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Use of preoperative MRI has increased among Canadian women with breast cancer
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The use of preoperative MRI increased eightfold over a 10-year span among women newly diagnosed with breast cancer in Canada, according to findings from a population-based retrospective cohort study.
Although guidelines recommend bilateral mammography as the primary option for preoperative imaging, the use of MRI has increased because of the potential to find metastases not picked up by more traditional imaging.
However, MRI may have higher false-positive rates and can be expensive, and previous studies have shown that these MRIs do not improve surgical outcomes, recurrence rates or survival, according to the researchers.
Angel Arnaout, MD, MSc, associate scientist in the cancer therapeutics program at Ottawa Hospital Research Institute and breast surgical oncologist at Ottawa Hospital, and colleagues conducted the study to evaluate the patterns of, factors associated with and secondary outcomes of preoperative MRI use in a population of women with newly diagnosed breast cancer.
Using administrative health care databases in Ontario, the investigators identified 53,015 women who were treated for primary operable breast cancer between 2003 and 2012.
Overall, 14.8% of the women had a preoperative MRI. The use of preoperative MRI increased from 3% to 24% during the study period (P < .001).
MRI use appeared associated with factors such as younger age, higher socioeconomic status, a higher Charlson comorbidity score, surgery at an academic or teaching hospital, and fewer years of experience for the surgeon.
Results of a multivariable analysis showed preoperative MRI receipt increased the likelihood a women also underwent postdiagnosis breast imaging (OR = 2.09; 95% CI, 1.92-2.28), postdiagnosis biopsies of the breast (OR = 1.74; 95% CI, 1.57-1.93), postdiagnosis imaging assessing for distant metastases (OR = 1.51; 95% CI, 1.42-1.61), mastectomy (OR= 1.73; 95% CI, 1.62-1.85), contralateral prophylactic mastectomy (OR = 1.48; 95% CI, 1.23-1.77) and a wait of 30 days or longer before surgery (OR = 2.52; 95% CI, 2.36-2.7).
“Irrespective of the reasons for increased preoperative MRI use, in an era of ever-increasing focus on cost containment in health care, consideration must also be given to the unintended consequences of those who undergo preoperative MRI,” Arnaout and colleagues wrote. “The increased sensitivity of breast MRI is achieved at the cost of lower specificity. In practice, this translates into more confirmatory imaging and biopsies needed to rule out a diagnosis of cancer.”
The researchers identified some limitations with their study including the use of claims-based registry data, which doesn’t include the indications for the use of the preoperative MRI or any of the procedure outcomes. The data also do not include details on whether treatment decisions were changed based on the results of the MRI.
Habib Rahbar
Although these results add to the evidence that preoperative MRI is associated with more aggressive breast surgery, the use of MRI preoperatively shouldn’t be dismissed, Habib Rahbar, MD, assistant professor of breast imaging in the department of radiology at University of Washington, and Constance D. Lehman, MD, PhD, radiologist at Massachusetts General Hospital, wrote in an accompanying editorial.
“It may be that advanced imaging, such as MRI, is unlikely to lead to better outcomes in the context of treatment paradigms developed in the settings of conventional imaging,” they wrote. “[However], MRI may support the next advance in treatment options that are more targeted to the individual patient’s disease burden.
“Because MRI can detect occult disease with high sensitivity, future research might explore its role in novel treatment approaches … It is [a] role in precision diagnostics and risk stratification that advanced imaging techniques may hold the greatest promise, and for which MRI should be studied in future prospective trials.” – by Anthony SanFilippo
Disclosure: The researchers report no relevant financial disclosures. Lehman reports grant support from and a consultant/advisory role with General Electric Healthcare.
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