Preoperative MRI in breast cancer: effect of breast density on biopsy rate and yield

Details

• Alternative Title:
  Breast Cancer Res Treat
• Personal Author:
  Onega, Tracy ; Zhu, Weiwei ; Kerlikowske, Karla ; Miglioretti, Diana L. ; Lee, Christoph I. ; Henderson, Louise M. ; Tosteson, Anna N.A. ; Wernli, Karen J. ; diFlorio, Roberta ; Weaver, Donald L. ; Buist, Diana S.M.
• Description:
  Purpose
  
  Preoperative breast MRI is used to evaluate for additional cancer and extent of disease for newly diagnosed breast cancer, yet benefits and harms of preoperative MRI are not well documented. We examined whether preoperative MRI yields additional biopsy and cancer detection by extent of breast density.
  
  Methods
  
  We followed women in the Breast Cancer Surveillance Consortium with an incident breast cancer diagnosed from 2005–2017. We quantified breast biopsies and cancers detected within 6 months of diagnosis by preoperative breast MRI receipt, overall and by breast density, accounting for MRI selection bias using inverse probability weighted logistic regression.
  
  Results
  
  Among 19,324 women with newly diagnosed breast cancer, 28% had preoperative MRI, 11% additional biopsy, and 5% additional cancer detected. Four times as many women with preoperative MRI underwent additional biopsy compared to women without MRI (22.6% v. 5.1%). Additional biopsy rates with preoperative MRI increased with increasing breast density (27.4% for extremely dense compared to 16.2% for almost entirely fatty breasts). Rates of additional cancer detection were almost four times higher for women with v. without MRI (9.9% v. 2.6%). Conditional on additional biopsy, age-adjusted rates of additional cancer detection were lowest among women with extremely dense breasts, regardless of imaging modality (with MRI: 35.0%; 95%CI=27.0%−43.0%; without MRI: 45.1%; 95%CI=32.6%−57.5%).
  
  Conclusion
  
  For women with dense breasts, preoperative MRI was associated with much higher biopsy rates, without concomitant higher cancer detection. Preoperative MRI may be considered for some women, but selecting women based on breast density is not supported by evidence.
  
  
• Subjects:
  Biopsy Breast Density Breast Neoplasms Female Humans Magnetic Resonance Imaging Mammography
• Source:
  Breast Cancer Res Treat. 191(1):177-190
• Pubmed ID:
  34686934
• Pubmed Central ID:
  PMC9881728
• Document Type:
  Journal Article
• Funding:
  HHSN261201000140C/CA/NCI NIH HHSUnited States/ ; P01 CA154292/CA/NCI NIH HHSUnited States/ ; CS-1504-30370/PCORI/Patient-Centered Outcomes Research InstituteUnited States/ ; U54 CA163303/CA/NCI NIH HHSUnited States/ ; HHSN261201300012I/CA/NCI NIH HHSUnited States/ ; HHSN261201000035I/CA/NCI NIH HHSUnited States/ ; U58 DP003862/DP/NCCDPHP CDC HHSUnited States/ ; HHSN261201000029C/CA/NCI NIH HHSUnited States/ ; N01 CN067009/CN/NCI NIH HHSUnited States/ ; U01 CA086082/CA/NCI NIH HHSUnited States/ ; N01PC35142/CA/NCI NIH HHSUnited States/ ; R01 CA149365/CA/NCI NIH HHSUnited States/ ; HHSN261201000035C/PC/NCI NIH HHSUnited States/ ; HHSN261201000034C/CA/NCI NIH HHSUnited States/ ; N01 CN005230/CN/NCI NIH HHSUnited States/ ; R01 HS018366/HS/AHRQ HHSUnited States/
• Volume:
  191
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:b1b1081b12ba69baaae36c5888cc1ff52af2307714e02882ea76c91fc400fedd
• Download URL:
  https://stacks.cdc.gov/view/cdc/124071/cdc_124071_DS1.pdf
• File Type:
  [PDF - 383.23 KB ]