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Laura L. Walters, M.D., Ph.D.
Article
Are we choosing wisely? Drivers of preoperative MRI use in breast cancer patients
American Journal of Surgery (2021)
  • Anees B Chagpar, Yale University
  • Elisabeth Dupont, Watson Clinic
  • Akiko Chiba, Women and Infants Hospital
  • Edward A Levine, Women and Infants Hospital
  • Jennifer S Gass, Womens and Infants Hospital
  • Sharon Lum, Loma Linda University
  • Eric Brown, Beaumont
  • Andrew Fenton, Cleveland Clinic
  • Naveenraj L Solomon, Loma Linda University
  • David W Ollila, University of North Carolina at Chapel Hill
  • Mary Murray, Cleveland Clinic
  • Kristalyn Gallagher, University of North Carolina at Chapel Hill
  • Marissa M Howard-McNatt, Wake Forest University
  • Melissa Lazar, Thomas Jefferson University
  • Carlos Garcia-Cantu, Doctors Hospital at Renaissance, Edinburg, TX.
  • Laura L Walters, Beaumont
  • Sonali V Pandya, Women and Infants Hospital, Providence, RI.
  • Amanda Mendiola, Cleveland Clinic
  • Jukes P. Namm, Loma Linda University
Link
Abstract
Introduction: Factors contributing to the use of preoperative MRI remain poorly understood.
Methods: Data from a randomized controlled trial of stage 0-3 breast cancer patients undergoing breast conserving surgery between 2016 and 2018 were analyzed.
Results: Of the 396 patients in this trial, 32.6% had a preoperative MRI. Patient age, race, ethnicity, tumor histology, and use of neoadjuvant therapy were significant predictors of MRI use. On multivariate analysis, younger patients with invasive lobular tumors were more likely to have a preoperative MRI. Rates also varied significantly by individual surgeon (p < 0.001); in particular, female surgeons (39.9% vs. 24.0% for male surgeons, p = 0.001) and those in community practice (58.9% vs. 14.2% for academic, p < 0.001) were more likely to order preoperative MRI. Rates declined over the two years of the study, particularly among female surgeons.
Conclusions: Preoperative MRI varies with patient age and tumor histology; however, there remains variability by individual surgeon.
Keywords
  • breast cancer surgery,
  • MRI,
  • preoperative evaluation
Disciplines
Publication Date
October 23, 2021
DOI
10.1016/j.amjsurg.2021.10.028
Citation Information
Chagpar AB, Dupont E, Chiba A, Levine EA, Gass JS, Lum S, Brown E, Fenton A, Solomon NL, Ollila DW, Murray M, Gallagher K, Howard-McNatt M, Lazar M, Garcia-Cantu C, Walters L, Pandya S, Mendiola A, Namm JP; SHAVE2 authors. Are we choosing wisely? Drivers of preoperative MRI use in breast cancer patients. Am J Surg. 2021 Oct 23:S0002-9610(21)00620-6. doi: 10.1016/j.amjsurg.2021.10.028. Epub ahead of print. PMID: 34706816.