It may be time to reevaluate the common practice of preoperative breast MRI. A new Canadian study suggested that it is associated with higher likelihood of post-diagnosis breast imaging and biopsies, staging imaging, mastectomy, contralateral prophylactic mastectomy, and a greater than 30-day wait to surgery.
Researchers reported that preoperative breast MRI use appears to be steadily increasing but instead of improving outcomes it may be causing some unwanted consequences.1
“We wanted to evaluate whether use of pre-op MR was associated with potential downstream harms in the form of increased interventions (biopsy, mastectomy) and wait times,” said study investigator Matthew McInnes, MD, who is an associate professor of radiology at the University of Ottawa, in Canada.
He and his colleagues used administrative health care databases in Ontario over 14 geographic regions. The study participants included 53,015 women with primary operable breast cancer treated from 2003 to 2012.
The study showed that 14.8% (7,824 of 53,015) had preoperative MRI and most patients (65%) underwent breast-conserving surgery. The use of preoperative MRI increased eight-fold across all stages during the 10-year period, from 3% of patients newly diagnosed with breast cancer in 2003 to 24% of patients in 2012.
The study found that use of preoperative MRI was associated with increased post-diagnosis breast imaging (odds ratio [OR], 2.09), post-diagnosis breast biopsies (OR: 1.74), and post-diagnosis imaging to assess for distant metastatic disease (OR: 1.51).
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It was also associated with higher rates of mastectomy (OR: 1.73), contralateral prophylactic mastectomy (OR: 1.48), and a greater than 30-day wait to surgery (OR: 2.52), according to the researchers.
Patient-related factors associated with higher preoperative MRI use were younger age, higher socioeconomic status, and higher comorbidity score. Health system and clinician factors related to increased preoperative MRI included surgery in a teaching hospital and fewer years of surgeon experience.