Clinical findings and outcomes of MRI staging of breast cancer in a diverse population
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The performance of magnetic resonance imaging (MRI), the effect of patient factors, and resulting surgical management in underserved and ethnically diverse breast cancer (BC) patient populations have been understudied.
We retrospectively analyzed the data of 1116 consecutive patients who were newly diagnosed with in situ or invasive BC with preoperative staging MRI. Non-index lesions (NILs) were defined as abnormal MRI findings with BI-RADS score of 4 or 5 in breast or axillary nodes not previously detected by conventional imaging. Occult cancers (OCs) were NILs found to be malignant by biopsy or surgery. Logistic regression was used to examine associations between probabilities of NILs or OCs and patient characteristics.
Staging MRI detected NILs and OCs in 24% and 7.5% of patients, respectively. Of 1116 patients, 271 (24%) had 327 NILs, and 84 (7.5%) had 87 OCs. Follow-up information was available for 306 NILs. Ipsilateral breast NILs (n = 124) were seen in 115 patients (10.3%), with OCs (n = 51) seen in 48 patients (4.4%). Contralateral breast NILs (n = 134) were seen in 118 (10.6%) patients, with OCs (n = 20) seen in 20 patients (1.8%). Laterality (p < 0.001) and disease stage (p = 0.018) were associated with probability of OC. Patients without BRCA mutations had a significantly higher probability of having NILs (p = 0.003) but not OCs.
Our study provides useful estimates of the rates of NILs and OCs anticipated in a younger, uninsured, ethnically diverse population. Prospective trials and larger pooled retrospective analyses are needed to define the long-term impacts of MRI staging after a BC diagnosis.
KeywordsMagnetic resonance imaging Non-index lesions Occult cancer Screening Risk factors BRCA Body mass index Breast density Neoadjuvant therapy Underserved populations
Joe Munch in MD Anderson’s Department of Scientific Publications edited the manuscript.
Design/conception: Akshara Raghavendra, Debu Tripathy. Data collection: Akshara S Raghavendra. Statistical analysis: Richard Sposto, Lingyun Ji. Data interpretation: All Authors. Manuscript writing: All Authors.
This study was supported by the Women’s Cancer Program, USC Norris Comprehensive Cancer Center, and by the National Cancer Institute through MD Anderson’s Cancer Center Support Grant (P30CA016672). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.
Compliance with ethical standards
Conflict of interest
The authors declare no potential conflicts of interest.
This article does not contain any studies with human participants or animals.
This study was approved by the institutional review board at University of Southern California, and waivers for obtaining informed consent were granted.
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