HR-Negative Breast Cancer: MRI Not Beneficial Early On
December 11, 2025
3 min read
Key takeaways:
Table of Contents
- Preoperative breast MRI provides no benefit in stage I or II hormone receptor-negative breast cancer.
- Five-year locoregional recurrence rates were similar regardless of preoperative MRI use.
SAN ANTONIO — Patients with stage I or II hormone receptor-negative breast cancer do not benefit from preoperative breast MRI, according to data from San Antonio Breast Cancer Symposium.
Given the comparable 5-year locoregional recurrence rates between those who underwent breast MRI in addition to diagnostic mammography and those who did not, researchers noted that “clinical benefit of MRI is lacking” and routine use is not justified for surgical planning.
Isabelle
Bedrosian, MD,
shares findings from the phase 3 Alliance A011104 trial, during San Antonio Breast Cancer Symposium.
Isabelle Bedrosian
“Use of breast MRI has become widespread in the care of breast cancer patients, driven by consensus within the field that MRI was more sensitive at detecting disease than mammography, providing both a more accurate assessment of the size of the index lesion and identifying additional areas of disease,” Isabelle Bedrosian, MDprofessor of breast surgical oncology at The University of Texas MD Anderson Cancer Center, told Healio. “The assumption for a long time was that detectingand treating, based on MRI extent of disease was important to optimizing patient outcomes — we set out to test this assumption.”
Study protocol
In the phase 3 Alliance A011104 trial, Bedrosian and colleagues enrolled 319 patients (median age, 58.9 years years) with stage I or II hormone receptor (HR)-negative breast cancer, including triple-negative, ER/PR-negative and HER2-positive subtypes. Patients were then randomly assigned to either undergo breast MRI (n = 161) following mammography or not (n = 158).
The majority of patients had T1 tumors (72.1%) and node-negative disease (93.4%); 19.7% were HER2-positive. Systemic chemotherapy use was reported for 85% of patients, with 17.6% having received it prior to surgery. Nearly all patients (93.4%) had previously undergone surgery, and 91.9% had breast-conserving surgery as their initial procedure, with no significant difference between the groups (92.7% no MRI vs. 91.9% MRI).
Among patients who received neoadjuvant chemotherapy, the overall pathologic complete response rate was 39.3% (29% in the MRI group vs. 52% in the no-MRI group; P = .10). Adjuvant radiation therapy rates were similar between groups (85.4% no MRI vs. 85% MRI).
The researchers compared categorical variables between the groups using Chi-square or Fisher’s exact tests. Local regional recurrence, distant recurrence and OS were estimated using Kaplan-Meier point estimates with 95% confidence intervals.
‘No benefit to MRI’
According to study results, median follow-up at just over 5 years (61.1 months) showed no difference in locoregional recurrence between patients with early-stage HR-negative breast cancer who received preoperative breast MRI and those who did not.
“[This] adds to the body of evidence that there does not appear to be a clinical benefit from routine use of breast MRI for purposes of surgical planning,” Bedrosian told Healio. “Our primary finding that MRI does not improve local regional control aligns with the BREAST-MRI Trial reported in 2023 out of Brazil — although the cohort for BREAST-MRI trial was primarily HR-positive — as well as with available retrospective studies that have reported local recurrence outcomes based on use of preoperative breast MRI.”
Five-year locoregional control was 93.2% in the MRI group vs. 95.7% in the no-MRI group (HR = 1.1; 95% CI, 0.3–3.9). Across the full cohort, the 5-year distant recurrence-free rate was 94.3% and OS was 92.2%, with no differences between groups.
“Breast MRI is associated with known harmsincluding additional biopsies, increased rates of mastectomy and delays to surgery,” Bedrosian told Healio. “It is important to balance these harms against the clinical benefits. Data from A011104 shows no benefit to MRI for reducing local regional recurrence. This finding, coupled with the preponderance of data showing no benefit for MRI in reducing reoperation rates suggests that harms appear to be greater than benefits, and thus routine use of breast MRI in newly-diagnosed patients is not warranted.”
Sources/Disclosures
Source:
Bedrosian I, et al. Abstract GS2-07. Presented at: San Antonio Breast Cancer Symposium; Dec. 9-12, 2025; San Antonio.
Disclosures:
NCI and NIH supported this study. Bedrosian reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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