Pre-surgery MRI scans recommended for all breast cancer patients

The pre-op use of magnetic resonance imaging (MRI) in women diagnosed with breast cancer often leads to a better adapted surgical approach, a scientist told the 6th European Breast Cancer Conference today.

Dr. David Martinez-Cecilia, a surgeon from the General Surgery Service, directed by Prof. Rufian-Peña, in the Hospital Universitario Reina Sofia, Cordoba, Spain, suggested that this technique should become standard in determining the stage of the tumour before any operation.

His team studied 249 patients who were undergoing surgery for breast cancer, and carried out routine MRI as soon as a biopsy showed malignancy. If additional lesions were discovered, a further biopsy was carried out.

"Using MRI, we found 20 additional malignant lesions in 18 patients", he said, "and that meant that for 15 patients we were able to change the surgical treatment to one which took care of all the tumours, as opposed to the single one that had originally been diagnosed."

Three patients needed surgery in both breasts, one required a second lumpectomy in the same breast, and 11 changed from lumpectomy to mastectomy. The surgical treatment also changed in those patients where the MRI showed up a larger tumour than that which was originally identified; 16 other patients changed from lumpectomy to mastectomy, and one from lumpectomy to quadrantectomy, a partial mastectomy where the tumour and some surrounding breast tissue is removed to be sure that the margins around the tumour are cancer-free.

The team then carried out a retrospective analysis of the surgical outcomes. They found that the changes in surgical treatment had been beneficial in 22 patients (9%), uncertain in 4 patients (1.6%), and unnecessary in 6 patients (2.4%). Conference chair Professor Emiel Rutgers, of the Netherlands Cancer Institute, noted that such a false positive rate was normal and still represented a good result, adding: "The 3-D imaging available to me prior to surgery is extremely useful. I can't do without MRI for breast cancer staging".

The scientists suggest that MRI is the best imaging technique for measuring tumour size - better than ultrasound or mammography - and although expensive (€400-€600 per scan depending on country) it should be used as widely as possible pre-surgery; hopefully dramatically reducing the current 10% recurrence rate for breast cancer surgery.

They also point out that the cost incurred by re-operating far outweighs the cost of the initial scan:

"It will not only improve the surgical treatment, which was our main aim, but in the long run it will probably reduce costs to healthcare systems by allowing us to identify exactly what needs to be treated, and in what way, to avoid possible recurrences of the cancer and the costs associated with its treatment. We will continue working prospectively with this issue as we would like to see MRI become a standard preoperative treatment for breast cancer, along with biopsy, mammography, and ultrasound", concluded Dr. Martinez-Cecilia.