Preoperative breast MRI for invasive ductal carcinoma with or without a DCIS component at needle biopsy: influence on surgical outcomes in 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

DOI: 10.1007/s00330-025-11572-7

Abstract

Objectives: To analyse the impact of preoperative breast MRI on surgical outcomes of patients diagnosed with pure invasive ductal carcinoma (IDC) or IDC with an associated in situ component (IDC + ductal carcinoma in situ [DCIS]) at needle biopsy. Methods: Patients aged 18–80 years referred for upfront surgery after a diagnosis of pure IDC or IDC + DCIS at needle biopsy were retrieved from the Multicenter International Prospective Analysis (MIPA) database. In each subgroup, patients who underwent preoperative MRI (MRI groups) were matched 1:1 to those who did not (noMRI groups) according to eight confounding covariates. Surgical outcomes were compared with non-parametric statistics after calculating odds ratios (ORs). Results: Among 1051 patients with IDC + DCIS, 510 were retained after matching (255 in each group): in comparison to the noMRI group, the MRI group had significantly higher rates of first-line mastectomy (13.3% vs 6.3%; OR 2.30, p = 0.011) and of overall mastectomy (14.5% vs 7.5%; OR 2.11, p = 0.016), without significantly lowering the reoperation rate (9.4% vs 10.6%, OR 0.88, p = 0.768). Among 2459 patients with pure IDC, 1638 were retained after matching (819 in each group): the first-line mastectomy rate was not significantly higher in the MRI group (12.9% vs 12.1% in the noMRI group; OR 1.08, p = 0.654). Instead, the reoperation rate was significantly lower (2.6% vs 7.9%; OR 3.28 for avoiding reoperation, p < 0.001) with no increase in overall mastectomies (13.6% vs 13.7%: OR 0.99, p = 1.000). Conclusions: In patients with IDC + DCIS, preoperative MRI did not reduce reoperations and increased mastectomies. Conversely, in patients with pure IDC, preoperative MRI reduced reoperations without increasing mastectomies. Key Points: Question The impact of preoperative breast MRI on surgical outcomes of patients with IDC at needle biopsy is controversial and lacks large-scale investigations. Findings For pure IDC at needle biopsy, MRI reduced reoperations without increasing mastectomies; for IDC + DCIS, MRI did not reduce reoperations and increased mastectomies. Clinical relevance In patients with IDC at needle biopsy, the decision to perform preoperative breast MRI should take into account the presence of associated DCIS, as the benefits of MRI on surgical outcomes were observed only in patients with pure IDC.

Authors with CRIS profile

Involved external institutions

Gruppo Ospedaliero San Donato Italy (IT) 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) 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) Fondazione IRCCS: Istituto Nazionale dei Tumori Italy (IT) European Institute of Oncology / Istituto Europeo di Oncologia (IEO) Italy (IT) Hospital Sírio-Libanês Brazil (BR) Semmelweis University / Semmelweis Egyetem Hungary (HU) The Breast Center | Fayetteville United States (USA) (US) Policlinico Universitario Paolo Giaccone Italy (IT) Maastricht University Netherlands (NL) Ospedale San Raffaele (früher: Centro San Raffaele del Monte Tabor Foundation) Italy (IT) 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) Kiwifarm Srl 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)

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 for invasive ductal carcinoma with or without a DCIS component at needle biopsy: influence on surgical outcomes in the MIPA study. European Radiology. https://doi.org/10.1007/s00330-025-11572-7

MLA:

Cozzi, Andrea, et al. "Preoperative breast MRI for invasive ductal carcinoma with or without a DCIS component at needle biopsy: influence on surgical outcomes in the MIPA study." European Radiology (2025).

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