Despite its high diagnostic performance, the use of breast MRI in the preoperative
setting is controversial. It has the potential for personalized surgical management
in breast cancer patients, but two of three randomized controlled trials did not show
results in favor of its introduction for assessing the disease extent before surgery.
Meta-analyses showed a higher mastectomy rate in women undergoing preoperative MRI
compared to those who do not. Nevertheless, preoperative breast MRI is increasingly
used and a survey from the American Society of Breast Surgeons showed that 41% of
respondents ask for it in daily practice. In this context, a large-scale observational
multicenter international prospective analysis (MIPA study) was proposed under the
guidance of the European Network for the Assessment of Imaging in Medicine (EuroAIM).
The aims were (1) to prospectively and systematically collect data on consecutive
women with a newly diagnosed breast cancer, not candidates for neoadjuvant therapy,
who are offered or not offered breast MRI before surgery according to local practice;
(2) to compare these two groups in terms of surgical and clinical endpoints, adjusting
for covariates. The underlying hypotheses are that MRI does not cause additional mastectomies
compared to conventional imaging, while reducing the reoperation rate in all or in
subgroups of patients. Ninety-six centers applied to a web-based call; 36 were initially
selected based on volume and quality standards; 27 were active for enrollment. On
November 2018, the target of 7000 enrolled patients was reached. The MIPA study is
presently at the analytic phase. Key Points center dot Breast MRI has a high diagnostic
performance but its utility in the preoperative setting is controversial. center dot
A large-scale observational multicenter prospective study was launched to compare
women receiving with those not receiving preoperative MRI. center dot Twenty-seven
centers enrolled more than 7000 patients. The study is presently at the analytic phase.
