Preoperative breast MRI positively impacts surgical outcomes of needle biopsy–diagnosed pure DCIS: a patient-matched analysis 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, Aksoy Ozcan U, Pediconi F, Pinker K, Preibsch H, Raya Povedano JL, Rossi Saccarelli C, Sacchetto D, Scaperrotta GP, Schlooz M, Szabó BK, Taylor DB, Ulus S, Van Goethem M, Veltman J, Weigel S, Wenkel E, Zuiani C, Sardanelli F (2023)

Publication Type: Journal article

Publication year: 2023


DOI: 10.1007/s00330-023-10409-5


Objectives: To investigate the influence of preoperative breast MRI on mastectomy and reoperation rates in patients with pure ductal carcinoma in situ (DCIS). Methods: The MIPA observational study database (7245 patients) was searched for patients aged 18–80 years with pure unilateral DCIS diagnosed at core needle or vacuum-assisted biopsy (CNB/VAB) and planned for primary surgery. Patients who underwent preoperative MRI (MRI group) were matched (1:1) to those who did not receive MRI (noMRI group) according to 8 confounding covariates that drive referral to MRI (age; hormonal status; familial risk; posterior-to-nipple diameter; BI-RADS category; lesion diameter; lesion presentation; surgical planning at conventional imaging). Surgical outcomes were compared between the matched groups with nonparametric statistics after calculating odds ratios (ORs). Results: Of 1005 women with pure unilateral DCIS at CNB/VAB (507 MRI group, 498 noMRI group), 309 remained in each group after matching. First-line mastectomy rate in the MRI group was 20.1% (62/309 patients, OR 2.03) compared to 11.0% in the noMRI group (34/309 patients, p = 0.003). The reoperation rate was 10.0% in the MRI group (31/309, OR for reoperation 0.40) and 22.0% in the noMRI group (68/309, p < 0.001), with a 2.53 OR of avoiding reoperation in the MRI group. The overall mastectomy rate was 23.3% in the MRI group (72/309, OR 1.40) and 17.8% in the noMRI group (55/309, p = 0.111). Conclusions: Compared to those going directly to surgery, patients with pure DCIS at CNB/VAB who underwent preoperative MRI had a higher OR for first-line mastectomy but a substantially lower OR for reoperation. Clinical relevance statement: When confounding factors behind MRI referral are accounted for in the comparison of patients with CNB/VAB-diagnosed pure unilateral DCIS, preoperative MRI yields a reduction of reoperations that is more than twice as high as the increase in overall mastectomies. Key Points: • Confounding factors cause imbalance when investigating the influence of preoperative MRI on surgical outcomes of pure DCIS. • When patient matching is applied to women with pure unilateral DCIS, reoperation rates are significantly reduced in women who underwent preoperative MRI. • The reduction of reoperations brought about by preoperative MRI is more than double the increase in overall mastectomies.

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Involved external institutions

Gruppo Ospedaliero San Donato IT Italy (IT) Institut Gustave-Roussy FR France (FR) University of Udine / Università degli Studi di Udine IT Italy (IT) University of Cambridge GB United Kingdom (GB) Radboud University Nijmegen Medical Centre / Radboudumc of voluit Radboud Universitair Medisch Centrum (UMC) NL Netherlands (NL) Ospedale Policlinico San Martino IT Italy (IT) Medizinische Universität Wien AT Austria (AT) European Institute of Oncology / Istituto Europeo di Oncologia (IEO) 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) Università degli Studi di Palermo IT Italy (IT) Maastricht University NL Netherlands (NL) Hospital Sírio-Libanês BR Brazil (BR) Semmelweis University / Semmelweis Egyetem HU Hungary (HU) Ospedale San Raffaele (früher: Centro San Raffaele del Monte Tabor Foundation) IT Italy (IT) Universitätsklinikum Tübingen DE Germany (DE) Hospital Universitario Reina Sofía de Córdoba Edificio IMIBIC ES Spain (ES) University Hospital of Verona / Azienda Ospedaliera Universitaria Integrata Verona (AOUI) IT Italy (IT) The Breast Center | Fayetteville US United States (USA) (US) Erasmus University Medical Center (MC) NL Netherlands (NL) Acıbadem Ataşehir Hospital / Acıbadem Ataşehir Hastanesi TR Turkey (TR) 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). Preoperative breast MRI positively impacts surgical outcomes of needle biopsy–diagnosed pure DCIS: a patient-matched analysis from the MIPA study. European Radiology.


Cozzi, Andrea, et al. "Preoperative breast MRI positively impacts surgical outcomes of needle biopsy–diagnosed pure DCIS: a patient-matched analysis from the MIPA study." European Radiology (2023).

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