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Relationship of Breast MRI to Recurrence Rates in Patients Undergoing Breast-Conservation Treatment
*Maureen V Hill1, *Julia L Beeman1, *Khushboo N Jhala2, Richard J Barth, Jr1
1Dartmouth Hitchcock Medical Center, Lebanon, NH;2Geisel School of Medicine, Hanover, NH

OBJECTIVE: The effect of pre-operative MRI on the in-breast recurrence rate of patients undergoing breast-conservation treatment (BCT) remains uncertain. In most studies, MRI is not done on a routine basis and is only performed on high risk patients. At our institution, we began to routinely perform pre-operative MRI for operative planning in 2006. Our goal was to determine the effect of pre-operative MRI on the in-breast recurrence rate.
DESIGN: Review of retrospective database.
SETTING: Academic medical center.
PATIENTS: Patients (1384) undergoing BCT from 2000-2010.
INTERVENTION:
MAIN OUTCOME MEASURE: In-breast recurrence using Kaplan-Meier estimates.
RESULTS: 693 (50.1%) patients underwent pre-operative MRI. The use of MRI increased from 13.2% in 2000-2004 to 83.7% in 2006-2010. For 993 patients with invasive cancer, at 5 years of follow-up the percent of patients with an in-breast recurrence was 4.2% in the MRI group and 3.9% in the no MRI group (p=NS). For 274 patient with DCIS who received radiation therapy at 5 years follow up the percent of patients with an in-breast recurrence was 3.5% in the MRI group and 2.4% in the no MRI group (p=NS). In the subgroup of 106 DCIS patients who did not receive radiation, the 5 year in-breast recurrence rate was lower in patients undergoing pre-operative MRI (0% vs. 11.4%, p=0.02).
CONCLUSION: In a study analyzing BCT patients from one time period who rarely had pre-operative MRI and a subsequent time period where most patients had MRI, the use of MRI was not associated with a decrease in in-breast recurrence rate. When looking specifically at patients with DCIS, those who did not receive radiation had a lower in-breast recurrence rate if they underwent pre-operative MRI.


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