Magnetic resonance imaging before breast cancer surgery: results of an observational multicenter international prospective analysis (MIPA)

Francesco Sardanelli*, Rubina M. Trimboli, Nehmat Houssami, Fiona J. Gilbert, Thomas H. Helbich, Marina Álvarez Benito, Corinne Balleyguier, Massimo Bazzocchi, Peter Bult, Massimo Calabrese, Julia Camps Herrero, Francesco Cartia, Enrico Cassano, Paola Clauser, Andrea Cozzi, Danúbia A. de Andrade, Marcos F. de Lima Docema, Catherine Depretto, Valeria Dominelli, Gábor ForraiRossano Girometti, Steven E. Harms, Sarah Hilborne, Raffaele Ienzi, Marc B.I. Lobbes, Claudio Losio, Ritse M. Mann, Stefania Montemezzi, Inge Marie Obdeijn, Umit A. Ozcan, Federica Pediconi, Katja Pinker, Heike Preibsch, José L. Raya Povedano, Daniela Sacchetto, Gianfranco P. Scaperrotta, Simone Schiaffino, Margrethe Schlooz, Botond K. Szabó, Donna B. Taylor, Özden S. Ulus, Mireille Van Goethem, Jeroen Veltman, Stefanie Weigel, Evelyn Wenkel, Chiara Zuiani, Giovanni Di Leo

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Objectives: Preoperative breast magnetic resonance imaging (MRI) can inform surgical planning but might cause overtreatment by increasing the mastectomy rate. The Multicenter International Prospective Analysis (MIPA) study investigated this controversial issue. Methods: This observational study enrolled women aged 18–80 years with biopsy-proven breast cancer, who underwent MRI in addition to conventional imaging (mammography and/or breast ultrasonography) or conventional imaging alone before surgery as routine practice at 27 centers. Exclusion criteria included planned neoadjuvant therapy, pregnancy, personal history of any cancer, and distant metastases. Results: Of 5896 analyzed patients, 2763 (46.9%) had conventional imaging only (noMRI group), and 3133 (53.1%) underwent MRI that was performed for diagnosis, screening, or unknown purposes in 692/3133 women (22.1%), with preoperative intent in 2441/3133 women (77.9%, MRI group). Patients in the MRI group were younger, had denser breasts, more cancers ≥ 20 mm, and a higher rate of invasive lobular histology than patients who underwent conventional imaging alone (p < 0.001 for all comparisons). Mastectomy was planned based on conventional imaging in 22.4% (MRI group) versus 14.4% (noMRI group) (p < 0.001). The additional planned mastectomy rate in the MRI group was 11.3%. The overall performed first- plus second-line mastectomy rate was 36.3% (MRI group) versus 18.0% (noMRI group) (p < 0.001). In women receiving conserving surgery, MRI group had a significantly lower reoperation rate (8.5% versus 11.7%, p < 0.001). Conclusions: Clinicians requested breast MRI for women with a higher a priori probability of receiving mastectomy. MRI was associated with 11.3% more mastectomies, and with 3.2% fewer reoperations in the breast conservation subgroup. Key Points: • In 19% of patients of the MIPA study, breast MRI was performed for screening or diagnostic purposes. • The current patient selection to preoperative breast MRI implies an 11% increase in mastectomies, counterbalanced by a 3% reduction of the reoperation rate. • Data from the MIPA study can support discussion in tumor boards when preoperative MRI is under consideration and should be shared with patients to achieve informed decision-making.

Original languageEnglish
Pages (from-to)1611-1623
Number of pages13
JournalEuropean Radiology
Volume32
Issue number3
Early online date13 Oct 2021
DOIs
Publication statusPublished - Mar 2022

Bibliographical note

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

Funding Information:
The MIPA study was promoted by the European Network for the Assessment of Imaging in Medicine (EuroAIM), a joint initiative of the European Institute for Biomedical Imaging Research (EIBIR), and endorsed by the European Society of Breast Imaging. The authors thank Bayer AG that provided an unconditional research grant, in particular Dr. Stephanie Schermuck-Joschko (who passed away due to a car accident after the study started) and Dr. Jan Endrikat. The authors also thank Monika Hierath, Eva Haas, Katharina Krischak, and Peter Gordebeke from the EIBIR staff for the management of all the administrative work of this study. The following persons collaborated at individual centres: Lucia Camera, MD, Department of Radiology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Sara Mirandola, MD, Department of Surgery, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Marta Maria Panzeri, MD, Department of Breast Radiology, IRCCS Ospedale San Raffaele, Milan, Italy; Carolina Rossi Saccarelli, MD,?Maria A. Rodi Carvalho Barros Bernardes, MD, Vera L. Nunes Aguillar, MD, PhD (all three from the?Department of Radiology), and Alfredo Carlos S. D. Barros, MD, PhD (Department of Breast Surgery),?Hospital S?rio Liban?s, S?o Paulo, Brazil; Katja Siegmann-Luz, MD, and Benjamin Wiesinger, MD, Department of Diagnostic and Interventional Radiology, University Hospital of T?bingen, Germany; James M. Anderson, Max Hobbs, and Wanda Gunawan, Royal Perth Hospital, Perth, Australia.

Funding Information:
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.

Funding Information:
This study received an unconditional research grant from Bayer AG. This company did not have any influence on the study protocol planning, did not have any access to the study database, and was not involved in any way in the data analysis, manuscript writing, or submission phases. Among authors, Fiona J. Gilbert and Sarah Hilborne were supported by the NIHR Cambridge Biomedical Research Centre (BRC-1215-20014). The views expressed are those of the authors and not necessarily those of the NIHR or the UK Department of Health and Social Care.

Publisher Copyright:
© 2021, The Author(s).

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