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Hypothesis:Women with newly diagnosed breast can- cers may harbor additional ipsilateral or contralateral breast malignancies that are undetected by mammogra- phy and ultrasonography. Magnetic resonance imaging (MRI) has demonstrated excellent sensitivity in the de- tection of breast cancers. However, the impact of rou- tine MRI on the surgical management of new, biopsy- proven breast cancers remains unclear. Design:Retrospectiveanalysisofaprospectivedatabase. Setting:Anacademic,tertiarycarecenterinalargemet- ropolitan area. Patients: A total of 155 women with breast cancer newly diagnosed by mammography, ultrasonography, and needle biopsy underwent preoperative bilateral breast MRI in a single-institution, single-surgeon set- ting during 1 year. Main Outcome Measures: Change in surgical man- agement based on breast MRI findings. Results:TheMRIdemonstrated124additionalsuspicious lesions in 73 patients. Post-MRI follow-up mammograms orultrasonogramswererequiredin65patients,and41pa- tientsunderwentadditionalimage-guidedbiopsies.There wasachangeinsurgicalmanagementasMRIdiscoveredad- ditional,otherwiseundetectedmalignanciesin36patients basedonradiographic-pathologiccorrelation.Lumpectomy wasconvertedtomastectomyin10patients(8beneficial), widerexcisionwasperformedin21patients(10beneficial), and 5 patients (2 beneficial) underwent contralateral sur- gery. Larger tumor size was an independent predictor of a beneficialchangeinsurgicalmanagement(oddsratio,1.66; 95% confidence interval, 1.04-2.66). Conclusions: Breast MRI results in a beneficial change insurgicalmanagementin9.7%ofnewlydiagnosedbreast cancers. The detection of additional, otherwise undetec- ted ipsilateral and contralateral breast malignancies with MRIsuggeststhatbreastMRImayhavearoleintheevalu- ation of new breast cancers.

Evaluating the Impact of Preoperative Breast Magnetic Resonance Imaging on the Surgical Management of Newly Diagnosed Breast Cancers