Pre-operative MRI May Play Role in Reducing Recurrence in Triple-negative Breast Cancer

Nevertheless, there is not yet a consensus on the association between the risk of recurrence and imaging factors such as the use of preoperative MRI or mammographic density in patients with triple-negative breast cancer, according to Woo Kyung Moon, MD, Professor of the Department of Radiology, Seoul National University Hospital. In research published in the February 2016 issue of Radiology, Dr. Moon and colleagues investigated the effectiveness of preoperative MRI in helping to reduce the risk of recurrence in patients with early stage triple-negative breast cancer, particularly women with dense breasts or a family history of breast cancer.

“It is important to stratify patients based on different features, which potentially enables more personalized screening, treatment and better prediction of outcome,” Dr. Moon said. “If there is an association between the absence of preoperative MRI and recurrence in patients with early stage triple-negative breast cancer, then the use of preoperative imaging may lead to lower recurrence rates in patients with triple-negative breast cancers.”

Triple-negative breast cancer is characterized by lack of estrogen receptor and progesterone receptor expression and absence of human epidermal growth factor receptor 2 (HER2) overexpression.

Dr. Moon and colleagues analyzed 398 patients with early stage (Stage I or II) triple-negative breast cancer, analyzing the patient’s age, symptom status, first-degree family history of breast cancer, presence or absence of preoperative MRI, and mammographic density. The use of preoperative MRI was determined on the basis of the breast surgeon’s recommendation, patient’s preference or availability of time slots for MRI. Patients demonstrated no significant differences in tumor size, lymph node status, tumor stage or receipt of adjuvant chemotherapy or radiation therapy, Dr. Moon said.

Results showed that 63 (15.8 percent) of the 398 patients studied showed a recurrent disease after a median follow- up of 6.1 years and that a family history of breast cancer, lymphovascular invasion, and dense breast tissue, were all found to be independently associated with recurrence.

In terms of MRI, researchers determined that patients who did not undergo preoperative MRI were 2.7 times more likely to have a recurrence than those patients who underwent preoperative MRI.

“Our study suggests that the use of preoperative MRI may help reduce the risk of recurrence in patients with early stage triple-negative breast cancer, particularly in women with dense breasts or a family history of breast cancer,” Dr. Moon said.

Results also demonstrated that mammographic density was an independent risk factor for recurrence in patients with triple-negative breast cancer.

“For women younger than 55, there was a stronger association of mammographic density with estrogen receptor–negative cancers compared with estrogen receptor–positive cancers, which suggests that high mammographic density may play an important role in tumor aggressiveness, especially in younger women,” Dr. Moon added.

Web Extras

• Access the study, “Early Stage Triple-Negative Breast Cancer: Imaging and Clinical-Pathologic Factors Associated with Recurrence,” by Dr. Moon and colleagues in the February 2016 issue of RSNA.org/Radiology