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Use of Preoperative Magnetic Resonance Imaging for Breast Cancer: A Canadian Population-Based Study.

Abstract：

IMPORTANCE:Contrary to practice guidelines, breast magnetic resonance imaging (MRI) is commonly used in the preoperative evaluation of women with breast cancer. While existing literature has found little benefit to MRI in most patients, potential downstream consequences associated with breast MRI are not well described. OBJECTIVE:To describe patterns of preoperative breast MRI utilization in a health care system with universal insurance and its association with downstream investigations and clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS:This was a population-based retrospective cohort study using administrative heath care databases in Ontario, Canada (2012 population, 13.5 million) over 14 geographic regions were evaluated within the data set. Participants comprised 53 015 patients with primary operable breast cancer treated from 2003 to 2012. MAIN OUTCOMES AND MEASURES:Use of preoperative breast MRI by year, geographic region, and breast cancer stage. Postdiagnosis imaging, biopsy, and short-term surgical outcomes were also evaluated between those who did and did not receive MRI. RESULTS:Overall, 14.8% of patients (7824 of 53 015) had a preoperative MRI. During the 10-year study period, MRI use increased across all stages by 8-fold (from 3% to 24%; P < .001 for trend). Factors associated with MRI use were younger age, higher socioeconomic status, higher Charlson comorbidity score, surgery performed in a teaching hospital, and fewer years of surgeon experience. Multivariate analyses showed that preoperative breast MRI was associated with higher likelihood of the following: postdiagnosis breast imaging (odds ratio [OR], 2.09; 95% CI, 1.92-2.28), postdiagnosis breast biopsies (OR, 1.74; 95% CI, 1.57-1.93), postdiagnosis imaging to assess for distant metastatic disease (OR, 1.51; 95% CI, 1.42-1.61), mastectomy (OR, 1.73; 95% CI, 1.62-1.85), contralateral prophylactic mastectomy (OR, 1.48; 95% CI, 1.23-1.77), and a greater than 30-day wait to surgery (OR, 2.52; 95% CI, 2.36-2.70) (all ORs are adjusted). CONCLUSIONS AND RELEVANCE:Preoperative breast MRI use has increased substantially in routine clinical practice and is associated with a significant increase in ancillary investigations, wait time to surgery, mastectomies, and contralateral prophylactic mastectomies.

journal_name

JAMA Oncol

journal_title

JAMA oncology

authors

Arnaout A,Catley C,Booth CM,McInnes M,Graham I,Kumar V,Simos D,Van Walraven C,Clemons M

doi

10.1001/jamaoncol.2015.3018

subject

Has Abstract

pub_date

2015-12-01 00:00:00

pages

1238-50

issue

eissn

2374-2437

issn

2374-2445

pii

2443152

journal_volume

pub_type

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Use of Preoperative Magnetic Resonance Imaging for Breast Cancer: A Canadian Population-Based Study.