MRI Before Surgery Provides Better-Adapted Treatment for Breast Cancer

The early use of magnetic resonance imaging (MRI) in women diagnosed with breast cancer can frequently lead to a better-adapted surgical approach to the tumor.

Dr. David Martinez-Cecilia, a surgeon from the General Surgery Service, directed by Prof. Sebastián Rufian-Peña, in the Hospital Universitario Reina Sofia (Cordoba, Spain), reported that this technique should become standard in determining the stage of the tumor before any operation. He presented his study's findings at the sixth European Breast Cancer Conference (EBCC-6) on April 16, 2008, held in Berlin, Germany.

Dr. Martinez-Cecilia and his team studied 249 patients who were undergoing surgery for breast cancer, and performed routine MRI as soon as a biopsy showed malignancy. If additional lesions were found, a further biopsy was carried out on them. "Using MRI, we found 20 additional malignant lesions in 18 patients, and that meant that for 15 patients we were able to change the surgical treatment to one which took care of all the tumors, as opposed to the single one that had originally been diagnosed,” Dr. Martinez-Cecilia stated.

Three patients needed surgery in both breasts, one required a second lumpectomy in the same breast, and 11 changed from lumpectomy to mastectomy. Treatment also changed in those where the MRI showed a larger tumor than the one originally identified. Sixteen other patients changed from lumpectomy to mastectomy, and one from lumpectomy to quadrantectomy, a partial mastectomy where the tumor and some surrounding breast tissue is removed to be sure that the margins around the tumor are cancer-free.

The scientists then performed a retrospective analysis of the surgical outcomes. "We found that the changes in surgical treatment had been beneficial in 22 patients [9%], non-beneficial in six patients [2.4%], and uncertain in four patients [1.6%],” said Dr. Martinez-Cecilia. "The results also showed us that MRI is the best imaging technique for measuring tumor size, better than mammography or ultrasound. MRI is being used more frequently in breast cancer preoperative staging these days, and we thought it was important to validate its efficacy.”

MRI is expensive, but with findings such as these, it should be used as widely as possible before surgery, according to the investigators. "It will not only improve the surgical treatment, which was our main aim, but in the long run it will probably reduce costs to healthcare systems by allowing us to identify exactly what needs to be treated, and in what way, to avoid possible recurrences of the cancer and the costs associated with its treatment,” said Dr. Martinez-Cecilia. "We will continue working prospectively with this issue as we would like to see MRI become a standard preoperative treatment for breast cancer, along with biopsy, mammography, and ultrasound.”


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Hospital Universitario Reina Sofia