Breast MRI Beneficial in Determining Surgical Treatment for Newly Diagnosed Breast Cancer

If these additional tumors are detected before surgery to remove the initially diagnosed tumor, the plan for surgical treatment of the disease can be altered. For instance, if an additional tumor is found in the same breast, a surgeon can perform a mastectomy (removal of the whole breast) instead of a lumpectomy (removal of a part of the breast) or remove a larger amount of tissue during a lumpectomy. If cancer is detected in the other breast, surgery can be performed on both breasts at once.

"However, the impact of routine MRI on the surgical management of new, biopsy-proven breast cancers remains unclear,” the investigators wrote in their article, which was published in the May 2007 issue of the journal Archives of Surgery.

Karl Y. Bilimoria, M.D., and colleagues at the Feinberg School of Medicine, Northwestern evaluated 155 women with breast cancer newly diagnosed by mammogram, ultrasound, and needle biopsy. The women, who were diagnosed between April 2005 and April 2006, went to a single surgeon who performed an assessment and developed a plan for the surgical management of the disease. After this consultation, MRI scanning was performed on both breasts. If the MRI identified new tumors that were found to be malignant or suspicious after a biopsy, patients went back to the surgeon for a re-evaluation of the surgical plan. Breast MRI detected a total of 124 additional suspicious areas in 73 patients.

"Breast MRI altered the surgical management of patients with newly diagnosed breast cancer in 36 (23.2%) of 155 patients,” the authors wrote. This included 10 patients who had a mastectomy instead of lumpectomy, 21 women whose lumpectomy removed more tissue than first planned, and five patients who had surgery on both breasts.

Following surgery, the researchers compared the actual appearance of the tumor to the original mammogram or ultrasound and also to the MRI. The alteration in surgical management was considered beneficial if pathologic findings correlated with the MRI more closely than they matched mammography or ultrasonography. "Of the 36 women who had a change in surgical management based on MRI findings, 15 were found to have a beneficial change when MRI findings were confirmed on the final pathologic report,” the investigators reported.


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Feinberg School of Medicine, Northwestern University