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

Autor: Cozzi A; Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy.; Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland., Di Leo G; Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy., Houssami N; The Daffodil Centre, Faculty of Medicine and Health, The University of Sydney (Joint Venture with Cancer Council NSW), Sydney, Australia., Gilbert FJ; Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK., Helbich TH; Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.; Division of Molecular and Structural Preclinical Imaging, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria., Álvarez Benito M; Department of Radiology, Hospital Universitario Reina Sofía, Córdoba, Spain., Balleyguier C; Department of Radiology, Institut Gustave Roussy, Villejuif, France.; Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, France., Bazzocchi M; Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy., Bult P; Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands., Calabrese M; Unit of Oncological and Breast Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy., Camps Herrero J; Department of Radiology, Hospital Universitario de La Ribera, Alzira, Spain.; Ribera Salud Hospitals, Valencia, Spain., Cartia F; Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Cassano E; Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy., Clauser P; Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria., de Lima Docema MF; Department of Radiology, Hospital Sírio Libanês, São Paulo, Brazil., Depretto C; Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Dominelli V; Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy., Forrai G; Department of Radiology, MHEK Teaching Hospital, Semmelweis University, Budapest, Hungary.; Department of Radiology, Duna Medical Center, GE-RAD Kft, Budapest, Hungary., Girometti R; Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy., Harms SE; Breast Center of Northwest Arkansas, Fayetteville, AR, USA., Hilborne S; Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK., Ienzi R; Department of Radiology, Di.Bi.MED, Policlinico Universitario Paolo Giaccone Università degli Studi di Palermo, Palermo, Italy., Lobbes MBI; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.; Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands., Losio C; Department of Breast Radiology, IRCCS Ospedale San Raffaele, Milan, Italy., Mann RM; Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.; Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands., Montemezzi S; Department of Radiology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy., Obdeijn IM; Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands., Aksoy Ozcan U; Department of Radiology, Acıbadem Atasehir Hospital, Istanbul, Turkey., Pediconi F; Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma 'La Sapienza', Rome, Italy., Pinker K; Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.; Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Preibsch H; Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany., Raya Povedano JL; Department of Radiology, Hospital Universitario Reina Sofía, Córdoba, Spain., Rossi Saccarelli C; Department of Radiology, Hospital Sírio Libanês, São Paulo, Brazil., Sacchetto D; Kiwifarm S.R.L., La Morra, Italy.; Disaster Medicine Service 118, ASL CN1, Levaldigi, Italy., Scaperrotta GP; Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Schlooz M; Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., Szabó BK; Department of Radiology, Barking Havering and Redbridge University Hospitals NHS Trust, London, UK., Taylor DB; Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia.; Department of Radiology, Royal Perth Hospital, Perth, Australia., Ulus SÖ; Department of Radiology, Acıbadem Atasehir Hospital, Istanbul, Turkey., Van Goethem M; Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Department of Radiology, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium., Veltman J; Maatschap Radiologie Oost-Nederland, Oldenzaal, The Netherlands., Weigel S; Clinic for Radiology and Reference Center for Mammography, University of Münster, Münster, Germany., Wenkel E; Department of Radiology, University Hospital of Erlangen, Erlangen, Germany., Zuiani C; Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy., Sardanelli F; Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy. francesco.sardanelli@unimi.it.; Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy. francesco.sardanelli@unimi.it.
Jazyk: angličtina
Zdroj: European radiology [Eur Radiol] 2024 Jun; Vol. 34 (6), pp. 3970-3980. Date of Electronic Publication: 2023 Nov 24.
DOI: 10.1007/s00330-023-10409-5
Abstrakt: 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.
(© 2023. The Author(s).)
Databáze: MEDLINE
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