Preoperative MRI Improves Staging Accuracy in Breast Cancer

Preoperative MRI Improves Staging Accuracy in Breast Cancer

According to a recent article published in the journal Cancer, preoperative magnetic resonance imaging (MRI) improves the accuracy of staging and may affect treatment options for patients diagnosed with breast cancer.

Breast cancer claims the lives of approximately 40,000 women annually in the United States alone. The stage of cancer refers to the extent the cancer has spread from its site of origin. The stage of cancer dictates treatment options; thus the accuracy of staging is imperative in order to provide the most appropriate therapeutic options for patients. Current staging procedures may include axillary (under the arm) lymph node dissection or sentinel node dissection, chest x-rays, mammography, blood tests and sometimes computerized tomography (CT) scans or bone scans. Magnetic resonance imaging (MRI) is another type of scan that is not a standard staging method for breast cancer, but has been demonstrated to improve staging accuracy in breast cancer in a number of small clinical studies. Since small areas of cancer that has spread from its original site may be difficult to detect with standard staging procedures, researchers are evaluating different combinations of staging methods in order to provide the most accurate approach.

Researchers from the University of Pennsylvania and the Mayo Clinic recently conducted a clinical study to further evaluate the effectiveness of MRI prior to surgery in the staging of breast cancer. This study was a review of data from 267 patients diagnosed with breast cancer between 1992 and 1998 who had undergone standard staging procedure plus preoperative MRI. Overall, MRI detected 95% of cancers. The surgical management of treatment was altered in 26% of patients following MRI, with 16.5% of patients who were originally scheduled to undergo breast-conserving therapy (lumpectomy plus radiation) following standard staging procedures ultimately treated with a mastectomy (removal of entire breast) due to the detection of cancer spread with an MRI. Upon evaluation of tissue that was surgically removed, it was determined that over 70% of patients who received more extensive surgery due to MRI results did have cancer spread that was only detected on MRI. MRI was most effective in patients with a specific type of breast cancer, called lobular breast cancer, which arises in the lobules of the breast.

The researchers concluded that preoperative MRI may alter treatment decisions in a significant number of patients diagnosed with breast cancer. They state that future, large clinical trials are necessary to determine if any subgroups of patients with breast cancer may benefit more from preoperative MRI than others. Patients with breast cancer may wish to speak with their physician about the risks and benefits of an MRI or the participation in a clinical trial evaluating other screening procedures. Two sources of information regarding ongoing clinical trials include the National Cancer Institute ( cancer.gov) and www.cancerconsultants.com. Personalized clinical trial searches on behalf of patients are also provided at cancerconsultants.com.

Reference: Bedrosian I, Mick R, Orel S, et al. Changes in the surgical management of patients with breast carcinoma based on preoperative magnetic resonance imaging. Cancer. 2003;98:468-473.

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