Effects of preoperative breast MRI on surgical management in women aged 40 years and younger with breast cancer.

e13656 Background: Evaluating the use of preoperative breast MRI on the management of breast cancer can help guide surgical decision making for young female patients newly diagnosed with breast cancer. Methods: A retrospective chart review of the George Washington University database between January 2015 and December 2020 identified 125 women age 40 or younger diagnosed with breast cancer. Of the 125 women, 23 were excluded from the study as they were lost to follow up due to care transfers. The management impact of pre-operative MRI was examined and variables collected include age, race, family history, genetic predisposition, breast density, method of detection, initial imaging findings, initial biopsy results, preoperative MRI findings, additional biopsies, additional biopsy results, and surgery type. Results: Patient ages ranged from 22 to 40 (mean 34.5), 69 (67.6%) had a family history of breast cancer, 81 (79.4%) had dense breasts (30 extremely dense and 51 heterogeneously dense), and 82 (80.4%) had the cancer detected due to clinical symptoms with the remaining during surveillance due to high risk. Of all women included, 55 (53.9%) had additional findings on MRI warranting biopsy of which 25 (45.5%) were biopsy proven cancer. 39 (39.4%) patients had lumpectomy and 59 (59.6%) had mastectomy. 1 (0.01%) patient did not undergo surgery due to widespread metastasis. The use of preoperative MRI identified additional carcinoma in 25 (24.5%) out of 102 patients. 24 (96%) in the ipsilateral breast, and 1 (4%) in the contralateral breast. Conclusions: Overall, this data indicates that the use of preoperative MRI for the treatment of breast cancer in young patients increases the detection of occult breast cancer prior to definitive therapy in 24.5% of patients, critically important information for optimal management. We recommend that all young women with newly diagnosed breast cancer undergo pre-operative MRI to further optimize patient care.