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Classification system for identifying women at risk for altered partial breast irradiation recommendations after breast magnetic resonance imaging.
Int J Radiat Oncol Biol Phys. 2013 Sep 01; 87(1):127-33.IJ

Abstract

PURPOSE

To study the utility of preoperative breast MRI for partial breast irradiation (PBI) patient selection, using multivariable analysis of significant risk factors to create a classification rule.

METHODS AND MATERIALS

Between 2002 and 2009, 712 women with newly diagnosed breast cancer underwent preoperative bilateral breast MRI at Mayo Clinic Florida. Of this cohort, 566 were retrospectively deemed eligible for PBI according to the National Surgical Adjuvant Breast and Bowel Project Protocol B-39 inclusion criteria using physical examination, mammogram, and/or ultrasound. Magnetic resonance images were then reviewed to determine their impact on patient eligibility. The patient and tumor characteristics were evaluated to determine risk factors for altered PBI eligibility after MRI and to create a classification rule.

RESULTS

Of the 566 patients initially eligible for PBI, 141 (25%) were found ineligible because of pathologically proven MRI findings. Magnetic resonance imaging detected additional ipsilateral breast cancer in 118 (21%). Of these, 62 (11%) had more extensive disease than originally noted before MRI, and 64 (11%) had multicentric disease. Contralateral breast cancer was detected in 28 (5%). Four characteristics were found to be significantly associated with PBI ineligibility after MRI on multivariable analysis: premenopausal status (P=.021), detection by palpation (P<.001), first-degree relative with a history of breast cancer (P=.033), and lobular histology (P=.002). Risk factors were assigned a score of 0-2. The risk of altered PBI eligibility from MRI based on number of risk factors was 0:18%; 1:22%; 2:42%; 3:65%.

CONCLUSIONS

Preoperative bilateral breast MRI altered the PBI recommendations for 25% of women. Women who may undergo PBI should be considered for breast MRI, especially those with lobular histology or with 2 or more of the following risk factors: premenopausal, detection by palpation, and first-degree relative with a history of breast cancer.

Authors+Show Affiliations

Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

23920391

Citation

Kowalchik, Kristin V., et al. "Classification System for Identifying Women at Risk for Altered Partial Breast Irradiation Recommendations After Breast Magnetic Resonance Imaging." International Journal of Radiation Oncology, Biology, Physics, vol. 87, no. 1, 2013, pp. 127-33.
Kowalchik KV, Vallow LA, McDonough M, et al. Classification system for identifying women at risk for altered partial breast irradiation recommendations after breast magnetic resonance imaging. Int J Radiat Oncol Biol Phys. 2013;87(1):127-33.
Kowalchik, K. V., Vallow, L. A., McDonough, M., Thomas, C. S., Heckman, M. G., Peterson, J. L., Adkisson, C. D., Serago, C., & McLaughlin, S. A. (2013). Classification system for identifying women at risk for altered partial breast irradiation recommendations after breast magnetic resonance imaging. International Journal of Radiation Oncology, Biology, Physics, 87(1), 127-33. https://doi.org/10.1016/j.ijrobp.2013.05.024
Kowalchik KV, et al. Classification System for Identifying Women at Risk for Altered Partial Breast Irradiation Recommendations After Breast Magnetic Resonance Imaging. Int J Radiat Oncol Biol Phys. 2013 Sep 1;87(1):127-33. PubMed PMID: 23920391.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Classification system for identifying women at risk for altered partial breast irradiation recommendations after breast magnetic resonance imaging. AU - Kowalchik,Kristin V, AU - Vallow,Laura A, AU - McDonough,Michelle, AU - Thomas,Colleen S, AU - Heckman,Michael G, AU - Peterson,Jennifer L, AU - Adkisson,Cameron D, AU - Serago,Christopher, AU - McLaughlin,Sarah A, PY - 2013/02/25/received PY - 2013/04/22/revised PY - 2013/05/08/accepted PY - 2013/8/8/entrez PY - 2013/8/8/pubmed PY - 2013/10/25/medline SP - 127 EP - 33 JF - International journal of radiation oncology, biology, physics JO - Int J Radiat Oncol Biol Phys VL - 87 IS - 1 N2 - PURPOSE: To study the utility of preoperative breast MRI for partial breast irradiation (PBI) patient selection, using multivariable analysis of significant risk factors to create a classification rule. METHODS AND MATERIALS: Between 2002 and 2009, 712 women with newly diagnosed breast cancer underwent preoperative bilateral breast MRI at Mayo Clinic Florida. Of this cohort, 566 were retrospectively deemed eligible for PBI according to the National Surgical Adjuvant Breast and Bowel Project Protocol B-39 inclusion criteria using physical examination, mammogram, and/or ultrasound. Magnetic resonance images were then reviewed to determine their impact on patient eligibility. The patient and tumor characteristics were evaluated to determine risk factors for altered PBI eligibility after MRI and to create a classification rule. RESULTS: Of the 566 patients initially eligible for PBI, 141 (25%) were found ineligible because of pathologically proven MRI findings. Magnetic resonance imaging detected additional ipsilateral breast cancer in 118 (21%). Of these, 62 (11%) had more extensive disease than originally noted before MRI, and 64 (11%) had multicentric disease. Contralateral breast cancer was detected in 28 (5%). Four characteristics were found to be significantly associated with PBI ineligibility after MRI on multivariable analysis: premenopausal status (P=.021), detection by palpation (P<.001), first-degree relative with a history of breast cancer (P=.033), and lobular histology (P=.002). Risk factors were assigned a score of 0-2. The risk of altered PBI eligibility from MRI based on number of risk factors was 0:18%; 1:22%; 2:42%; 3:65%. CONCLUSIONS: Preoperative bilateral breast MRI altered the PBI recommendations for 25% of women. Women who may undergo PBI should be considered for breast MRI, especially those with lobular histology or with 2 or more of the following risk factors: premenopausal, detection by palpation, and first-degree relative with a history of breast cancer. SN - 1879-355X UR - https://www.unboundmedicine.com/medline/citation/23920391/Classification_system_for_identifying_women_at_risk_for_altered_partial_breast_irradiation_recommendations_after_breast_magnetic_resonance_imaging_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0360-3016(13)00556-7 DB - PRIME DP - Unbound Medicine ER -