A comparative analysis of MRI findings versus final pathology in multicentric breast cancer patients at King Abdulaziz Medical City, Jeddah.

Introduction: Multicentric breast cancer (MCBC) identified on preoperative breast magnetic resonance imaging (MRI) often influences surgical management toward mastectomy. However, MRI may overestimate true multicentric disease when compared with final pathological findings, potentially leading to overtreatment. This study evaluated the agreement between preoperative MRI and final pathology in diagnosing MCBC at a tertiary oncology center in Jeddah, Saudi Arabia, and explored factors associated with final pathological focality, including biopsy strategy and neoadjuvant chemotherapy (NAC). Methodology: A retrospective cohort study was conducted at the Princess Noorah Oncology Center, King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia, between January 2016 and December 2024. Adult patients (≥18 years) with MRI-diagnosed multicentric breast cancer who subsequently underwent mastectomy were included. Demographic characteristics, tumor and nodal features, risk factors, biopsy findings, treatment modalities, and final pathological focality were retrospectively collected and analyzed. Results: A total of 233 patients met the inclusion criteria (mean age: 52.76 ± 10.19 years), of whom 102 (43.8%) received NAC. Although all patients were diagnosed with multicentric disease on preoperative MRI, final pathology confirmed multicentric disease in only 25 patients (10.7%). When stratified by NAC status, multicentric disease was confirmed in 4 of 102 patients (3.9%) who received NAC and 21 of 131 patients (16.0%) who did not receive NAC. Among patients who did not receive NAC, biopsy of multiple suspicious lesions was significantly associated with pathologically confirmed multicentric disease ( Conclusion: Preoperative breast MRI demonstrated limited agreement with final pathological findings in patients with presumed multicentric breast cancer, particularly among those who did not receive NAC, in whom only 16.0% had multicentric disease confirmed on final pathology. These findings suggest that histopathological confirmation of all MRI-detected suspicious lesions that may alter surgical management should be considered whenever technically feasible. Integrating MRI with second-look ultrasound, ultrasound-guided biopsy, or MRI-guided biopsy when appropriate may improve diagnostic accuracy, reduce unnecessary mastectomy, and optimize surgical decision-making.