Preoperative
MRI Improves Staging Accuracy in Breast Cancer
According to a recent article published in the journal Cancer,
preoperative magnetic resonance imaging (MRI) improves the
accuracy of staging and may affect treatment options for patients
diagnosed with breast cancer.
Breast cancer claims the lives of approximately 40,000 women
annually in the United States alone. The stage of cancer refers
to the extent the cancer has spread from its site of origin.
The stage of cancer dictates treatment options; thus the accuracy
of staging is imperative in order to provide the most appropriate
therapeutic options for patients. Current staging procedures
may include axillary (under the arm) lymph node dissection
or sentinel node dissection, chest x-rays, mammography, blood
tests and sometimes computerized tomography (CT) scans or
bone scans. Magnetic resonance imaging (MRI) is another type
of scan that is not a standard staging method for breast cancer,
but has been demonstrated to improve staging accuracy in breast
cancer in a number of small clinical studies. Since small
areas of cancer that has spread from its original site may
be difficult to detect with standard staging procedures, researchers
are evaluating different combinations of staging methods in
order to provide the most accurate approach.
Researchers from the University of Pennsylvania and the Mayo
Clinic recently conducted a clinical study to further evaluate
the effectiveness of MRI prior to surgery in the staging of
breast cancer. This study was a review of data from 267 patients
diagnosed with breast cancer between 1992 and 1998 who had
undergone standard staging procedure plus preoperative MRI.
Overall, MRI detected 95% of cancers. The surgical management
of treatment was altered in 26% of patients following MRI,
with 16.5% of patients who were originally scheduled to undergo
breast-conserving therapy (lumpectomy plus radiation) following
standard staging procedures ultimately treated with a mastectomy
(removal of entire breast) due to the detection of cancer
spread with an MRI. Upon evaluation of tissue that was surgically
removed, it was determined that over 70% of patients who received
more extensive surgery due to MRI results did have cancer
spread that was only detected on MRI. MRI was most effective
in patients with a specific type of breast cancer, called
lobular breast cancer, which arises in the lobules of the
breast.
The researchers concluded that preoperative MRI may alter
treatment decisions in a significant number of patients diagnosed
with breast cancer. They state that future, large clinical
trials are necessary to determine if any subgroups of patients
with breast cancer may benefit more from preoperative MRI
than others. Patients with breast cancer may wish to speak
with their physician about the risks and benefits of an MRI
or the participation in a clinical trial evaluating other
screening procedures. Two sources of information regarding
ongoing clinical trials include the National Cancer Institute
( cancer.gov) and www.cancerconsultants.com. Personalized
clinical trial searches on behalf of patients are also provided
at cancerconsultants.com.
Reference: Bedrosian I, Mick R, Orel S, et al. Changes in
the surgical management of patients with breast carcinoma
based on preoperative magnetic resonance imaging. Cancer.
2003;98:468-473.
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