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Observational Study
. 2025 Jul;35(7):3990-4000.
doi: 10.1007/s00330-024-11338-7. Epub 2025 Feb 28.

Preoperative breast MRI reduces reoperations for unilateral invasive lobular carcinoma: a patient-matched analysis from the MIPA study

Andrea Cozzi  1   2 , Giovanni Di Leo  1 , Nehmat Houssami  3 , Fiona J Gilbert  4 , Thomas H Helbich  5   6 , Marina Álvarez Benito  7   8   9 , Corinne Balleyguier  10   11 , Massimo Bazzocchi  12 , Peter Bult  13 , Massimo Calabrese  14 , Julia Camps Herrero  15   16 , Francesco Cartia  17   18 , Enrico Cassano  19 , Paola Clauser  5 , Marcos F de Lima Docema  20 , Catherine Depretto  17 , Valeria Dominelli  19 , Gábor Forrai  21   22 , Rossano Girometti  12 , Steven E Harms  23 , Sarah Hilborne  4 , Raffaele Ienzi  24 , Marc B I Lobbes  25   26 , Claudio Losio  27 , Ritse M Mann  28   29 , Stefania Montemezzi  30   31 , Inge-Marie Obdeijn  32 , Umit Aksoy Ozcan  33 , Federica Pediconi  34 , Katja Pinker  5   35   36 , Heike Preibsch  37 , José L Raya Povedano  7 , Carolina Rossi Saccarelli  20 , Daniela Sacchetto  38   39 , Gianfranco P Scaperrotta  17 , Margrethe Schlooz  40 , Botond K Szabó  41 , Donna B Taylor  42   43   44 , Sıla Ö Ulus  33 , Mireille Van Goethem  45 , Jeroen Veltman  46 , Stefanie Weigel  47 , Evelyn Wenkel  48 , Chiara Zuiani  12 , Francesco Sardanelli  49   50   51
Affiliations
Observational Study

Preoperative breast MRI reduces reoperations for unilateral invasive lobular carcinoma: a patient-matched analysis from the MIPA study

Andrea Cozzi et al. Eur Radiol. 2025 Jul.

Abstract

Objectives: To investigate the surgical impact of preoperative breast MRI in patients diagnosed with invasive lobular breast cancer (ILC) in a prospective observational study.

Methods: The prospective MIPA observational study database was queried for patients aged 18-80 with newly diagnosed unilateral ILC at needle biopsy referred for primary surgery. Patients who underwent preoperative MRI (MRI group) were matched (1:1) with those who did not (noMRI group) according to nine confounding covariates. Surgical outcomes were compared between the matched groups with nonparametric statistics after calculating odds ratios (ORs).

Results: A total of 547 women with unilateral needle biopsy-diagnosed ILC were identified (158 noMRI group, 389 MRI group). After patient matching, each group retained 103 patients, for a total of 206 matched patients. For the rate of women having a first-line mastectomy, there was no significant difference between the MRI group (21.4%, 22/103; p = 0.727; OR 1.20, 95% CI: 0.61-2.38) and the noMRI group (18.4%, 19/103). Conversely, the reoperation rate in the MRI group (1.9%, 2/103) was significantly lower (p = 0.007; OR of avoiding reoperation 7.29, 95% CI: 1.60-33.21) than in the noMRI group (12.6%, 13/103 patients). Overall mastectomy rates (first plus second-line) did not significantly differ between the MRI group (23.3%, 24/103; p = 0.867, OR 1.12, 95% CI: 0.58-2.16) and the noMRI group (21.4%, 22/103).

Conclusions: Women who had preoperative MRI after a needle biopsy diagnosis of ILC had a significant six-fold reduction in reoperations compared to those who did not have an MRI examination, with similar overall mastectomy rates.

Key points: Question No randomized controlled trials investigating the impact of preoperative MRI on surgical outcomes (mastectomy rates and reoperation) of needle-biopsy-diagnosed ILC have been conducted. Findings In a patient-matched analysis of 103 vs 103 women, preoperative MRI led to a greater than six-fold reduction of reoperations, without significant differences in first-line and overall mastectomy rates. Clinical relevance In the absence of randomized controlled trials, patient matching can be applied to mitigate confounding factors that drive the referral to preoperative MRI, showing that preoperative MRI has beneficial effects on surgical outcomes in patients with needle biopsy-diagnosed unilateral ILC.

Keywords: Breast neoplasms; Carcinoma (Lobular); Magnetic resonance imaging; Mastectomy; Reoperation.

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Conflict of interest statement

Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Francesco Sardanelli. Conflict of interest: Outside the present work, the authors declare the following relations with companies and institutions: F.S. declares relationships with Bayer Healthcare (consultation/speaker fees), Bracco Imaging (grant/research support), and General Electric Healthcare (speaker fee). A.C. received speaker’s fees from BD—Becton Dickinson. N.H. receives research funding via a National Breast Cancer Foundation (NBCF Australia) Breast Cancer Research Leadership Fellowship. F.J.G. received research grants from General Electric Healthcare, GSK and Hologic, and had research collaborations with Volpara and Bayer AG. She is an NIHR senior investigator and receives funding from the Cambridge BRC. M.B.I.L. received research grants from and is a member of the speakers’ bureau of General Electric Healthcare. K.P. declares being part of speakers’ bureaus for the European Society of Breast Imaging (active), Bayer AG (ended), Siemens Healthineers (ended), DKD 2019 (ended), and Olea Medical (ended); consulting for Genentech, Merantix Healthcare, AURA Health Technologies, and Guerbet. D.S. is affiliated with Kiwifarm S.r.l., La Morra, Italy. P.C. and K.P. are part of the Scientific Editorial Board of European Radiology (Section: Breast), and R.G. is the Deputy Editor of European Radiology. R.M.M. is a member of the Advisory Editorial Board of European Radiology (European Society of Breast Imaging). 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. Statistics and biometry: The first three authors (A.C., G.D.L, and N.H.) have significant statistical expertise. Informed consent: Written informed consent was obtained from all patients in this study, unless waived by local Ethics Committees. Ethical approval: This study was approved by the Ethics Committee of the coordinating centre on January 29, 2013 (protocol number 2784) and thereafter by local Ethics Committees of participating centres. Study subjects or cohorts overlap: This paper is a targeted subgroup analysis of 547 patients that were previously included in the main paper of the MIPA study (Sardanelli et al, [50]) and in the paper comparing patients with different MRI referrals (Cozzi et al, [51]). Preliminary and/or partial results from the MIPA study have been presented as oral communications at the National Congress of the Italian Society of Radiology (SIRM) in 2016, at the Congress of the European Society of Breast Imaging (EUSOBI) in 2016, 2017, and 2024, at the 2018 International Society for Magnetic Resonance in Medicine (ISMRM) Workshop on Breast MRI, and at the European Congress of Radiology in 2017, 2018, 2019, 2022, and 2024. Methodology: Prospective Observational Multicentre study

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