Solving the preoperative breast MRI conundrum: design and protocol of the MIPA study

• DOI: 10.1007/s00330-020-06824-7
• Publication Date: 2020-05-06T20:02:31Z
• Authors: Francesco Sardanelli; Rubina M. Trimboli; Nehmat Houssami; Fiona J. Gilbert; Thomas H. Helbich; Marina Alvarez Be...; Corinne Balleyguier; Massimo Bazzocchi; Peter Bult; Massimo Calabrese; Julia Camps Herrero; Francesco Cartia; Enrico Cassano; Paola Clauser; Danubia A. de And...; Marcos F. de Lima...; Catherine Depretto; Gabor Forrai; Rossano Girometti; Steven E. Harms; Sarah Hilborne; Raffaele Ienzi; Marc B. I. Lobbes; Claudio Losio; Ritse M. Mann; Stefania Montemezzi; Inge-Marie Obdeijn; Umit Aksoy Ozcan; Federica Pediconi; Heike Preibsch; José L. Raya-Pove...; Daniela Sacchetto; Gianfranco P. Sca...; Margrethe Schlooz; Botond K. Szabo; Ozden S. Ulus; Donna B. Taylor; Mireille Van Goethem; Jeroen Veltman; Stefanie Weigel; Evelyn Wenkel; Chiara Zuiani; Giovanni Di Leo
• Keywords: Reoperation; ANZSRC FoR code::42 HEALTH SCIENCES::4206 Public health; EMC OR-01; Radboudumc 17: Women's cancers RIHS: Radboud Institute for Health Sciences; 610; Breast Neoplasms; MUTATION CARRIERS; RECOMMENDATIONS; Breast neoplasms; Breast-conserving surgery; Magnetic resonance imaging; Mastectomy; Prospective studies; 03 medical and health sciences; Magnetic resonance imaging; Clinical Trial Protocols as Topic; 0302 clinical medicine; Breast-conserving surgery; Medical Imaging - Radboud University Medical Center; Preoperative Care; Humans; Breast; Prospective Studies; METAANALYSIS; Mastectomy; Aged; Computer. Automation; 20-YEAR FOLLOW-UP; Pathology - Radboud University Medical Center; WOMEN; :42 HEALTH SCIENCES::4206 Public health [ANZSRC FoR code]; RESONANCE; Middle Aged; CONSERVING SURGERY; SCREENING MAMMOGRAPHY; CANCER; Magnetic Resonance Imaging; Radboudumc 17: Women's cancers RIMLS: Radboud Institute for Molecular Life Sciences; EMC NIHES-03-30-02; 3. Good health; Female; Breast neoplasms; ADDITIONAL FINDINGS; Prospective studies; Radboudumc 10: Reconstructive and regenerative medicine RIHS: Radboud Institute for Health Sciences

Despite its high diagnostic performance, the use of breast MRI in the preoperative setting is controversial. It has the potential for personalized surgical management in breast cancer patients, but two of three randomized controlled trials did not show results in favor of its introduction for assessing the disease extent before surgery. Meta-analyses showed a higher mastectomy rate in women undergoing preoperative MRI compared to those who do not. Nevertheless, preoperative breast MRI is increasingly used and a survey from the American Society of Breast Surgeons showed that 41% of respondents ask for it in daily practice. In this context, a large-scale observational multicenter international prospective analysis (MIPA study) was proposed under the guidance of the European Network for the Assessment of Imaging in Medicine (EuroAIM). The aims were (1) to prospectively and systematically collect data on consecutive women with a newly diagnosed breast cancer, not candidates for neoadjuvant therapy, who are offered or not offered breast MRI before surgery according to local practice; (2) to compare these two groups in terms of surgical and clinical endpoints, adjusting for covariates. The underlying hypotheses are that MRI does not cause additional mastectomies compared to conventional imaging, while reducing the reoperation rate in all or in subgroups of patients. Ninety-six centers applied to a web-based call; 36 were initially selected based on volume and quality standards; 27 were active for enrollment. On November 2018, the target of 7000 enrolled patients was reached. The MIPA study is presently at the analytic phase. Key Points • Breast MRI has a high diagnostic performance but its utility in the preoperative setting is controversial. • A large-scale observational multicenter prospective study was launched to compare women receiving with those not receiving preoperative MRI. • Twenty-seven centers enrolled more than 7000 patients. The study is presently at the analytic phase.