Effects of preoperative magnetic resonance image on survival rates and surgical planning in breast cancer conservative surgery: randomized controlled trial (BREAST-MRI trial)

• Published in: Breast cancer research and treatment Vol. 198; no. 3; pp. 447 - 461
• Main Authors: Mota, Bruna Salani, Reis, Yedda Nunes, de Barros, Nestor, Cardoso, Natália Pereira, Mota, Rosa Maria Salani, Shimizu, Carlos, de Mello Tucunduva, Tatiana Cardoso, de Siqueira Ferreira, Vera Christina Camargo, Goncalves, Rodrigo, Doria, Maíra Teixeira, Ricci, Marcos Desidério, Trinconi, Angela Francisca, Camargo, Cristina Pires, Riera, Rachel, Baracat, Edmund Chada, Soares Jr, José Maria, Filassi, José Roberto
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.04.2023; Springer; Springer Nature B.V
• Subjects: Breast cancer; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - surgery; Cancer research; Cancer surgery; Clinical Trial; Comparative analysis; Female; Humans; Lumpectomy; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Mammography; Mastectomy; Mastectomy - methods; Mastectomy, Segmental - methods; Medicine; Medicine & Public Health; Neoplasm Recurrence, Local - diagnostic imaging; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Oncology; Patient outcomes; Preoperative Care; Surgery; Surgical outcomes; Survival; Survival analysis; Survival Rate; Conservative breast cancer surgery; Breast cancer; Magnetic resonance imaging; Randomized controlled trial
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-023-06884-5

Background Breast magnetic resonance imaging (MRI) has high sensitivity in detecting invasive neoplasms. Controversy remains about its impact on the preoperative staging of breast cancer surgery. This study evaluated survival and surgical outcomes of preoperative MRI in conservative breast cancer surgery. Methods A phase III, randomized, open-label, single-center trial including female breast cancer participants, stage 0–III disease, and eligible for breast-conserving surgery. We compared the role of including MRI in preoperative evaluation versus radiologic exam routine with mammography and ultrasound in breast cancer conservative candidates. The primary outcome was local relapse-free survival (LRFS), and secondary outcomes were overall survival (OS), mastectomy rate, and reoperation rate. Results 524 were randomized to preoperative MRI group ( n  = 257) or control group ( n  = 267). The survival analysis showed a 5.9-years LRFS of 99.2% in MRI group versus 98.9% in control group (HR = 0.72; 95% CI 0.12—4.28; p  = 0.7) and an OS of 95.3% in the MRI group versus 96.3% in the control group (HR = 1.37 95% CI 0.59–3.19; p  = 0.8). Surgical management changed in 21 ipsilateral breasts in the MRI group; 21 (8.3%) had mastectomies versus one in the control group. No difference was found in reoperation rates, 22 (8.7%) in the MRI group versus 23 (8.7%) in the control group (RR = 1.002; 95% CI 0.57–1.75; p  = 0.85). Conclusion Preoperative MRI increased the mastectomy rates by 8%. The use of preoperative MRI did not influence local relapse-free survival, overall survival, or reoperation rates.