Multi-disciplinary clinic discussion associated with decreased performance of breast MRI and increased eligibility for breast conservation

Background/Objective: The management of breast cancer benefits from a multi-disciplinary approach as this leads to better adherence to management guidelines. There is much variability in the utilization of MRI in the management of breast cancer. This study examines the effect of implementation of a multi-disciplinary clinic (MDC) on the utilization of MRI and breast-conserving therapy (BCT). Methods: We conducted a retrospective review of patients who were diagnosed with invasive breast cancer 1 year prior to and after the implementation of an MDC at our institution. We examined various clinical factors including age, sex, tumor characteristics, radiologic studies, surgical and medical treatment, and rates of BCT. We performed univariate analysis to compare differences among rates of pre-treatment MRI and BCT between patients who were and were not presented at the MDC. Results: A total of 539 patients were eligible for the study. There were 122 patients who were diagnosed prior to MDC, and 419 patients discussed at MDC. There was no difference in the average age (59.9 vs 62.2, p=0.1). There were no differences between the non-MDC and MDC patients among rates of BCT offered if eligible (96.8% vs 96.7%, p=0.95) and BCT performed if eligible (98.8% vs 93.9%, p=0.07). There was, however, a significant difference between the 2 groups in rates of pre-treatment MRI performed (32.2% vs 14.4%, p\u3c0.001). When comparing the groups that did not have a pre-treatment MRI and those that did, there was a decrease in the rate of BCT eligibility (82% vs 72.9%, p=0.02), BCT offered (98.6% vs 87.0%, p\u3c0.001), but not in the rates of BCT performed if eligible (95% vs 94.2%, p=0.82). Conclusions: Having a pre-treatment MRI resulted in patients more likely to be considered ineligible for BCT, and also less likely to be offered BCT. Having lower rates of BCT offered is a negative repercussion that may be mitigated through an MDC approach because patients are less likely to have a pretreatment MRI when presented at MDC. Further research is warranted, and more detailed conclusions may be obtained through prospective trials such as the ALLIANCE-MRI trial