Preoperative breast MRI positively impacts surgical outcomes of needle biopsy-diagnosed pure DCIS: a patient-matched analysis from the MIPA study

Eur Radiol. 2024 Jun;34(6):3970-3980. doi: 10.1007/s00330-023-10409-5. Epub 2023 Nov 24.

Abstract

Objectives: To investigate the influence of preoperative breast MRI on mastectomy and reoperation rates in patients with pure ductal carcinoma in situ (DCIS).

Methods: The MIPA observational study database (7245 patients) was searched for patients aged 18-80 years with pure unilateral DCIS diagnosed at core needle or vacuum-assisted biopsy (CNB/VAB) and planned for primary surgery. Patients who underwent preoperative MRI (MRI group) were matched (1:1) to those who did not receive MRI (noMRI group) according to 8 confounding covariates that drive referral to MRI (age; hormonal status; familial risk; posterior-to-nipple diameter; BI-RADS category; lesion diameter; lesion presentation; surgical planning at conventional imaging). Surgical outcomes were compared between the matched groups with nonparametric statistics after calculating odds ratios (ORs).

Results: Of 1005 women with pure unilateral DCIS at CNB/VAB (507 MRI group, 498 noMRI group), 309 remained in each group after matching. First-line mastectomy rate in the MRI group was 20.1% (62/309 patients, OR 2.03) compared to 11.0% in the noMRI group (34/309 patients, p = 0.003). The reoperation rate was 10.0% in the MRI group (31/309, OR for reoperation 0.40) and 22.0% in the noMRI group (68/309, p < 0.001), with a 2.53 OR of avoiding reoperation in the MRI group. The overall mastectomy rate was 23.3% in the MRI group (72/309, OR 1.40) and 17.8% in the noMRI group (55/309, p = 0.111).

Conclusions: Compared to those going directly to surgery, patients with pure DCIS at CNB/VAB who underwent preoperative MRI had a higher OR for first-line mastectomy but a substantially lower OR for reoperation.

Clinical relevance statement: When confounding factors behind MRI referral are accounted for in the comparison of patients with CNB/VAB-diagnosed pure unilateral DCIS, preoperative MRI yields a reduction of reoperations that is more than twice as high as the increase in overall mastectomies.

Key points: • Confounding factors cause imbalance when investigating the influence of preoperative MRI on surgical outcomes of pure DCIS. • When patient matching is applied to women with pure unilateral DCIS, reoperation rates are significantly reduced in women who underwent preoperative MRI. • The reduction of reoperations brought about by preoperative MRI is more than double the increase in overall mastectomies.

Keywords: Breast neoplasms (biopsy, needle); Carcinoma (intraductal, noninfiltrating); Magnetic resonance imaging; Mastectomy; Reoperation.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy, Needle
  • Breast / diagnostic imaging
  • Breast / pathology
  • Breast / surgery
  • Breast Neoplasms* / diagnostic imaging
  • Breast Neoplasms* / pathology
  • Breast Neoplasms* / surgery
  • Carcinoma, Intraductal, Noninfiltrating* / diagnostic imaging
  • Carcinoma, Intraductal, Noninfiltrating* / pathology
  • Carcinoma, Intraductal, Noninfiltrating* / surgery
  • Female
  • Humans
  • Magnetic Resonance Imaging* / methods
  • Mastectomy* / methods
  • Middle Aged
  • Preoperative Care / methods
  • Reoperation* / statistics & numerical data
  • Treatment Outcome
  • Young Adult