Screening and diagnostic breast MRI: how do they impact surgical treatment? Insights from the MIPA study

Cozzi A, Di Leo G, Houssami N, Gilbert FJ, Helbich TH, Álvarez Benito M, Balleyguier C, Bazzocchi M, Bult P, Calabrese M, Camps Herrero J, Cartia F, Cassano E, Clauser P, de Lima Docema MF, Depretto C, Dominelli V, Forrai G, Girometti R, Harms SE, Hilborne S, Ienzi R, Lobbes MB, Losio C, Mann RM, Montemezzi S, Obdeijn IM, Ozcan UA, Pediconi F, Pinker K, Preibsch H, Raya Povedano JL, Rossi Saccarelli C, Sacchetto D, Scaperrotta GP, Schlooz M, Szabó BK, Taylor DB, Ulus ÖS, Van Goethem M, Veltman J, Weigel S, Wenkel E, Zuiani C, Sardanelli F (2023)

Publication Type: Journal article

Publication year: 2023


DOI: 10.1007/s00330-023-09600-5


Objectives: To report mastectomy and reoperation rates in women who had breast MRI for screening (S-MRI subgroup) or diagnostic (D-MRI subgroup) purposes, using multivariable analysis for investigating the role of MRI referral/nonreferral and other covariates in driving surgical outcomes. Methods: The MIPA observational study enrolled women aged 18–80 years with newly diagnosed breast cancer destined to have surgery as the primary treatment, in 27 centres worldwide. Mastectomy and reoperation rates were compared using non-parametric tests and multivariable analysis. Results: A total of 5828 patients entered analysis, 2763 (47.4%) did not undergo MRI (noMRI subgroup) and 3065 underwent MRI (52.6%); of the latter, 2441/3065 (79.7%) underwent MRI with preoperative intent (P-MRI subgroup), 510/3065 (16.6%) D-MRI, and 114/3065 S-MRI (3.7%). The reoperation rate was 10.5% for S-MRI, 8.2% for D-MRI, and 8.5% for P-MRI, while it was 11.7% for noMRI (p ≤ 0.023 for comparisons with D-MRI and P-MRI). The overall mastectomy rate (first-line mastectomy plus conversions from conserving surgery to mastectomy) was 39.5% for S-MRI, 36.2% for P-MRI, 24.1% for D-MRI, and 18.0% for noMRI. At multivariable analysis, using noMRI as reference, the odds ratios for overall mastectomy were 2.4 (p < 0.001) for S-MRI, 1.0 (p = 0.957) for D-MRI, and 1.9 (p < 0.001) for P-MRI. Conclusions: Patients from the D-MRI subgroup had the lowest overall mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). This analysis offers an insight into how the initial indication for MRI affects the subsequent surgical treatment of breast cancer. Key Points: • Of 3065 breast MRI examinations, 79.7% were performed with preoperative intent (P-MRI), 16.6% were diagnostic (D-MRI), and 3.7% were screening (S-MRI) examinations. • The D-MRI subgroup had the lowest mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). • The S-MRI subgroup had the highest mastectomy rate (39.5%) which aligns with higher-than-average risk in this subgroup, with a reoperation rate (10.5%) not significantly different to that of all other subgroups.

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Involved external institutions

University of Cambridge GB United Kingdom (GB) Medizinische Universität Wien AT Austria (AT) Hospital Universitario Reina Sofía de Córdoba Edificio IMIBIC ES Spain (ES) Institut Gustave-Roussy FR France (FR) University of Udine / Università degli Studi di Udine IT Italy (IT) Ospedale Policlinico San Martino IT Italy (IT) University Hospital of La Ribera / Hospital Universitario de La Ribera ES Spain (ES) Fondazione IRCCS: Istituto Nazionale dei Tumori IT Italy (IT) European Institute of Oncology / Istituto Europeo di Oncologia (IEO) IT Italy (IT) Hospital Sírio-Libanês BR Brazil (BR) Semmelweis University / Semmelweis Egyetem HU Hungary (HU) Policlinico Universitario Paolo Giaccone IT Italy (IT) Maastricht University NL Netherlands (NL) Ospedale San Raffaele (früher: Centro San Raffaele del Monte Tabor Foundation) IT Italy (IT) Radboud University Nijmegen Medical Centre / Radboudumc of voluit Radboud Universitair Medisch Centrum (UMC) NL Netherlands (NL) Gruppo Ospedaliero San Donato IT Italy (IT) The Breast Center | Fayetteville US United States (USA) (US) University Hospital of Verona / Azienda Ospedaliera Universitaria Integrata Verona (AOUI) IT Italy (IT) Erasmus University Medical Center (MC) NL Netherlands (NL) Acıbadem Mehmet Ali Aydınlar University / Acıbadem Mehmet Ali Aydınlar Üniversitesi TR Turkey (TR) Universitätsklinikum Tübingen DE Germany (DE) Kiwifarm Srl IT Italy (IT) Barking, Havering and Redbridge University Hospitals NHS Trust GB United Kingdom (GB) University of Western Australia (UWA) AU Australia (AU) Hospital Network Antwerp / Ziekenhuis Netwerk Antwerpen (ZNA) BE Belgium (BE) Maatschap Radiol Oost Nederland (MRON) NL Netherlands (NL) Westfälische Wilhelms-Universität (WWU) Münster DE Germany (DE)

How to cite


Cozzi, A., Di Leo, G., Houssami, N., Gilbert, F.J., Helbich, T.H., Álvarez Benito, M.,... Sardanelli, F. (2023). Screening and diagnostic breast MRI: how do they impact surgical treatment? Insights from the MIPA study. European Radiology.


Cozzi, Andrea, et al. "Screening and diagnostic breast MRI: how do they impact surgical treatment? Insights from the MIPA study." European Radiology (2023).

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