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Does preoperative breast MRI lead to an improvement of survival of breast cancer patients in the Netherlands?

Tiel, L.P.T. van (2019) Does preoperative breast MRI lead to an improvement of survival of breast cancer patients in the Netherlands?

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Abstract:Purpose Breast magnetic resonance imaging (MRI) is used in patients with breast cancer for the evaluation of tumor diameter, multifocality, and potential presence of contralateral breast cancer, and therefore aims to optimize the extent of surgery and radiotherapy. This may result in improved local control, fewer metastasis, and an improved overall survival (OS). Previous studies show no statistically significant differences for these outcomes, however some do state that it has a tendency towards better OS. The purpose of this retrospective population-based study was to evaluate the effect of preoperative breast MRI on OS for invasive breast cancer patients in the Netherlands. Methods In this study we selected all women from the Netherlands Cancer Registry diagnosed with invasive breast cancer between 2011 and 2013. Patients without surgical treatment, with distant metastases, and/or treated with neoadjuvant therapies were excluded. The study population was divided into a MRI and non-MRI group, according to preoperative use of breast MRI. Subsequently, the study population was assigned to one of the following subgroups: invasive carcinoma of no special type (NST) or the invasive lobular carcinoma (ILC). The OS with and without MRI was calculated with the Kaplan-Meier method and was compared with the log-rank test. A Cox proportional hazard regression analysis was performed to estimate the hazard ratio (HR) for OS with a 95% confidence interval (CI). To account for missing data multiple imputation was performed. Results Of the 31,756 included patients, 9,632 (30.3%) received preoperative breast MRI and 22,124 (69.7%) did not. The subgroup invasive carcinoma NST consisted of 27,752 patients (26.6% MRI vs 56.1% non-MRI) and the subgroup ILC consisted of 4,004 patients (56.1% MRI vs 43.9% non-MRI). The mean follow-up period was 5.3 years. In both the total study population and both subgroups, the Kaplan-Meier, logrank, and univariable Cox regression analysis showed that breast MRI was significantly associated with improved OS compared to non-MRI (p<0.0001). After stratification by age categories of the log-rank test, it was only significant for patients older than 60 years in the total study population, and patients older than 70 in both subgroups. The calculated HR for breast MRI per age category in the multivariable Cox regression analysis showed that preoperative breast MRI had a tendency towards better OS, however not always statistically significant. In the total study population the association between breast MRI and OS was only significant for the age categories 50-59 (HR 0.80, 95%-CI 0.66-0.97), 60-69 (HR 0.80, 95%-CI 0.68-0.94), and older than 70 (HR 0.66, 95%-CI 0.57-0.76). For the invasive carcinoma NST significant differences were only found for the age categories 60-69 (HR 0.80, 95%-CI 0.67-0.96) and older than 70 (HR 0.67, 95%-CI 0.56-0.79). And for the ILC subgroup it was only significant for patients older than 70 years (HR 0.59, 95%-CI 0.46-0.76). Also noteworthy, the upper endpoint of the 95%-CI of patients aged 50-59 in the invasive carcinoma NST subgroup (HR 0.82, 95%-CI 0.67-1.01) and the HR of patients aged <50 in the ILC subgroup, which was the lowest of all, but with a large 95%-CI (HR 0.54, 95%-CI 0.23-1.24). Conclusion The calculated HR for breast MRI per age category showed that preoperative breast MRI tended to be associated with a better OS, but this association was only statistically significant for patients aged >50 in the total study population, patients aged >60 in the invasive carcinoma NST subgroup, and patients aged >70 in the ILC subgroup. In addition, the HR for patients aged 50-59 in the invasive carcinoma NST subgroup was almost statistically significant and for patients aged <50 in the ILC subgroup, the HR was low but with a large 95%-CI. These results suggest that the indication for preoperative breast MRI use in ILC patients, and in particular young woman, is correct. However, in order to provide a better recommendation for preoperative breast MRI in general use, it is recommended to evaluate the effect of preoperative breast MRI on disease free survival and to perform a cost-effectiveness analysis.
Item Type:Essay (Master)
Clients:
Comprehensive Cancer Organization the Netherlands
Maastricht Universitair Medisch Centrum
Faculty:TNW: Science and Technology
Subject:30 exact sciences in general
Programme:Health Sciences MSc (66851)
Link to this item:https://purl.utwente.nl/essays/77337
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