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

Andrea Cozzi; Giovanni Di Leo; 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; Marcos F. de Lima Docema; Catherine Depretto; Valeria Dominelli; Gábor Forrai; Rossano 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; Carolina Rossi Saccarelli; Daniela Sacchetto; Gianfranco P. Scaperrotta; Margrethe Schlooz; Botond K. Szabó; Donna B. Taylor; Özden S. Ulus; Mireille Van Goethem; Jeroen Veltman; Stefanie Weigel; Evelyn Wenkel; Chiara Zuiani; Francesco Sardanelli

doi:10.1007/s00330-023-09600-5

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

Andrea Cozzi, Giovanni Di Leo, 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, Marcos F. de Lima Docema, Catherine Depretto, Valeria Dominelli, Gábor Forrai, Rossano Girometti, Steven E. HarmsSarah 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, Carolina Rossi Saccarelli, Daniela Sacchetto, Gianfranco P. Scaperrotta, Margrethe Schlooz, Botond K. Szabó, Donna B. Taylor, Özden S. Ulus, Mireille Van Goethem, Jeroen Veltman, Stefanie Weigel, Evelyn Wenkel, Chiara Zuiani, Francesco Sardanelli^*

^*Corresponding author for this work

Radiology & Nuclear Medicine

Research output: Contribution to journal › Article › Academic › peer-review

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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.

Original language	English
Pages (from-to)	6213-6225
Number of pages	13
Journal	European Radiology
Volume	33
Issue number	9
Early online date	3 May 2023
DOIs	https://doi.org/10.1007/s00330-023-09600-5
Publication status	Published - Sept 2023

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 was 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 which managed 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 M. Panzeri, MD, Department of Breast Radiology, IRCCS Ospedale San Raffaele, Milan, Italy; Danúbia A. de Andrade, MD, PhD, and Alfredo Carlos S. D. Barros, MD, PhD, Department of Breast Surgery, Hospital Sírio Libanês, São Paulo, Brazil; Katja Siegmann-Luz, MD, and Benjamin Wiesinger, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Germany; James M. Anderson, Max Hobbs, and Wanda Gunawan, Royal Perth Hospital, Perth, Australia.

Funding Information:
Open access funding provided by Università degli Studi di Milano within the CRUI-CARE Agreement. 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 manuscript writing or submission phases.

Funding Information:
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.

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.

Publisher Copyright:
© 2023, The Author(s).

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Screening and diagnostic breast MRI how do they impact surgical treatmentFinal published version, 1.5 MBLicence: CC BY

Cite this

Cozzi, A., Di Leo, G., Houssami, N., Gilbert, F. J., Helbich, T. H., Álvarez Benito, M., Balleyguier, C., Bazzocchi, M., Bult, P., Calabrese, M., Camps Herrero, J., Cartia, F., Cassano, E., Clauser, P., de Lima Docema, M. F., Depretto, C., Dominelli, V., Forrai, G., Girometti, R., ... Sardanelli, F. (2023). Screening and diagnostic breast MRI: how do they impact surgical treatment? Insights from the MIPA study. European Radiology, 33(9), 6213-6225. https://doi.org/10.1007/s00330-023-09600-5

@article{f6a869a982404723bb1c05fd5dac57eb,

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

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.",

author = "Andrea Cozzi and {Di Leo}, Giovanni and Nehmat Houssami and Gilbert, {Fiona J.} and Helbich, {Thomas H.} and {{\'A}lvarez Benito}, Marina and Corinne Balleyguier and Massimo Bazzocchi and Peter Bult and Massimo Calabrese and {Camps Herrero}, Julia and Francesco Cartia and Enrico Cassano and Paola Clauser and {de Lima Docema}, {Marcos F.} and Catherine Depretto and Valeria Dominelli and G{\'a}bor Forrai and Rossano Girometti and Harms, {Steven E.} and Sarah Hilborne and Raffaele Ienzi and Lobbes, {Marc B.I.} and Claudio Losio and Mann, {Ritse M.} and Stefania Montemezzi and Obdeijn, {Inge Marie} and Ozcan, {Umit A.} and Federica Pediconi and Katja Pinker and Heike Preibsch and {Raya Povedano}, {Jos{\'e} L.} and {Rossi Saccarelli}, Carolina and Daniela Sacchetto and Scaperrotta, {Gianfranco P.} and Margrethe Schlooz and Szab{\'o}, {Botond K.} and Taylor, {Donna B.} and Ulus, {{\"O}zden S.} and {Van Goethem}, Mireille and Jeroen Veltman and Stefanie Weigel and Evelyn Wenkel and Chiara Zuiani and Francesco Sardanelli",

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 was 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 which managed 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 M. Panzeri, MD, Department of Breast Radiology, IRCCS Ospedale San Raffaele, Milan, Italy; Dan{\'u}bia A. de Andrade, MD, PhD, and Alfredo Carlos S. D. Barros, MD, PhD, Department of Breast Surgery, Hospital S{\'i}rio Liban{\^e}s, S{\~a}o Paulo, Brazil; Katja Siegmann-Luz, MD, and Benjamin Wiesinger, MD, Department of Diagnostic and Interventional Radiology, University Hospital of T{\"u}bingen, Germany; James M. Anderson, Max Hobbs, and Wanda Gunawan, Royal Perth Hospital, Perth, Australia. Funding Information: Open access funding provided by Universit{\`a} degli Studi di Milano within the CRUI-CARE Agreement. 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 manuscript writing or submission phases. Funding Information: 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. 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, Jubil{\"a}umsfonds of the Austrian National Bank. Publisher Copyright: {\textcopyright} 2023, The Author(s).",

year = "2023",

month = sep,

doi = "10.1007/s00330-023-09600-5",

language = "English",

volume = "33",

pages = "6213--6225",

journal = "European Radiology",

issn = "0938-7994",

publisher = "Springer-Verlag",

number = "9",

}

Cozzi, A, Di Leo, G, Houssami, N, Gilbert, FJ, Helbich, TH, Álvarez Benito, M, Balleyguier, C, Bazzocchi, M, Bult, P, Calabrese, M, Camps Herrero, J, Cartia, F, Cassano, E, Clauser, P, de Lima Docema, MF, Depretto, C, Dominelli, V, Forrai, G, Girometti, R, Harms, SE, Hilborne, S, Ienzi, R, Lobbes, MBI, Losio, C, Mann, RM, Montemezzi, S, Obdeijn, IM, Ozcan, UA, Pediconi, F, Pinker, K, Preibsch, H, Raya Povedano, JL, Rossi Saccarelli, C, Sacchetto, D, Scaperrotta, GP, Schlooz, M, Szabó, BK, Taylor, DB, Ulus, ÖS, Van Goethem, M, Veltman, J, Weigel, S, Wenkel, E, Zuiani, C & Sardanelli, F 2023, 'Screening and diagnostic breast MRI: how do they impact surgical treatment? Insights from the MIPA study', European Radiology, vol. 33, no. 9, pp. 6213-6225. https://doi.org/10.1007/s00330-023-09600-5

TY - JOUR

T1 - Screening and diagnostic breast MRI

T2 - how do they impact surgical treatment? Insights from the MIPA study

AU - Cozzi, Andrea

AU - Di Leo, Giovanni

AU - Houssami, Nehmat

AU - Gilbert, Fiona J.

AU - Helbich, Thomas H.

AU - Álvarez Benito, Marina

AU - Balleyguier, Corinne

AU - Bazzocchi, Massimo

AU - Bult, Peter

AU - Calabrese, Massimo

AU - Camps Herrero, Julia

AU - Cartia, Francesco

AU - Cassano, Enrico

AU - Clauser, Paola

AU - de Lima Docema, Marcos F.

AU - Depretto, Catherine

AU - Dominelli, Valeria

AU - Forrai, Gábor

AU - Girometti, Rossano

AU - Harms, Steven E.

AU - Hilborne, Sarah

AU - Ienzi, Raffaele

AU - Lobbes, Marc B.I.

AU - Losio, Claudio

AU - Mann, Ritse M.

AU - Montemezzi, Stefania

AU - Obdeijn, Inge Marie

AU - Ozcan, Umit A.

AU - Pediconi, Federica

AU - Pinker, Katja

AU - Preibsch, Heike

AU - Raya Povedano, José L.

AU - Rossi Saccarelli, Carolina

AU - Sacchetto, Daniela

AU - Scaperrotta, Gianfranco P.

AU - Schlooz, Margrethe

AU - Szabó, Botond K.

AU - Taylor, Donna B.

AU - Ulus, Özden S.

AU - Van Goethem, Mireille

AU - Veltman, Jeroen

AU - Weigel, Stefanie

AU - Wenkel, Evelyn

AU - Zuiani, Chiara

AU - Sardanelli, Francesco

N1 - 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 was 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 which managed 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 M. Panzeri, MD, Department of Breast Radiology, IRCCS Ospedale San Raffaele, Milan, Italy; Danúbia A. de Andrade, MD, PhD, and Alfredo Carlos S. D. Barros, MD, PhD, Department of Breast Surgery, Hospital Sírio Libanês, São Paulo, Brazil; Katja Siegmann-Luz, MD, and Benjamin Wiesinger, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Germany; James M. Anderson, Max Hobbs, and Wanda Gunawan, Royal Perth Hospital, Perth, Australia. Funding Information: Open access funding provided by Università degli Studi di Milano within the CRUI-CARE Agreement. 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 manuscript writing or submission phases. Funding Information: 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. 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. Publisher Copyright: © 2023, The Author(s).

PY - 2023/9

Y1 - 2023/9

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85158138407&partnerID=8YFLogxK

U2 - 10.1007/s00330-023-09600-5

DO - 10.1007/s00330-023-09600-5

M3 - Article

C2 - 37138190

AN - SCOPUS:85158138407

SN - 0938-7994

VL - 33

SP - 6213

EP - 6225

JO - European Radiology

JF - European Radiology

IS - 9

ER -

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

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