Impact of MRI on high grade Ductal Carcinoma Insitu (HG DCIS) management, are we using the full scope of MRI?

Hajaj, Mohamad; Karim, Ahmed; Pascaline, Sana; Noor, Lubna; Patel, Salma; Dakka, Mahmoud

doi:10.1016/j.ejrad.2017.08.027

Cited by 11 publications

(13 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We found that MRI did not result in higher mastectomy rates, which is in line with some studies that also reported no effect of MRI on mastectomy rates [21,23]. By contrast, the majority of the studies on the effect of MRI on mastectomy rates reported an increased rate [8,20,22,24,26]. Differences between these studies are hard to explain but are probably related to the radiologists' interpretations of the MRI images.…”

Section: Discussionsupporting

confidence: 88%

“…The impact of preoperative MRI for DCIS on re-intervention rates remains controversial [17]. Some studies claimed that MRI allowed for a more accurate determination of the extent of disease without reporting on re-intervention rates, [13,18,19], and some others also reported a lower re-intervention rate [20,21]. However, some of the larger studies did not find lower re-excision rates [8,22e24].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Preoperative breast MRI in management of patients with needle biopsy-proven ductal carcinoma in situ (DCIS)

Bekkum

Braak

Plaisier

et al. 2020

European Journal of Surgical Oncology

View full text Add to dashboard Cite

Background: In 20e25% of patients with biopsy-proven DCIS underestimation occurs. Sentinel lymph node biopsy (SLNB) is offered to patients with biopsy-proven ductal carcinoma in situ (DCIS) and a high risk of occult invasive cancer. However, assessment of high risk is controversial. We aimed to improve selection of patients for SLNB with preoperative breast magnetic resonance imaging (MRI). Methods: In this prospective observational study, MRI was offered to all subsequent patients with a biopsy-proven DCIS admitted to a large Dutch teaching hospital between April 2012 and March 2017. MRI images were analysed for signs of invasive cancer and the results were compared with the pathologic results after surgical treatment. The diagnostic accuracy of additional MRI in detecting occult invasive cancer was determined. Results: Of 211 patients eligible for additional MRI analysis, 149 underwent breast MRI. The majority (67%) received breast-conserving therapy, and the underestimation rate was 20%. Subsequent to MRI analysis, 20 additional invasive diagnostic procedures were performed. Occult invasive cancer was suspected on MRI in 46 patients (31%) and was confirmed in 18 (12%). In this study, breast MRI had a sensitivity of 67%, a specificity of 77%, and a true negative rate of 91%. Conclusion: Preoperative breast MRI cannot reliably predict the presence of invasive cancer in patients with biopsy proven DCIS. Therefore, it cannot be used to in the selection of patients for a SLNB.

show abstract

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Preoperative breast MRI in management of patients with needle biopsy-proven ductal carcinoma in situ (DCIS)

Bekkum

Braak

Plaisier

et al. 2020

European Journal of Surgical Oncology

View full text Add to dashboard Cite

show abstract

“…Three studies were RCTs [19][20][21], 18 were comparative cohorts [11,12,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] and five were single arm cohorts [12,21,[37][38][39], with a total of 20,415 patients (260 from the RCTs and 20,155 from the observational studies). Most studies were conducted in the USA or in the Netherlands.…”

Section: Study Characteristicsmentioning

confidence: 99%

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

et al. 2021

View full text Add to dashboard Cite

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.

show abstract

“…Nori et al [23] compared the mean absolute error between preoperative MRI and mammography evaluations and final disease extent; MRI showed an improved accuracy of 51.2%. Study done by Hajaj et al [24] suggests that MRI could be an important tool in reducing the re-excision rates in the surgical management of high-grade DCIS. In our experience, most of the infiltrating duct carcinoma cases were (IDC) associated with DCIS, and most cases were detected by mammogram and ultrasound, apart from few cases which were negative by mammogram due to dense parenchyma.…”

Section: Discussionmentioning

confidence: 99%

MRI for assessment of pathologic nipple discharge: is it mandatory?

Zaky

Hafez

Zaky

et al. 2019

Egypt J Radiol Nucl Med

View full text Add to dashboard Cite

Background: Benign breast lesions is the most common cause of nipple discharge; however, a rare but major cause is breast cancer. This study assesses the superadded value of MRI in diagnosing causes of pathologic nipple discharge. Ninety-three patients with pathologic nipple discharge were evaluated by sonomammography and DCE-MRI. Sonomammography and MR imaging features were analyzed and correlated with the histopathology. Results: Histopathology revealed 69 benign, three high-risk, and 21 malignant lesions. Simply dilated ducts and presence of a mass on US examination as well as non-mass enhancement and STIR signal changes on MRI were of statistically significant probability in differentiation between benign and malignant causes of pathological nipple discharge (p value = 0.017 and 0.001) and (p value ≤ 0.001). Sensitivity and specificity of mammogram and ultrasound in differentiation between benign and malignant causes of pathologic nipple discharge were 71.4% and 54.2% respectively with positive predictive value of 31.2%,negative predictive value of 86.7%, and accuracy of 58.1%. MRI gave higher sensitivity and specificity of 100% and 83.3% with positive predictive value of 63.6%, negative predictive value of 100%, and accuracy of 87.1%. Conclusion: Magnetic resonance imaging is superior to sonommagraphy in diagnosis of pathologic nipple discharge and we recommend it in special situations.

show abstract

Impact of MRI on high grade Ductal Carcinoma Insitu (HG DCIS) management, are we using the full scope of MRI?

Cited by 11 publications

References 19 publications

Preoperative breast MRI in management of patients with needle biopsy-proven ductal carcinoma in situ (DCIS)

Preoperative breast MRI in management of patients with needle biopsy-proven ductal carcinoma in situ (DCIS)

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

MRI for assessment of pathologic nipple discharge: is it mandatory?

Contact Info

Product

Resources

About