MRI and Mammography Before Surgery in Patients With Stage I-II Breast Cancer

Study Overview
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Brief Summary
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The purpose of this study is to test whether patients undergoing a breast MRI (magnetic resonance imaging) before breast surgery will have better results after the surgery. Breast tumors are routinely evaluated using mammograms and ultrasound before surgery. This study would like to find out if using MRI in addition to mammography before surgery improves our ability to evaluate tumors and decide what kind of surgery is best for the patient.

Detailed Description
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This is a randomized trial of preoperative breast MRI in patients deemed eligible for breast conserving surgery by conventional clinical criteria will provide important information about the clinical and biologic relevance of occult disease identified by MRI alone. Patients will be assigned to standard pre-operative breast cancer disease assessment without the addition of MRI prior to breast conserving surgery or standard pre-operative breast cancer disease assessment with the use of MRI prior to breast conserving surgery. The primary objective is to compare the rates of local-regional recurrence (LRR) following attempted breast conserving therapy in a cohort of women with triple negative or HER-2 amplified breast cancer randomized to preoperative staging with mammography (control arm) or mammography plus breast MRI (MRI arm). Secondary objectives are: To compare the re-operation rates following attempted breast conserving therapy between women assessed preoperatively with breast MRI to those assessed without the use of breast MRI To compare local recurrence rates between women who undergo BCT on the control arm to women who undergo BCT on the MRI arm To compare the conversion rate to mastectomy secondary to persistent positive margins or poor cosmesis within the first 6 months of attempting BCT (prior to the administration of RT) between women assessed preoperatively with breast MRI to those assessed without the use of breast MRI To compare the contralateral breast cancer rates in women randomized to preoperative breast MRI to those not receiving pre-operative breast MRI To compare the disease-free survival rates between women assessed preoperatively with breast MRI to those assessed without the use of breast MRI To compare breast cancer specific and overall survival outcomes of women assessed preoperatively with breast MRI to those assessed without the use of breast MRI To estimate the rate of MRI-guided localization assisted surgery To estimate the rate of multi-centric disease in the index breast for women in the MRI arm To evaluate the accuracy of index lesion characteristics and other factors in predicting multi-centricity in the cohort randomized to breast MRI To assess the positive predictive values (PPV) of MRI in detecting ipsilateral multi-centric disease and contralateral disease in women with breast cancer undergoing preoperative breast MRI To estimate the false positive rate for detection of multiple foci of breast cancer by MRI All registered patients will be monitored for relapse and survival for 5 years from the date of surgery. Patients will be followed a minimum of every 4 months for the first 2 years from diagnosis and a minimum of every 6 months during years 3-5. Patients will be monitored for local, regional, distant relapse and vital status.

Official Title
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Effect of Preoperative Breast MRI on Surgical Outcomes, Costs and Quality of Life of Women With Breast Cancer

Conditions
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Estrogen Receptor-negative Breast Cancer, Progesterone Receptor-negative Breast Cancer, Stage IA Breast Cancer, Stage IB Breast Cancer, Stage II Breast Cancer, Triple-negative Breast Cancer

Intervention / Treatment
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* Procedure: Breast surgery
* Procedure: Magnetic resonance imaging
* Procedure: Mammography


Participation Criteria
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Eligibility Criteria
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Female. Men are excluded from this study because the number of men with breast cancer is insufficient to provide a statistical basis for assessment of effects in this subpopulation of people with breast cancer. Pathologically confirmed diagnosis of breast cancer, clinical stage I-II (T1-3 N0 M0, T0-2 N1 M0). Diagnosis must be by needle biopsy; patients diagnosed by surgical excision are excluded. Patients must have either: Estrogen receptor (ER) negative/progesterone receptor (PR) negative (< 10% by immunohistochemistry IHC staining) and HER-2 negative breast cancer OR ER negative/PR negative (< 10% by IHC staining) and HER-2 positive tumors HER-2 status will be determined as per the 2013 ASCO CAP guidelines: HER-2 is considered positive if there is IHC 3+ staining or ISH positive using either single probe ISH or dual probe ISH HER-2 is considered negative if there is IHC 0 or 1+ staining or ISH negative using either single probe ISH or dual probe ISH No patients with previous ipsilateral invasive breast cancer or ductal carcinoma in situ (DCIS) No patients with bilateral breast cancer No patients with known deleterious mutations in breast cancer (BRCA) genes No current history of receiving hormonal therapy, tamoxifen, and or aromatase inhibitors for therapeutic measures No history of chemotherapy for cancer within 6 months prior to registration No patients scheduled to receive neoadjuvant chemotherapy or partial breast irradiation following breast conserving surgery Eligible for BCT based on clinical examination, mammography and, if standard practice at a given institution, ultrasound and/or tomogram. Women who cannot be appropriately selected for BCT based on these standard imaging studies, and for whom additional imaging is recommended to clarify local disease extent, will not be eligible for this trial. No patients with multicentric or multifocal disease scheduled to undergo multiple lumpectomies. Multifocal disease that can be encompassed in a single operative bed can be enrolled. Suitable to undergo MRI and receive the contrast agent gadolinium (exclusions follow): No history of untreatable claustrophobia No presence of metallic objects or implanted medical devices in body (i.e., cardiac pacemaker, aneurysm clips, surgical clips, prostheses, artificial hearts, valves with steel parts, metal fragments, shrapnel, tattoos near the eye, or steel implants) No history of sickle cell disease No contraindication to intravenous contrast administration No known allergy-like reaction to gadolinium or moderate or severe allergic reactions to one or more allergens as defined by the American College of Radiology (ACR); patient may be eligible if willing to undergo pre-treatment as defined by the institution's policy and/or ACR guidance No findings consistent with renal failure, as determined by glomerular filtration rate (GFR) < 30 mL/min/1.73 m^2 based on a creatinine level obtained within 28 days prior to registration Weight lower than that allowable by the MRI table No prior MRI of study breast within the 12 months prior to registration Non-pregnant and non-lactating. Patients of child-bearing potential must have a negative pregnancy test within 7 days prior to registration. Perimenopausal patients must be amenorrheic > 12 months to be considered not of child-bearing potential ≥ 18 years of age Signed study-specific informed consent prior to registration

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Arm 1 (control)<br>Patients undergo a clinical breast examination and mammography with ultrasound of the breast and regional nodes followed by breast conserving surgery. | Procedure: Breast surgery<br> <br> Procedure: Mammography<br> <br> |
| Experimental: Arm 2 (experimental)<br>Patients undergo a clinical breast examination, mammography with ultrasound of breast and regional nodes and breast MRI followed by breast conserving surgery or mastectomy. | Procedure: Breast surgery<br> <br> Procedure: Magnetic resonance imaging<br> <br> Procedure: Mammography<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Local-regional recurrence (LRR) |  | Up to 5 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Re-operation rate |  | Up to 5 years | 
| Conversion rate to mastectomy secondary to persistent positive margins or poor cosmesis |  | Within the first 6 months | 
| Time to contralateral breast cancer |  | Up to 5 years post-randomization | 
| Disease-free survival (DFS) |  | Up to 5 years post-randomization | 
| Overall survival |  | Up to 5 years post-randomization | 
| Breast cancer specific survival will be measured |  | Up to 5 years post-randomization | 
| Rate of MRI-guided localization assisted surgery (Arm B) |  | Up to 5 years | 
| False positive rate for MRI detection of multiple disease foci |  | Up to 5 years |