Preoperative breast MRI reduces reoperations for unilateral invasive lobular carcinoma: a patient-matched analysis from the MIPA study

Cozzi A, Di Leo G, Houssami N, Gilbert FJ, Helbich TH, Álvarez Benito M, Balleyguier C, Bazzocchi M, Bult P, Calabrese M, Camps Herrero J, Cartia F, Cassano E, Clauser P, de Lima Docema MF, Depretto C, Dominelli V, Forrai G, Girometti R, Harms SE, Hilborne S, Ienzi R, Lobbes MB, Losio C, Mann RM, Montemezzi S, Obdeijn IM, Aksoy Ozcan U, Pediconi F, Pinker K, Preibsch H, Raya Povedano JL, Rossi Saccarelli C, Sacchetto D, Scaperrotta GP, Schlooz M, Szabó BK, Taylor DB, Ulus S, Van Goethem M, Veltman J, Weigel S, Wenkel E, Zuiani C, Sardanelli F (2025)

Publication Type: Journal article

Publication year: 2025

Journal

Article Number: 6

DOI: 10.1007/s00330-024-11338-7

Abstract

Objectives: To investigate the surgical impact of preoperative breast MRI in patients diagnosed with invasive lobular breast cancer (ILC) in a prospective observational study. Methods: The prospective MIPA observational study database was queried for patients aged 18–80 with newly diagnosed unilateral ILC at needle biopsy referred for primary surgery. Patients who underwent preoperative MRI (MRI group) were matched (1:1) with those who did not (noMRI group) according to nine confounding covariates. Surgical outcomes were compared between the matched groups with nonparametric statistics after calculating odds ratios (ORs). Results: A total of 547 women with unilateral needle biopsy-diagnosed ILC were identified (158 noMRI group, 389 MRI group). After patient matching, each group retained 103 patients, for a total of 206 matched patients. For the rate of women having a first-line mastectomy, there was no significant difference between the MRI group (21.4%, 22/103; p = 0.727; OR 1.20, 95% CI: 0.61–2.38) and the noMRI group (18.4%, 19/103). Conversely, the reoperation rate in the MRI group (1.9%, 2/103) was significantly lower (p = 0.007; OR of avoiding reoperation 7.29, 95% CI: 1.60–33.21) than in the noMRI group (12.6%, 13/103 patients). Overall mastectomy rates (first plus second-line) did not significantly differ between the MRI group (23.3%, 24/103; p = 0.867, OR 1.12, 95% CI: 0.58–2.16) and the noMRI group (21.4%, 22/103). Conclusions: Women who had preoperative MRI after a needle biopsy diagnosis of ILC had a significant six-fold reduction in reoperations compared to those who did not have an MRI examination, with similar overall mastectomy rates. Key Points: Question No randomized controlled trials investigating the impact of preoperative MRI on surgical outcomes (mastectomy rates and reoperation) of needle-biopsy-diagnosed ILC have been conducted. Findings In a patient-matched analysis of 103 vs 103 women, preoperative MRI led to a greater than six-fold reduction of reoperations, without significant differences in first-line and overall mastectomy rates. Clinical relevance In the absence of randomized controlled trials, patient matching can be applied to mitigate confounding factors that drive the referral to preoperative MRI, showing that preoperative MRI has beneficial effects on surgical outcomes in patients with needle biopsy-diagnosed unilateral ILC.

Authors with CRIS profile

Involved external institutions

University of Cambridge United Kingdom (GB) Medizinische Universität Wien Austria (AT) Hospital Universitario Reina Sofía de Córdoba Edificio IMIBIC Spain (ES) Institut Gustave-Roussy France (FR) University of Udine / Università degli Studi di Udine Italy (IT) Ospedale San Raffaele (früher: Centro San Raffaele del Monte Tabor Foundation) Italy (IT) Radboud University Nijmegen Medical Centre / Radboudumc of voluit Radboud Universitair Medisch Centrum (UMC) Netherlands (NL) Ospedale Policlinico San Martino Italy (IT) University Hospital of the Ribera / Hospital Universitario de la Ribera Spain (ES) University Hospital of Verona / Azienda Ospedaliera Universitaria Integrata Verona (AOUI) Italy (IT) Erasmus University Medical Center (MC) Netherlands (NL) Acıbadem Ataşehir Hospital / Acıbadem Ataşehir Hastanesi Turkey (TR) Universitätsklinikum Tübingen Germany (DE) Hospital Sírio-Libanês Brazil (BR) Kiwifarm Srl Italy (IT) Fondazione IRCCS: Istituto Nazionale dei Tumori Italy (IT) Barking, Havering and Redbridge University Hospitals NHS Trust United Kingdom (GB) University of Western Australia (UWA) Australia (AU) Hospital Network Antwerp / Ziekenhuis Netwerk Antwerpen (ZNA) Belgium (BE) Maatschap Radiol Oost Nederland (MRON) Netherlands (NL) Westfälische Wilhelms-Universität (WWU) Münster Germany (DE) Gruppo Ospedaliero San Donato Italy (IT) European Institute of Oncology / Istituto Europeo di Oncologia (IEO) Italy (IT) Semmelweis University / Semmelweis Egyetem Hungary (HU) The Breast Center | Fayetteville United States (USA) (US) Policlinico Universitario Paolo Giaccone Italy (IT) Maastricht University Netherlands (NL)

How to cite

APA:

Cozzi, A., Di Leo, G., Houssami, N., Gilbert, F.J., Helbich, T.H., Álvarez Benito, M.,... Sardanelli, F. (2025). Preoperative breast MRI reduces reoperations for unilateral invasive lobular carcinoma: a patient-matched analysis from the MIPA study. European Radiology. https://doi.org/10.1007/s00330-024-11338-7

MLA:

Cozzi, Andrea, et al. "Preoperative breast MRI reduces reoperations for unilateral invasive lobular carcinoma: a patient-matched analysis from the MIPA study." European Radiology (2025).

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