Breast Cancer Research and Treatment

, Volume 174, Issue 2, pp 315–324 | Cite as

Clinical findings and outcomes of MRI staging of breast cancer in a diverse population

  • Akshara Raghavendra
  • Julie Wecsler
  • Lingyun Ji
  • Pulin Sheth
  • Charite Ricker
  • Terry Church
  • Richard Sposto
  • Julie Lang
  • Stephen Sener
  • Linda Larsen
  • Debu TripathyEmail author



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.


Magnetic 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.

Author contributions

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.

Ethical approval

This article does not contain any studies with human participants or animals.

Informed consent

This study was approved by the institutional review board at University of Southern California, and waivers for obtaining informed consent were granted.

Supplementary material

10549_2018_5084_MOESM1_ESM.docx (24 kb)
Supplementary material 1 (DOCX 24 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Akshara Raghavendra
    • 1
  • Julie Wecsler
    • 2
    • 3
  • Lingyun Ji
    • 4
  • Pulin Sheth
    • 5
  • Charite Ricker
    • 2
    • 6
  • Terry Church
    • 6
  • Richard Sposto
    • 4
  • Julie Lang
    • 3
  • Stephen Sener
    • 3
  • Linda Larsen
    • 5
  • Debu Tripathy
    • 1
    • 7
    Email author
  1. 1.Division of Cancer Medicine, Department of Breast Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Los Angeles County and University of Southern California Healthcare Network Los AngelesLos AngelesUSA
  3. 3.Division of Breast and Soft Tissue Surgery, Department of SurgeryUniversity of Southern California Norris Comprehensive Cancer CenterLos AngelesUSA
  4. 4.Department of Preventive Medicine, Norris Comprehensive Cancer CenterUniversity of Southern CaliforniaLos AngelesUSA
  5. 5.Division of Women’s Imaging, Department of RadiologyUniversity of Southern California Norris Comprehensive Cancer CenterLos AngelesUSA
  6. 6.Division of Oncology, Department of MedicineUniversity of Southern California Norris Comprehensive Cancer CenterLos AngelesUSA
  7. 7.Department of Breast Medical Oncology, Unit 1354The University of Texas MD Anderson Cancer CenterHoustonUSA

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