For women with human epidermal growth factor receptor 2 (HER-2) positive, hormone receptor negative breast cancer, emerging research suggests that pre-operative magnetic resonance imaging (MRI) has no impact on recurrence-free survival and overall survival outcomes.
For the retrospective study, recently published in Radiology, researchers reviewed data from 1,094 women (median age of 52) with HER-2 positive, hormone receptor negative breast cancer. The study authors noted that 523 women (47.81 percent) in the cohort had preoperative MRI exams.
Employing propensity score matching, the study authors noted no impact of preoperative MRI on total recurrence (hazard ratio (HR) 0.69). They also saw no improvement with pre-op MRI with respect to local-regional breast cancer recurrence (HR 0.94), contralateral breast recurrence (HR 0.55) and distant recurrence (HR 0.56).
A multivariable analysis revealed no impact of pre-op MRI use upon recurrence-free survival (RFS) (HR 0.89) nor overall survival (OS) (HR 0.73) in this patient population, according to the researchers.
“ … Our study found that preoperative breast MRI was not associated with improved recurrence-free survival (RFS) or overall survival (OS) in patients with human epidermal growth factor receptor 2–positive and hormone receptor-negative breast cancer,” wrote lead study author Hee Jeong Kim, M.D., who is affiliated with the Department of Radiology and Research Institute of Radiology with the Asan Medical Center at the University of Ulsan College of Medicine in Seoul, South Korea, and colleagues.
However, emphasizing that different molecular subtypes in breast cancer have distinct presentations, metastasis spread and treatment response, the authors maintained that pre-op MRI can inform the management of patients with HER-2 positive, hormone receptor negative breast cancer.
“The HER2-positive and hormone receptor–negative subtype, which is associated with a higher likelihood of multifocal and multi-centric disease, may particularly benefit from preoperative MRI because multifocal and multi-centric cases are often unsuitable for breast-conserving surgery,” posited Kim and colleagues. “Furthermore, breast MRI has proven effective in detecting metastatic lymphadenopathy in this subtype, thereby aiding in axillary management and systemic therapy.”
Three Key Takeaways
1. No survival benefit from pre-op MRI. Preoperative MRI did not improve recurrence-free survival (RFS) or overall survival (OS) in women with HER2-positive, hormone receptor–negative breast cancer.
2. Limited impact on recurrence. MRI use showed no statistically significant impact on total, local-regional, contralateral, or distant breast cancer recurrence, according to the researchers.
3. MRI may still be beneficial for informing treatment decisions. While not affecting survival, pre-op MRI may be useful for detecting multifocal/multi-centric disease and axillary lymph node metastasis, potentially guiding surgical and systemic treatment strategies.
The researchers pointed out that postmenopausal status was associated with improved RFS and suggested the use of neoadjuvant chemotherapy may have “overshadowed” the significance of pre-op MRI. The study authors also noted that larger tumor size was associated with poorer RFS and lymphovascular invasion was 58 percent more likely to be associated with poorer RFS.
“ … Decisions regarding preoperative MRI should consider the overall clinical context of the patient rather than focusing solely on this cancer subtype,” cautioned Kim and colleagues.
(Editor’s note: For related content, see “Emerging AI Algorithm Shows Promise for Abbreviated Breast MRI in Multicenter Study,” “Breast MRI Quantification of Intra-Tumoral Heterogeneity May Help Predict Response to Neoadjuvant Chemotherapy” and “Could Ultrafast MRI Enhance Detection of Malignant Foci for Breast Cancer?”)
Beyond the inherent limitations of a single-center retrospective study, the authors acknowledged the predominant focus on early-stage breast cancer in the cohort, noting the exclusion of patients with distant metastasis and those undergoing neoadjuvant chemotherapy. The researchers also conceded that comorbidities and socioeconomic status were not addressed in the study.
