Macfarlan, Jennifer, MPH

Sareen, Priya, MD

Xue, Christine, MD

English

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Lehigh Valley Health Network LVHN Scholarly Works Department of Medicine Evaluating the Role of Preoperative Breast MRI in Improving Diagnostic Christine Xue MD Jennifer Macfarlan MPH Lehigh Valley Health Network, jennifer.macfarlan@lvhn.org Priya Sareen MD Lehigh Valley Health Network, Priya_K.Sareen@lvhn.org Follow this and additional works at: https://scholarlyworks.lvhn.org/medicine Published In/Presented At Xue, C. Macfarlan, J. Sareen, P. (2019, May). Evaluating the Role of Preoperative Breast MRI in Improving Diagnostic. Poster Presented at: The American College of Radiology, Washington, DC. This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact LibraryServices@lvhn.org. LVHN.org© 2019 Lehigh Valley Health NetworkEvaluating the Role of Preoperative Breast MRI in Improving  Diagnostic Accuracy of Breast Cancer PatientsChristine Xue, MD, Jennifer Macfarlan, MPH, Priya Sareen, MDLehigh Valley Health Network, Allentown, Pa.PURPOSEPreoperative breast MRI is often used as an adjunct to mammography and ultrasound to guide diagnostic and surgical management of breast cancer patients. Given the high cost and performance time of MRI, it is important to identify which patients would benefit most from preoperative MRI evaluation. The purpose of our study is to assess the value of preoperative MRI in characterizing the extent of cancer, identify risk factors associated with additional MRI lesions not visualized on prior imaging, and evaluate the impact on patient management. MATERIALS AND METHODSA retrospective chart review was conducted on 199 patients with biopsy-proven breast cancer who underwent preoperative MRI between January 2014 and February 2018. We evaluated the accuracy of MRI at predicting the extent of disease, the frequency of additional lesions detected on MRI, and the changes in surgical management. Statistical analysis of associated risk factors was performed with the Chi-Square test and Fisher’s exact test, with a P-value <0.05 considered statistically significant.RESULTSThe cohort included 199 patients with known breast cancer, with a median age of 52 and range of 33-79. The sensitivity of MRI in detecting breast cancer was 98%. MRI predicted tumor size within 10 mm of the pathological tumor size in 155 (78%) patients. 72 (36%) MRIs detected additional lesions, which led to additional biopsy-proven sites of cancer in 37 (19%) patients. Surgical management was altered in 33 (17%) patients from either a lumpectomy to mastectomy, or mastectomy to bilateral mastectomy. Younger age (<50 years) was associated with increased frequency of additional lesions detected on MRI (P = 0.004). Risk factors such as race, breast density, histopathology, hormone receptor status, and BRCA positivity did not have a significant association with additional lesions detected on MRI. CONCLUSIONPreoperative MRI is a useful adjunct to con-ventional breast imaging in characterizing the extent of breast cancer and detecting additional lesions, particularly in younger patients, resulting in clinically relevant changes in patient management.Figure 1. Detection of additional lesion on breast MRI. Right mediolateral oblique (a) and craniocaudal (b) views of a mammogram from an outside institution demonstrated a right breast mass at 12 o’clock. Right breast ultrasound from the same day (c) redemonstrated this mass, located 5 cm from the nipple, found to be invasive ductal carcinoma. Sagittal (d) and axial (e, f) MRI images from our institution showed an additional mass at 1 o’clock, approximately 7-8 cm from the nipple. Second-look ultrasound confirmed the presence of this additional mass. Subsequent ultrasound-guided core biopsy of this mass demonstrated an additional focus of invasive ductal carcinoma. TABLE 1. RISK FACTORS ASSOCIATED WITH ADDITIONAL LESIONS ON MRI RISK FACTOR ADDITIONAL FINDINGS (N=91)NO ADDITIONAL FINDINGS (N=108) pAge 0.0041a<50 46 (58.2) 33 (41.8)≥50 45 (37.5) 75 (62.5)Race 0.8642aWhite 75 (45.5) 90 (54.6)Non-white 16 (47.1) 18 (52.9)Breast Density 0.5807bLow density 26 (41.9) 36 (58.1)High density 63 (47.0) 71 (53.0)Density cannot  be determined 2 (66.7) 1 (33.3)Type of Breast Cancer 0.6504bIDC 66 (46.5) 76 (53.5)ILC 20 (41.7) 28 (58.3)Mixed ILC/ID 3 (75.0) 1 (25.0)Other 2 (40.0) 3 (60.0)Hormone Receptor Statusc 0.4048bER/PR+ 85 (47.0) 96 (53.0)HER2+ 10 (38.5) 16 (61.5)Triple negative 2 (25.0) 6 (75.0)BRCA Positivity 0.6618bPositive 3 (60.0) 2 (40.0)Negative 88 (45.4) 106 (54.6)Data are n(%) unless otherwise stated; percentages might not add to 100% due to rounding.aChi-Square test was used to calculate p-valuebFisher’s exact test was used to calculate p-valuecN for analysis was 215; additional findings n=97, no additional findings n=118a bc de f

Evaluating the Role of Preoperative Breast MRI in Improving Diagnostic

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=2710&context=medicine

Evaluating the Role of Preoperative Breast MRI in Improving Diagnostic

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