Breast MRI spots other cancers, may alter treatment plan

In about 20 percent of women with breast cancer who plan to undergo a lumpectomy, breast magnetic resonance imaging reveals important diagnostic information that alters their treatment plan, University of Florida surgeons reported today (Dec. 5).

This study was presented at the 119th annual meeting of the Southern Surgical Association, held Dec. 2-5 in Hot Springs, Va., and will appear in the May 2008 issue of the Journal of the American College of Surgeons.

MRI, which is not routinely administered to these patients, can find additional cancerous areas in the breast that previously evaded detection, discover cancer in the opposite breast that standard imaging tests such as mammography and ultrasound missed, or determine a tumor is actually larger than expected, the doctors say.

Some of these women end up needing a total mastectomy instead of breast-conserving lumpectomy. Others whose tumors are bigger than indicated on standard imaging could be less likely to face a second operation to remove cancerous cells left behind after a tumor is removed if MRI findings signal the need for surgeries to be more aggressive.

Either way, UF surgeons say MRI can help confirm which women are indeed candidates for a breast-sparing operation.

“In these patients, we did one of three things: We offered them a mastectomy, we offered them another treatment — preoperative chemotherapy to shrink the lesion and allow us to save the breast — or, in some cases, we could perform a more precise excision to remove the cancer,” said Stephen R. Grobmyer, M.D., an assistant professor of surgical oncology and endocrine surgery in the UF College of Medicine’s department of surgery.

“When you operate for breast cancer, you need to achieve clear margins around the tumor,” he added. “This inability to clear the margin is a problem that continues to plague both breast surgeons and patients. In some recent reports the margin-positive resection rate for breast cancer is up to 50 percent.”

Findings from the UF study, a retrospective review of 79 women ages 29 to 82 who had localized noninvasive or early stage invasive breast cancer and were planning to have a lumpectomy, were presented at the Southern Surgical Association’s 119th annual meeting in Hot Springs, Va. Study participants had undergone preoperative MRI — which provides highly detailed images of the breast, particularly in women whose breast tissue is very dense — for diagnostic purposes and, when indicated, MRI-directed biopsies for preoperative evaluation of suspicious areas between January 2006 and July 2007.

“We’re talking about MRIs for patients who have breast cancer and would like to save the breast, to make sure there is (no other cancer) in the breast that would eliminate them from breast conservation,” said Edward M. Copeland III, M.D., the Edward R. Woodward professor of surgical oncology and endocrine surgery at UF.