71 Utility of Performing Staging MRI in Breast Cancer Patients Over the Age of 75

Utility of Performing Staging MRI in Breast Cancer Patients Over the Age of 75

Background

The purpose of this study is to determine the utility of staging MRI in patients over age 75 with breast cancer. The National Comprehensive Cancer Center guidelines state that MRI may be used for staging MRI, but there is currently no high-level data stating that treatment decision-making based on MRI improves recurrence or overall survival. In the era of de-escalation of treatment, we chose to evaluate if there is a benefit of breast MRI in patients over age 75. We hypothesize that an MRI will change the management of patients over age 75 and therefore provide utility in this population. The secondary aim is to identify factors that might be incorporated into patient-specific decision-making to prevent overtreatment of patients and overuse of resources.

Methods

This is a retrospective review of data from the electronic medical records from 2017 to 2023. Eligible patients include those 75 or older with complete medical records who were diagnosed with breast cancer. Of the eligible patients who received an MRI, we reviewed how many additional biopsies were performed and the percentage of those biopsies that revealed additional malignancies or led to a change in the patient’s overall treatment. Also evaluated were breast density, clinical stage, tumor grade, and tumor receptors.

Results

A total of 316 patients were diagnosed with breast cancer within the study period, and of those patients, 131 (41.4%) received a staging breast MRI. Metastatic disease, claustrophobia, kidney disease, and patient refusal were among the reasons that patients did not receive a staging MRI. Thirty-six (35.2%) patients underwent additional biopsies due to MRI findings and 2 patients opted for mastectomy. Twenty-nine (80.5%) patients were found to have additional malignancies, 2 patients had atypical ductal hyperplasia, and 1 patient had atypical hyperplasia. The patients with additional malignancies were most commonly clinical stage I (65.4%), grade II (69%), hormone receptor positive, and HER2 negative (95.8%) with type B breast density (48%), although these factors were not found to be statistically significant (Table).

Conclusions

Currently we utilize MRI selectively at the discretion of the individual practitioner. In this review, 30 (29.4%) patients over the age of 75 who received MRI had additional cancers that altered their treatment plan. Although this is a limited retrospective study, it does suggest that patients within this population will likely benefit from a staging MRI. This study suggests that age, breast density, hormonal status, and tumor grade may not be appropriate criteria to limit the use of stage MRI in this population. Additional studies are needed to confirm the utility of MRI in this population.