1. Does Preoperative MRI Reduce Positive Margins after Breast-Conserving Surgery?
- Author
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Cairns A, Chagpar AB, Dupont E, Levine EA, Gass JS, Chiba A, Ollila DW, and Howard-McNatt M
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Middle Aged, Magnetic Resonance Imaging methods, Margins of Excision, Mastectomy, Segmental methods, Breast Neoplasms diagnostic imaging, Breast Neoplasms surgery, Breast Neoplasms pathology, Carcinoma, Ductal, Breast diagnostic imaging, Carcinoma, Ductal, Breast surgery, Carcinoma, Ductal, Breast pathology
- Abstract
Background: Breast-conserving surgery (BCS) is a mainstay for breast cancer management, and obtaining negative margins is critical. Some have advocated for the use of preoperative magnetic resonance imaging (MRI) in reducing positive margins after BCS. We sought to determine whether preoperative MRI was associated with reduced positive margins., Patients and Methods: The SHAVE/SHAVE2 trials were multicenter trials in ten US centers with patients with stage 0-3 breast cancer undergoing BCS. Use of preoperative MRI was at the discretion of the surgeon. We evaluated whether or not preoperative MRI was associated with margin status prior to randomization regarding resection of cavity with shave margins., Results: A total of 631 patients participated. Median age was 64 (range 29-94) years, with a median tumor size of 1.3 cm (range 0.1-9.3 cm). Patient factors included 26.1% of patients (165) had palpable tumors, and 6.5% (41) received neoadjuvant chemotherapy. Tumor factors were notable for invasive lobular histology in 7.0% (44) and extensive intraductal component (EIC) in 32.8% (207). A preoperative MRI was performed in 193 (30.6%) patients. Those who underwent preoperative MRI were less likely to have a positive margin (31.1% versus 38.8%), although this difference was not statistically significant (p = 0.073). On multivariate analysis, controlling for patient and tumor factors, utilization of preoperative MRI was not a significant factor in predicting margin status (p = 0.110). Rather, age (p = 0.032) and tumor size (p = 0.040) were the only factors associated with margin status., Conclusion: These data suggest that preoperative MRI is not associated margin status; rather, patient age and tumor size are the associated factors., (© 2023. Society of Surgical Oncology.)
- Published
- 2023
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