Preoperative breast magnetic resonance imaging in patients with ductal carcinoma in situ: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC)

Abstract

Objective To evaluate the impact of preoperative MRI in the management of Ductal carcinoma in situ (DCIS). Methods We searched the PubMed, EMBASE and Cochrane Library databases to identify randomised clinical trials (RCTs) or cohort studies assessing the impact of preoperative breast MRI in surgical outcomes, treatment change or loco-regional recurrence. We provided pooled estimates for odds ratios (OR), relative risks (RR) and proportions and assessed the certainty of the evidence using the GRADE approach. Results We included 3 RCTs and 23 observational cohorts, corresponding to 20,415 patients. For initial breast-conserving surgery (BCS), the RCTs showed that MRI may result in little to no difference (RR 0.95, 95% CI 0.90 to 1.00) (low certainty); observational studies showed that MRI may have no difference in the odds of re-operation after BCS (OR 0.96; 95% CI 0.36 to 2.61) (low certainty); and uncertain evidence from RCTs suggests little to no difference with respect to total mastectomy rate (RR 0.91; 95% CI 0.65 to 1.27) (very low certainty). We also found that MRI may change the initial treatment plans in 17% (95% CI 12 to 24%) of cases, but with little to no effect on locoregional recurrence (aHR = 1.18; 95% CI 0.79 to 1.76) (very low certainty). Conclusion We found evidence of low to very low certainty which may suggest there is no improvement of surgical outcomes with pre-operative MRI assessment of women with DCIS lesions. There is a need for large rigorously conducted RCTs to evaluate the role of preoperative MRI in this population. Key Points • Evidence of low to very low certainty may suggest there is no improvement in surgical outcomes with pre-operative MRI. • There is a need for large rigorously conducted RCTs evaluating the role of preoperative MRI to improve treatment planning for DCIS.

Overcoming Barriers in Ductal Carcinoma In Situ Management: From Overtreatment to Optimal Treatment

“…30,33 Still, the potential for surgical outcome improvements with MRI remains unclear. A meta-analysis 34 and systematic review 35 found limited evidence that MRI reduced reoperation rate, although many of the included studies predated published guidelines to improve quality of imaging acquisition 36 and interpretation. 37 The single-arm ECOG-ACRIN E4112 DCIS trial showed that when MRI is performed in accordance with American College of Radiology accreditation requirements, rate of successful WLE is high (96%) while re-excision (22%) is low.…”

Breast MRI for Extent of Disease: Association of Demographic Factors and Biopsy Compliance on Surgical Decisions in Patients with BI-RADS 4 and 5 Findings

“…4 In addition, the findings of possible multicentric disease, whether confirmed with a biopsy or not, are associated with higher mastectomy rates [5][6][7] without a demonstrated improvement in surgical outcomes, cancer recurrence rates, or long-term survival. 8,9 Although a host of factors may play a role in a patient's surgical choice, data suggests that new information from preoperative MRI likely influences patients' decisionmaking regarding mastectomy. 10 The American Society of Breast Surgeons currently states mastectomy is indicated for any cancer unsuitable for breast conservation surgery (BCS) based on tumor size, multicentricity, insufficient response to neoadjuvant chemotherapy, and other factors.…”

Application of deep learning to identify ductal carcinoma in situ and microinvasion of the breast using ultrasound imaging

“…Although MRI also provides high sensitivity, it is expensive, and there is conflicting evidence as to whether preoperative MRI is beneficial to DCIS patients (24)(25)(26)(27)(28). A recent systematic review by Canelo-Aybar et al (29) showed that preoperative MRI did not reduce the rate of repeat surgery or mastectomy. With increasing access to imaging technology and screening, patients with DCIS can be identified earlier.…”