Is there a Role for MRI in the Preoperative Assessment of Patients with DCIS?

Allen, Lisa R.; Lago-Toro, Claudia E.; Hughes, Jenevieve H.; Careaga, Eduardo; Brown, Anjeanette T.; Chernick, Michael R.; Barrio, Andrea V.; Frazier, Thomas G.

doi:10.1245/s10434-010-1000-9

Cited by 59 publications

(44 citation statements)

References 18 publications

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“…Nine studies were eligible for the meta‐analysis; seven of these were studies that compared cohorts defined by whether or not MRI was performed, and two were RCTs of preoperative MRI. Four studies included patients with both DCIS and invasive breast cancer, whereas five included patients with DCIS only. Four studies included patients undergoing BCS as primary surgery, whereas five evaluated preoperative MRI in patients scheduled for either mastectomy or breast conservation as initial surgery.…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis of the effect of preoperative breast MRI on the surgical management of ductal carcinoma in situ

Fancellu

Turner

Dixon

et al. 2015

British Journal of Surgery

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Section: Resultsmentioning

confidence: 99%

Meta-analysis of the effect of preoperative breast MRI on the surgical management of ductal carcinoma in situ

Fancellu

Turner

Dixon

et al. 2015

British Journal of Surgery

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“…Studies that examine patients with DCIS alone have not shown a decrease in positive margins or the need for re-excision, and some show unnecessary increases in mastectomy rates. 18–21 In addition, two large, randomized trials have evaluated the addition of preoperative breast MRI in women undergoing BCS for breast carcinoma; one found no difference in reoperation rates (19 vs. 19 %, p = 0.77), whereas the other showed a paradoxical increased rate of re-excision among women randomized to MRI. 22,23 Of note, just over 70 % of the re-excisions in the latter study were for DCIS, suggesting that MRI was relatively insensitive to extent of DCIS.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Breast MRI Is Not Associated with Lower Locoregional Recurrence Rates in DCIS Patients Treated With or Without Radiation

et al. 2014

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Introduction For women with ductal carcinoma in situ (DCIS) undergoing breast-conserving surgery (BCS), the benefit of magnetic resonance imaging (MRI) remains unknown. Here we examine the relationship of MRI and locoregional recurrence (LRR) and contralateral breast cancer (CBC) for DCIS treated with BCS, with and without radiotherapy (RT). Methods A total of 2,321 women underwent BCS for DCIS from 1997 to 2010. All underwent mammography, and 596 (26 %) also underwent perioperative MRI; 904 women (39 %) did not receive RT, and 1,391 (61 %) did. Median follow-up was 59 months, and 548 women were followed for ≥8 years. The relationship between MRI and LRR was examined using multivariable analysis. Results There were 184 LRR events; 5- and 8-year LRR rates were 8.5 and 14.6 % (MRI), respectively, and 7.2 and 10.2 % (no-MRI), respectively (p = 0.52). LRR was significantly associated with age, menopausal status, margin status, RT, and endocrine therapy. After controlling for these variables and family history, presentation, number of excisions, and time period of surgery, there remained no trend toward association of MRI and lower LRR [hazard ratio (HR) 1.18, 95 % confidence interval (CI) 0.79–1.78, p = 0.42]. Restriction of analysis to the no-RT subgroup showed no association ofMRI with lower LRR rates (HR 1.36, 95 % CI 0.78–2.39, p = 0.28). No difference in 5- or 8-year rates of CBC was seen between the MRI (3.5 and 3.5 %) and no-MRI (3.5 and 5.1 %) groups (p = 0.86). Conclusions We observed no association between perioperative MRI and lower LRR or CBC rates in patients with DCIS, with or without RT. In the absence of evidence that MRI improves outcomes, the routine perioperative use of MRI for DCIS should be questioned.

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“…21 However, Kuhl et al 22 investigated pure DCIS and achieved a much higher sensitivity to detecting DCIS by MRI (92%, compared to a mammogram 56%, P < 0.0001) and which was particularly sensitive to high grade DCIS. Age, menopausal status, personal or family history of breast cancer or of benign breast disease and breast density of women with MRIonly diagnosed DCIS did not differ significantly from those of women with mammography-diagnosed DCIS.…”

Section: Detection Of Additional Diseasementioning

confidence: 99%

The role of magnetic resonance imaging in early breast cancer

Skandarajah

Mann

2012

Asia-Pac J Clncl Oncology

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Despite recent evidence that fails to detect a benefit in surgical and local recurrence outcomes in those who receive optimal surgery and adjuvant systemic and radiotherapy, magnetic resonance imaging (MRI) is still being employed. We review the recent literature to clarify the role in the use of MRI in early breast cancer. A literature search using the Medline and Ovid databases was conducted between 2004 and 2011 using the terms "magnetic resonance imaging' and 'early breast cancer'. Only articles with clinical trials published in English in adult humans with available abstracts were included. Articles on high-risk women, response to neoadjuvant therapy, advanced breast cancer, the occult primary, the contralateral breast and technical articles were excluded. Articles examining the role of MRI in the staging of early breast cancer were retained. Over 260 articles regarding breast MRI have been published in the last 5 years. Additional foci may be found in 16% of patients but the impact on the extent of surgery and local recurrence rate is yet to be defined. Certain sub-groups who may benefit include those with invasive lobular carcinoma and mammographically dense breasts and those for consideration of partial breast irradiation. With standard adjuvant radiotherapy, there is no benefit in routine MRI with respect surgical extent and local recurrence. Should MRI be used, pre-operative biopsy to confirm additional disease must be undertaken prior to a change in surgical extent of resection. However, MRI may be useful in the evaluation of those who can be considered for partial breast irradiation. Centres undertaking breast MRI must have MRI-biopsy capabilities and constantly audit the reporting of MRI with correlation to the final pathology.

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Is there a Role for MRI in the Preoperative Assessment of Patients with DCIS?

Cited by 59 publications

References 18 publications

Meta-analysis of the effect of preoperative breast MRI on the surgical management of ductal carcinoma in situ

Meta-analysis of the effect of preoperative breast MRI on the surgical management of ductal carcinoma in situ

Perioperative Breast MRI Is Not Associated with Lower Locoregional Recurrence Rates in DCIS Patients Treated With or Without Radiation

The role of magnetic resonance imaging in early breast cancer

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