Another challenge to routine preop breast MRI

Those advocating against the routine use of preoperative breast MRI—an issue that has been in debate for years—received some more support in the literature this week, as a meta-analysis found no evidence that preoperative MRI for staging the cancerous breast reduces local or distant recurrence.

The analysis—conducted by Nehmat Houssami, MBBS, PhD, of the University of Sydney, and colleagues and published online in the Journal of Clinical Oncology—is the first meta-analysis to evaluate local and distant recurrence in women undergoing preop MRI before attempted breast conservation.

Underscoring the conclusions of the analysis, Richard Bleicher, MD, from the Fox Chase Cancer Center in Philadelphia, submitted an associated editorial that argued a growing body of research has reached the same conclusion.

“Breast MRI, like so many other tests, has advantages for particular clinical scenarios, but not as a routine, reflexively ordered test to be used in all cancer patients preoperatively,” wrote Bleicher.

Prior to the work of Houssami et al, Bleicher points out that previous studies have not supported the idea that MRI could not improve survival or lead to improvements in surgical technique.

This doesn’t mean MRI shouldn’t play a role in breast cancer imaging. Bleicher argued that while routinely using the modality in a non-high-risk, preoperative setting won’t lead to improved outcomes, it has been found to be advantageous in cases of Paget’s disease, occult primaries and in deleterious BRCA mutation carriers.

The meta-analysis may not have delivered the knockout blow, as the study could be challenged due to the fact that Houssami and colleagues could not obtain data from all eligible studies and that the data that was included featured short overall follow-up. But routine use, especially in today’s environment, may be on the ropes.

“Irrespective of one’s thoughts about the promise of MRI (or lack thereof), the study’s significance lies in the fact that now, more than ever, today’s cost-conscious health care world dictates that we must demonstrate improved outcomes (or some other substantial benefit) to justify costs,” wrote Bleicher.

-Evan Godt
Editor – Health Imaging