Daughtry Department of Surgery, University of Miami, Miami, FL, USA
| | - Deukwoo Kwon
- Division of Biostatistics, Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Wei Zhao
- Division of Biostatistics, Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Tulay Koru-Sengul
- Division of Biostatistics, Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Gareth Gilna
- Division of Surgical Oncology, Dewitt Daughtry Department of Surgery, University of Miami, Miami, FL, USA
| | - Jose Net
- Division of Breast Imaging, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Susan Kesmodel
- Division of Surgical Oncology, Dewitt Daughtry Department of Surgery, University of Miami, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Neha Goel
- Division of Surgical Oncology, Dewitt Daughtry Department of Surgery, University of Miami, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Yamini Patel
- Wright Center for Graduate Medical Education, Scranton, PA, USA
| | - Alexa Griffiths
- Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | | | | | | | | | - Natalie Zelenko
- Department of Radiology, Maimonides Medical Center, Brooklyn, NY, USA
| | | | - Patrick Borgen
- Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Kristin E Rojas
- Division of Surgical Oncology, Dewitt Daughtry Department of Surgery, University of Miami, Miami, FL, USA.
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.
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Singh P, Agnese D, Amin M, Barrio AV, Botty Van den Bruele A, Burke E, Danforth DN, Dirbas FM, Eladoumikdachi F, Kantor O, Kumar S, Lee MC, Matsen C, Nguyen TT, Ozmen T, Park KU, Plichta JK, Reyna C, Showalter SL, Styblo T, Tranakas N, Weiss A, Laronga C, Boughey J. Society of Surgical Oncology Breast Disease Site Working Group Statement on Contralateral Mastectomy: Indications, Outcomes, and Risks. Ann Surg Oncol 2024; 31:2212-2223. [PMID: 38261126 DOI: 10.1245/s10434-024-14893-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/29/2023] [Indexed: 01/24/2024]
Abstract
Rates of contralateral mastectomy (CM) among patients with unilateral breast cancer have been increasing in the United States. In this Society of Surgical Oncology position statement, we review the literature addressing the indications, risks, and benefits of CM since the society's 2017 statement. We held a virtual meeting to outline key topics and then conducted a literature search using PubMed to identify relevant articles. We reviewed the articles and made recommendations based on group consensus. Patients consider CM for many reasons, including concerns regarding the risk of contralateral breast cancer (CBC), desire for improved cosmesis and symmetry, and preferences to avoid ongoing screening, whereas surgeons primarily consider CBC risk when making a recommendation for CM. For patients with a high risk of CBC, CM reduces the risk of new breast cancer, however it is not known to convey an overall survival benefit. Studies evaluating patient satisfaction with CM and reconstruction have yielded mixed results. Imaging with mammography within 12 months before CM is recommended, but routine preoperative breast magnetic resonance imaging is not; there is also no evidence to support routine postmastectomy imaging surveillance. Because the likelihood of identifying an occult malignancy during CM is low, routine sentinel lymph node surgery is not recommended. Data on the rates of postoperative complications are conflicting, and such complications may not be directly related to CM. Adjuvant therapy delays due to complications have not been reported. Surgeons can reduce CM rates by encouraging shared decision making and informed discussions incorporating patient preferences.
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Affiliation(s)
- Puneet Singh
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | | | | | - Andrea V Barrio
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | | | - Erin Burke
- University of Kentucky, Lexington, KY, USA
| | | | | | | | - Olga Kantor
- Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Shicha Kumar
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | | | | | - Tolga Ozmen
- Massachusetts General Hospital, Boston, MA, USA
| | - Ko Un Park
- Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | - Anna Weiss
- University of Rochester Medical Center, Rochester, NY, USA
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Steadman JA, Hoskin TL, Klassen C, Boughey JC, Degnim AC, Piltin MA, Mrdutt MM, Johnson JE, Hieken TJ. Assessment of the effect of the American Society of Breast Surgery guidelines on contralateral prophylactic mastectomy rates for unilateral breast cancer. Surgery 2024; 175:677-686. [PMID: 37863697 DOI: 10.1016/j.surg.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/31/2023] [Accepted: 09/05/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND In July 2016, the American Society of Breast Surgeons published guidelines discouraging contralateral prophylactic mastectomy for average-risk women with unilateral breast cancer. We incorporated these into practice with structured patient counseling and aimed to assess the effect of this initiative on contralateral prophylactic mastectomy rates. METHODS We evaluated female patients with unilateral breast cancer undergoing mastectomy at our institution from January 2011 to November 2022. Variables associated with contralateral prophylactic mastectomy and trends over time were analyzed using the Wilcoxon rank sum test or χ2 analysis as appropriate. RESULTS Among 3,208 patients, (median age 54 years) 1,366 (43%) had a unilateral mastectomy, and 1,842 (57%) also had a concomitant contralateral prophylactic mastectomy. Across all patients, contralateral prophylactic mastectomy rates significantly decreased post-implementation from 2017 to 2019 (55%) vs 2015 to 2016 (62%) (P = .01) but increased from 2020 to 2022 (61%). Immediate breast reconstruction rate was 70% overall (81% with contralateral prophylactic mastectomy and 56% without contralateral prophylactic mastectomy, P < .001). Younger age, White race, mutation status, and earlier stage were also associated with contralateral prophylactic mastectomy. Genetic testing increased from 27% pre-guideline to 74% 2020 to 2022, as did the proportion of patients with a pathogenic variant (4% pre-guideline vs 11% from 2020-2022, P < .001), of whom 91% had a contralateral prophylactic mastectomy. Among tested patients without a pathogenic variant and patients not tested, contralateral prophylactic mastectomy rates declined from 78% to 67% and 48% to 38% pre -and post-guidelines, respectively, P < .001. CONCLUSION Implementation of specific patient counseling was effective in decreasing contralateral prophylactic mastectomy rates. While recognizing that patient choice plays a significant role in the decision for contralateral prophylactic mastectomy, further educational efforts are warranted to affect contralateral prophylactic mastectomy rates, particularly in the setting of negative genetic testing.
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Affiliation(s)
- Jessica A Steadman
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Tanya L Hoskin
- Division of Biostatistics and Clinical Trials, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | - Judy C Boughey
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Amy C Degnim
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Mara A Piltin
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Mary M Mrdutt
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Jeffrey E Johnson
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Tina J Hieken
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN.
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Cozzi A, Schiaffino S. Preoperative breast MRI in women with dense breasts: can we keep up with a rapidly changing scenario? Eur Radiol 2023; 33:8077-8079. [PMID: 37646816 DOI: 10.1007/s00330-023-10075-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 05/14/2023] [Accepted: 06/11/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Andrea Cozzi
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Simone Schiaffino
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland.
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Miyake T, Shimazu K. Third-look contrast-enhanced ultrasonography plus needle biopsy for differential diagnosis of magnetic resonance imaging-only detected breast lesions. J Med Ultrason (2001) 2023:10.1007/s10396-023-01298-8. [PMID: 36905491 DOI: 10.1007/s10396-023-01298-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/23/2023] [Indexed: 03/12/2023]
Abstract
Research has shown that in approximately 20-30% of cases, breast lesions that were not detected on mammography (MG) or ultrasonography (US) were incidentally found during preoperative magnetic resonance imaging (MRI) examination for breast cancer. MRI-guided needle biopsy is recommended or considered for such MRI-only detected breast lesions invisible on second-look US, but many facilities in Japan cannot perform this biopsy procedure because it is expensive and time consuming. Thus, a simpler and more accessible diagnostic method is needed. Two studies to date have shown that third-look contrast-enhanced US (CEUS) plus needle biopsy for MRI-only detected breast lesions (i.e., MRI + /MG-/US-) that were not detected on second-look US showed moderate/high sensitivity (57.1 and 90.9%) and high specificity (100.0% in both studies) with no severe complications. In addition, the identification rate was higher for MRI-only lesions with a higher MRI BI-RADS category (i.e., category 4/5) than for those with a lower category (i.e., category 3). Despite the fact that there are limitations in our literature review, CEUS plus needle biopsy is a feasible and convenient diagnostic tool for MRI-only lesions invisible on second-look US and is expected to reduce the frequency of MRI-guided needle biopsy. When third-look CEUS does not reveal MRI-only lesions, a further indication for MRI-guided needle biopsy should be considered according to the BI-RADS category.
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Affiliation(s)
- Tomohiro Miyake
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2-E10 Yamada-Oka, Suita-Shi, Osaka, 565-0871, Japan.
| | - Kenzo Shimazu
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2-E10 Yamada-Oka, Suita-Shi, Osaka, 565-0871, Japan
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