Lancet: Adding MRI doesnt affect reoperation rates for breast cancer
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Lindsay Turnbull, PhD, from the University of Hull and Hull Royal Infirmary in England, and colleagues undertook this randomized controlled study that took place in 45 U.K. centers. They recruited 1,623 women aged 18 years or older with biopsy-proven primary breast cancer who were scheduled for surgery to remove their tumors after triple assessment.
The researchers randomly assigned patients to receive either MRI (816) or no further imaging (807). The primary endpoint was the proportion of patients undergoing a repeat operation or further mastectomy within six months of randomization, or a pathologically avoidable mastectomy at initial operation.
The addition of MRI to conventional triple assessment was not significantly associated with a reduced reoperation rate, with 153 (19 percent) needing reoperation in the MRI group versus 156 (19 percent) in the no MRI group, according to the authors.
“In the analysis, we identified no difference in health-related quality of life between groups 12 months after initial surgery,” Turnbull and colleagues wrote. “However, in terms of total costs, results suggested a difference between the two trial groups, with the MRI group costing more than the no MRI group, although the difference was not statistically significant.”
“In view of the similar clinical and health related quality-of-life outcomes of patients in both groups, we conclude that the addition of MRI to the conventional triple assessment might result in extra use of resources at the initial surgery period, with few or no benefits to saving resources or health outcomes, and the additional burden on patients to attend extra hospital visits," they continued.
“Our results have important implications in routine clinical practice for the appropriate use of health service resources and patient burden on health services. MRI is an expensive procedure,” the authors concluded. “Because surgical use of MRI data to direct wide local excision is similar worldwide, we believe that our findings are generalizable to all healthcare providers, and show that MRI might not be necessary in this population of patients in terms of reduction of reoperation rates."
In the accompanying commentary, Elizabeth A Morris, MD, Sloan-Kettering Cancer Center and Weill Cornell Medical College in New York City, wrote: "It is too early to completely dispense with preoperative breast MRI. Importantly, COMICE has shown that preoperative breast MRI might not be for all women and that routine breast MRI in the evaluation of early breast cancer, as managed by those participating in this study, does not decrease reoperation rates."
National Institute for Health Research's Health Technology Assessment Program funded the study.