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The accuracy of incremental pre-operative breast MRI findings - Concordance with histopathology in the Swedish randomized multicenter POMB trial
Capio St Gorans Hosp, Dept Radiol, S-11281 Stockholm, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
Karolinska Univ Hosp, Dept Neuroradiol, S-17176 Stockholm, Sweden.
Karolinska Inst, Unit Biostat, Inst Environm Med, S-17177 Stockholm, Sweden.
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2019 (English)In: European Journal of Radiology, ISSN 0720-048X, E-ISSN 1872-7727, Vol. 114, p. 185-191Article in journal (Refereed) Published
Abstract [en]

Purpose: The Pre-Operative MRI of the Breast (POMB) trial was a randomized, prospective, multicenter trial evaluating the impact of pre-operative breast MRI on treatment regimens and short-term surgical outcomes in women up to 56 years of age with breast cancer. The purpose of this study was to evaluate the performance of pre-operative breast MRI in the POMB trial with respect to incremental MRI findings - over conventional breast imaging methods - and their concordance with histopathology.

Patients and methods: Two-hundred and ten patients (n = 210) participating in the POMB trial underwent preoperative breast MRI at two Swedish breast units. Positive predictive values (PPV) for the incremental MRI findings were calculated for three subgroups of patients with: 1. alteration/alterations of treatment plan; 2. no alteration of treatment plan; and, 3. MRI-related conversion from BCS to mastectomy. Area under the receiver operating characteristic curve (AUC) was calculated using in-breast BI-RADS based ratings for the whole MRI group.

Results: After exclusions a total number of 99 incremental findings in 78 patients were eligible for statistical analysis resulting in a PPV = 74%: (95% CI 60-84%) in 39 patients with MRI related alterations of initial treatment plans and 27%: (95% CI 14-44%) in 39 patients without. Positive predictive values of incremental findings decisive for specific treatment alteration/s were 83% (95% CI 68-92%) in patients with any alteration of initial treatment plans and 91% (95% CI 70-98%) for patients (n = 20/22) with conversion from breast conserving surgery to mastectomy. The empirical AUC for the incremental findings in the whole MRI group was 85% (95% CI 78-91%).

Conclusion: Breast MRI, performed and evaluated together with conventional breast imaging methods can provide relevant information at a high degree of accuracy in the pre-operative setting.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD , 2019. Vol. 114, p. 185-191
Keywords [en]
Breast cancer, Pre-operative breast MRI, Breast conserving surgery
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
URN: urn:nbn:se:uu:diva-382815DOI: 10.1016/j.ejrad.2019.03.005ISI: 000464983700027PubMedID: 31005171OAI: oai:DiVA.org:uu-382815DiVA, id: diva2:1313741
Funder
King Gustaf V Jubilee FundStockholm County CouncilThe Breast Cancer FoundationAvailable from: 2019-05-06 Created: 2019-05-06 Last updated: 2019-05-06Bibliographically approved

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Gonzalez, VirginiaEriksson, Staffan

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