Radiology: The value of preoperative MRI for bilateral synchronous breast cancer screening

As the incidence of breast cancer increases, treatments improve, and life expectancy increases, the risk of bilateral breast cancer in women also increases
significantly.
Even with the current high rate of contralateral prophylactic mastectomy, patients with a history of breast cancer are twice as likely to develop contralateral breast cancer as the general population, and the lifetime risk of developing contralateral breast cancer increases by 2%-20%
。 If the time interval between the first and second breast cancer is short, the contralateral breast cancer is considered synchronous, and if the time interval is longer, it is considered hemilateral
.
However, there is no clinical consensus on the cut-off between synchronous and non-synchronous disorders (ranging from 1 to 12 months).

MRI with contrast can detect occult breast cancers missed on mammography, including multifocal/multicentric lesions of the ipsilateral breast and synchronised disease
of the contralateral breast.
However, the use of preoperative MRI for ipsilateral breast evaluation is controversial
.
Two randomised controlled trials showed that preoperative MRI did not reduce the rate
of reoperation or transition from preservation treatment to mastectomy.
Although three retrospective studies found a significant reduction in the incidence of contralateral breast cancer in patients undergoing MRI, this contradicted
the results of some studies.

Recently, a study published in the journal Radiology evaluated the impact of MRI as a screening tool on the long-term prognosis of newly diagnosed breast cancer patients, providing technical support
for further improving the survival of breast cancer patients.

This study conducted a retrospective analysis of data from newly diagnosed breast cancer patients between January 2008 and December 2010.

Patients with neoadjuvant chemotherapy, previous breast cancer, distant metastases, and no planned surgery were excluded.

Preoperative MRI was compared with those without
.
Survival analysis was performed on the propensity score match group using the Kaplan-Meier method to estimate etiological-specific survival (CSS) and overall survival (OS).

A marginal Cox proportional hazards model was used to assess the relationship
between MRI and clinicopathological variables and OS.

Of the 1846 patients, 1199 met the inclusion criteria
.
The median follow-up was 10 years (range 0-14 years).

The 2:1 matching sample included 705 patients (470 in the MRI group and 235 in the no MRI group); The median age at surgery was 59 years (range, 31-87 years) and 64 years (range, 37-92 years).

Between groups, there was an increase in the incidence of occult breast cancer (MRI group: 21 of 470 patients [4.
5%]; No MRI group
.
10 of 235 patients [4.
3%]; There were no statistically significant differences in P>0.
99) and CSS (HR, 1.
34; 95% CI: 0.
56, 3.
21; P=0.
51).

。 MRI benefit was greater
in patients with larger tumor sizes (>2 cm) (HR, 2.
58; 95% CI: 1.
11, 5.
99; P = .
03) and histological grade III tumors (HR, 2.
94; 95% CI: 1.
18, 7.
32; P = .
02).

Figure Axial orientation, fat saturation, enhanced T1-weighted MRI scan of a 65-year-old woman diagnosed with breast cancer showed that: (A) there was an irregularly uniformly enhanced, 0.
7 cm mass (arrow) above the outside of the right breast (arrow), (B) contralateral lesion detected by MRI alone, In the inner upper quadrant there is a non-mass-enhancing area of 1.
2 cm (arrow).

After bilateral tumor resection and sentinel lymph node biopsy, the final pathological examination showed bilateral invasive ductal carcinoma, histological grade I, negative lymphatic invasion, positive estrogen and progesterone receptors, and negative human epidermal growth factor 2 receptors; Both axillary nodules are negative
.
The patient received radiation therapy followed by 5 years of endocrine therapy, and after 11 years of treatment there was no evidence of local or distant recurrence

The results of this study suggest that a single breast MRI screening of patients with newly diagnosed breast cancer can improve the detection rate of early-stage synchronous breast cancer and further improve the overall survival of
patients.

Original source:

Vivianne Freitas,Xuan Li,Yoav Amitai,et al.
Contralateral Breast Screening with Preoperative MRI: Long-Term Outcomes for Newly Diagnosed Breast Cancer.
DOI:10.
1148/radiol.
212361