Clinical utility of MRI in breast cancer diagnosed over age 70.

Abstract

e12689 Background: Previous observational studies evaluating the role of MRI in the management of breast cancer patients have shown alterations in management in 14-18% of cases due to detection of more extensive disease, and higher yield in younger women with dense breasts. However, a randomized controlled trial evaluating the clinical efficacy of MRI in women with primary breast cancer showed that the addition of MRI has no benefit on reduction of reoperation rate. We aim to assess the utilization and impact on management of MRI in breast cancer patients age 70 and older. Methods: A retrospective chart review was conducted of 1200 patients age 70 and older diagnosed with breast cancer between 2018-2023 who either received preoperative MRI or did not. Data was analyzed for correlation between MRI use, additional biopsy after MRI, result of additional biopsy, and type of surgery performed. Results: Of 1200 patients, 473 (39%) underwent MRI whereas 727 (61%) did not. Patients in the 70-79 age group were more likely to undergo MRI compared to those 80+; 396/924 (43%) vs. 77/276 (28%) (OR 0.52, 95% CI 0.38-0.69; p< 0.001). Patients with high breast density (C/D) were more likely to receive an MRI compared to those with low breast density (A/B); 168/349 (48%) vs. 171/501 (34%) (OR 1.79, 95% CI 1.35-2.37; p< 0.001). Of 345 patients who had MRI, 88 (26%) had an additional biopsy recommended. See Table for biopsy results. The likelihood of having an additional biopsy was similar in patients across both age brackets, as was the overall yield of cancer, both ipsilateral and contralateral. Conclusions: Breast cancer patients aged 80 and above are less likely to undergo preoperative MRI. However, when they do have an MRI, they are just as likely to undergo an additional biopsy with a similar ipsilateral and contralateral breast cancer yield compared to patients aged 70-79. Therefore, MRI remains clinically useful in a select subset of older patients, particularly those with higher breast density. Utilization and diagnostic yield of MRI. Outcome All Patientsn/N (%) Age 70-79n/N (%) Age ≥ 80n/N (%) Odds Ratio [95% CI] p-value MRI utilization 473/1200 (39.4) 396/924 (42.9) 77/276 (27.9) 0.52 [0.38–0.69] <0.001 Additional biopsy recommended 88/345 (25.5) 74/293 (25.3) 14/52 (26.9) 1.09 [0.56–2.12] 0.799 Biopsy yield for cancer 49/88 (55.7) 41/74 (55.4) 8/14 (57.1) 1.07 [0.34–3.40] 0.904 Biopsy yield for contralateral cancer 19/88 (21.6) 17/74 (23.0) 2/14 (14.3) 0.56 [0.11–2.75] 0.474 Odds Ratio compares the odds of the outcome in Age ≥ 80 to the odds in Age 70-79. OR < 1 indicates lower odds in ≥ 80; OR > 1 indicates higher odds.