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Observational Study
. 2023 Sep;33(9):6213-6225.
doi: 10.1007/s00330-023-09600-5. Epub 2023 May 3.

Screening and diagnostic breast MRI: how do they impact surgical treatment? Insights from the MIPA study

Andrea Cozzi  1 , Giovanni Di Leo  1 , Nehmat Houssami  2 , Fiona J Gilbert  3 , Thomas H Helbich  4 , Marina Álvarez Benito  5 , Corinne Balleyguier  6   7 , Massimo Bazzocchi  8 , Peter Bult  9 , Massimo Calabrese  10 , Julia Camps Herrero  11 , Francesco Cartia  12 , Enrico Cassano  13 , Paola Clauser  4 , Marcos F de Lima Docema  14 , Catherine Depretto  12 , Valeria Dominelli  13 , Gábor Forrai  15 , Rossano Girometti  8 , Steven E Harms  16 , Sarah Hilborne  3 , Raffaele Ienzi  17 , Marc B I Lobbes  18 , Claudio Losio  19 , Ritse M Mann  20   21 , Stefania Montemezzi  22 , Inge-Marie Obdeijn  23 , Umit A Ozcan  24 , Federica Pediconi  25 , Katja Pinker  4   26 , Heike Preibsch  27 , José L Raya Povedano  5 , Carolina Rossi Saccarelli  14 , Daniela Sacchetto  28   29   30 , Gianfranco P Scaperrotta  12 , Margrethe Schlooz  31 , Botond K Szabó  32 , Donna B Taylor  33   34 , Özden S Ulus  24 , Mireille Van Goethem  35 , Jeroen Veltman  36 , Stefanie Weigel  37 , Evelyn Wenkel  38 , Chiara Zuiani  8 , Francesco Sardanelli  39   40
Affiliations
Observational Study

Screening and diagnostic breast MRI: how do they impact surgical treatment? Insights from the MIPA study

Andrea Cozzi et al. Eur Radiol. 2023 Sep.

Abstract

Objectives: To report mastectomy and reoperation rates in women who had breast MRI for screening (S-MRI subgroup) or diagnostic (D-MRI subgroup) purposes, using multivariable analysis for investigating the role of MRI referral/nonreferral and other covariates in driving surgical outcomes.

Methods: The MIPA observational study enrolled women aged 18-80 years with newly diagnosed breast cancer destined to have surgery as the primary treatment, in 27 centres worldwide. Mastectomy and reoperation rates were compared using non-parametric tests and multivariable analysis.

Results: A total of 5828 patients entered analysis, 2763 (47.4%) did not undergo MRI (noMRI subgroup) and 3065 underwent MRI (52.6%); of the latter, 2441/3065 (79.7%) underwent MRI with preoperative intent (P-MRI subgroup), 510/3065 (16.6%) D-MRI, and 114/3065 S-MRI (3.7%). The reoperation rate was 10.5% for S-MRI, 8.2% for D-MRI, and 8.5% for P-MRI, while it was 11.7% for noMRI (p ≤ 0.023 for comparisons with D-MRI and P-MRI). The overall mastectomy rate (first-line mastectomy plus conversions from conserving surgery to mastectomy) was 39.5% for S-MRI, 36.2% for P-MRI, 24.1% for D-MRI, and 18.0% for noMRI. At multivariable analysis, using noMRI as reference, the odds ratios for overall mastectomy were 2.4 (p < 0.001) for S-MRI, 1.0 (p = 0.957) for D-MRI, and 1.9 (p < 0.001) for P-MRI.

Conclusions: Patients from the D-MRI subgroup had the lowest overall mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). This analysis offers an insight into how the initial indication for MRI affects the subsequent surgical treatment of breast cancer.

Key points: • Of 3065 breast MRI examinations, 79.7% were performed with preoperative intent (P-MRI), 16.6% were diagnostic (D-MRI), and 3.7% were screening (S-MRI) examinations. • The D-MRI subgroup had the lowest mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). • The S-MRI subgroup had the highest mastectomy rate (39.5%) which aligns with higher-than-average risk in this subgroup, with a reoperation rate (10.5%) not significantly different to that of all other subgroups.

Keywords: Breast neoplasms; Breast-conserving surgery; Magnetic resonance imaging; Mastectomy; Reoperation.

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Conflict of interest statement

Outside the present work, the authors declare the following relation with companies and institutions:

Francesco Sardanelli received research grants from — and is a member of the speakers’ bureau of — General Electric Healthcare, Bayer, and Bracco; he is also member of the Bracco Advisory Group.

Nehmat Houssami receives research funding via a National Breast Cancer Foundation (NBCF Australia) Breast Cancer Research Leadership Fellowship.

Fiona J. Gilbert received research grants from General Electric Healthcare, GSK, and Hologic, and had research collaborations with Volpara and Bayer. She is an NIHR senior investigator and receives funding from the Cambridge BRC.

Marc B. I. Lobbes received research grants and is member of the speakers’ bureau of GE Healthcare.

Katja Pinker declares funding by the NIH/NCI Cancer Centre Support Grant P30 CA008748, Digital Hybrid Breast PET/MRI for Enhanced Diagnosis of Breast Cancer (HYPMED), H2020—Research and Innovation Framework Programme PHC-11-2015 # 667211-2, A Body Scan for Cancer Detection using Quantum Technology (CANCERSCAN), H2020-FETOPEN-2018-2019-2020-01 # 828978, Multiparametric 18F-Fluoroestradiol PET/MRI coupled with Radiomics Analysis and Machine Learning for Prediction and Assessment of Response to Neoadjuvant Endocrine Therapy in Patients with Hormone Receptor+/HER2− Invasive Breast Cancer 02.09.2019/31.08.2020 # Nr: 18207, Jubiläumsfonds of the Austrian National Bank.

Paola Clauser and Katja Pinker are part of the Scientific Editorial Board of European Radiology, and Rossano Girometti is Deputy Editor of European Radiology. As such, none of them had any role in handling this manuscript and none of them took part in the decision processes.

All other authors declare that they have no conflict of interest related to the present work, and that they have nothing to disclose.

Figures

Fig. 1
Fig. 1
Stage-by-stage analysis of surgical endpoints in the four subgroups. Red lines indicate comparisons of rates between subgroups that were statistically significant at post hoc testing after adjustment with the Bonferroni-Holm correction (adjusted p values are shown). S-MRI, screening magnetic resonance imaging; D-MRI, diagnostic magnetic resonance imaging; P-MRI, preoperative magnetic resonance imaging
See this image and copyright information in PMC

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