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Background: Local recurrence after breast conserving surgery is reported in 5-10% of cases. This study aims to determine if preoperative MRI is associated with reduced IBTR rates in the longer term and evaluate IBTR rates of a high risk (TN and Her-2 positive) subgroup in those receiving MRI or not., Methods: Between 1999 and 2005, patients with invasive breast cancer undergoing BCS and radiation were identified. Primary endpoint was IBTR rate., Results: The cohort consisted of 470 cases: 27% underwent MRI and 73% did not. Median follow-up was 97 months. Overall 10-year IBTR rate was 3.6%. There was no significant difference in IBTR rate at 10 years between those receiving MRI or not (1.6% vs. 4.2% (P = 0.37). The TN and Her-2 positive combined subgroup had a higher IBTR rate than all others (9.8% vs. 1.7%, P = 0.001). In the group without MRI, the IBTR rate of the high risk group was 11.8% compared to 1.8% in the remainder (P = 0.002)., Conclusion: With 10-year follow-up, there was no significant difference in IBTR rate whether preoperative MRI is performed versus not. The high risk population showed an increased IBTR rate, this was more marked in those who did not receive MRI., (© 2017 Wiley Periodicals, Inc.)

Background: It remains uncertain whether routine preoperative breast magnetic resonance imaging (MRI) will lead to improved local outcomes after breast-conserving surgery (BCS) and radiation (RT) for invasive carcinoma. The purpose of this study was to determine whether MRI in the planning of the first lumpectomy reduces ipsilateral breast tumor recurrence (IBTR)., Methods: Using a prospective database, 472 initial lumpectomies from 463 women between 1999 and 2005 were examined. All patients had invasive cancer excised to negative margins on BCS, received RT, and were followed. IBTR rates were calculated by Kaplan-Meier method. Univariate and multivariate analyses were performed to investigate the association between MRI for initial lumpectomies and IBTR outcomes., Results: MRI was performed before 127 (27%) lumpectomies, while 345 (73%) patients did not have a preoperative breast MRI. At median follow-up of 54 months (range 4.8-111.6 months), there was no significant difference in actuarial 8-year IBTR rates between women with preoperative MRI evaluation and women without MRI (1.8% versus 2.5%, respectively; P=0.67). After adjusting for adjuvant therapies, patient, and tumor characteristics, there continued to be no increased risk of IBTR [hazard ratio (HR) 1.7; P=0.60]. MRI visualization of tumors prior to lumpectomy did not influence the achievement of negative margins and was not associated with lower rates of re-excision (MRI: 11.8% versus no-MRI: 13.3%; P=0.50)., Conclusion: MRI evaluation of invasive carcinoma in the planning of initial lumpectomies was not associated with improved local outcomes after BCS with RT in this cohort of patients.

Background: Lumpectomy followed by radiation is standard treatment for early breast cancer. Recently, the use of partial breast intraoperative radiation (IORT) has been developed, and patients selected for IORT should not have positive margins. This study's purpose was to identify factors predicting negative margins after lumpectomy., Methods: Patient age, preoperative investigations, surgery, final pathology, and margin status were examined using a prospective database between 1999 and 2005. Univariate and multivariate logistic regression analysis were performed to identify patient and tumor factors predicting an increased rate of negative margins. The results were used to generate a patient selection algorithm., Results: The rate of positive margins at first resection was 17% in 730 lumpectomies (708 patients). Multivariate analysis revealed that older age (P = .0006), smaller tumor size (P < .0025), type of surgery (OR = 3.4 for ultrasound vs mammogram-guided wire localization, P = .003), and having a core needle biopsy (CNB) with preoperative cancer diagnosis (P < .0001) were predictive for having a negative margin. Patients older than age 50 with a preoperative CNB showing invasive cancer less that 3 cm that can be localized under ultrasound had a negative margin rate of 98% (n = 178). These patients would be ideal for consideration of IORT., Conclusions: Negative margin rates after lumpectomy are predicted by age, tumor size, preoperative investigations, and localization technique. These variables can be used to select patients for IORT with a 2.2% chance of positive margins.