MRI of the Breast for the Detection and Assessment of the Size of Ductal Carcinoma in Situ

Kim, Do Youn; Moon, Woo Kyung; Cho, Nariya; Ko, Eun Sook; Yang, Sang Kyu; Park, Jeong Seon; Kim, Sun Mi; Park, In-Ae; Hee, Joo; Lee, Eun Hye

doi:10.3348/kjr.2007.8.1.32

Cited by 63 publications

(31 citation statements)

References 19 publications

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“…Proponents of breast MRI argue that MRI better characterizes tumor extent and, as such, should improve surgical planning and decrease the rate of positive surgical resection margins and, therefore, the need for re‐excision. However, studies have demonstrated significant variability in tumor size estimation by MRI, with underestimation reported in 8% to 59% of cases and overestimation in 11% to 70% of cases …”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging in patients with newly diagnosed breast cancer: A review of the literature

Pilewskie

King

2014

Cancer

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The use of magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer remains controversial. Here we review the current use of breast MRI and the impact of MRI on short-term surgical outcomes and rates of local recurrence. In addition, we address the use of MRI in specific patient populations, such as those with ductal carcinoma in situ, invasive lobular carcinoma, and occult primary breast cancer, and discuss the potential role of MRI for assessing response to neoadjuvant chemotherapy. Although MRI has improved sensitivity compared with conventional imaging, this has not translated into improved short-term surgical outcomes or long-term patient benefit, such as improved local control or survival, in any patient population. MRI is an important diagnostic test in the evaluation of patients presenting with occult primary breast cancer and has shown promise in monitoring response to neoadjuvant chemotherapy; however, the data do not support the routine use of perioperative MRI in patients with newly diagnosed breast cancer. Cancer 2014;120:2080-9. V C 2014 American Cancer Society.KEYWORDS: magnetic resonance imaging (MRI), breast cancer, breast-conserving surgery, local recurrence. INTRODUCTIONThe use of magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer requires balancing the positive and negative aspects of additional imaging and, as evidenced by the growing number of editorials and reviews arguing for or against the routine use of MRI, 1-8 remains an area of significant controversy. This debate has been fueled by inconsistent data largely comprised of small, single-institution retrospective studies, although 2 randomized controlled trials (RCTs) and several meta-analyses have provided more robust data evaluating MRI in the perioperative setting. The "pros" of perioperative MRI include improved sensitivity compared with conventional imaging and therefore increased identification of multifocal, multicentric, or contralateral disease. With improved sensitivity comes a theoretical improvement in short-term surgical management and/or long-term outcomes. The "cons" of perioperative MRI include the high falsepositive rate, potential treatment delays, increased mastectomy rates and cost, and, some argue, overdiagnosis and overtreatment of MRI-only detected disease. Here we review the relevant data regarding MRI use in patients with newly diagnosed breast cancer, examining both the short-term and long-term outcomes, MRI use in populations of women with ductal carcinoma in situ (DCIS) and invasive lobular carcinoma (ILC), MRI's role in patients presenting with occult primary breast cancer, and MRI's ability to evaluate neoadjuvant chemotherapy (NAC) response.

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Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging in patients with newly diagnosed breast cancer: A review of the literature

Pilewskie

King

2014

Cancer

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“…[45678910192021222324252627] In our analysis of women of age 60 years and above undergoing presurgical bilateral breast MRI, we found additional malignancy in 9% of the patients (114/1268). Of these new malignancies, 2.4% were in the contralateral breast.…”

Section: Discussionmentioning

confidence: 83%

Importance of Presurgical Breast MRI in Patients 60 Years of Age and Older

Destounis¹,

Arieno²,

Morgan³

2014

Journal of Clinical Imaging Science

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Objective:To demonstrate the importance of presurgical bilateral breast Magnetic Resonance Imaging (MRI) in women 60 years of age and older.Materials and Methods:Institutional review board approval was obtained with waiver of informed consent for this retrospective review. From December 2003 to December 2011, all patients 60 years and older who had presurgical bilateral breast MRI were reviewed, revealing 1268 presurgical MRI examinations; 310 had a new lesion identified by MRI. Cases were excluded due to incomplete or missing data, resulting in 243 patients with 272 findings eligible for analysis. Data recorded included patient demographics, core biopsy method and pathology, type of surgery, and surgical pathology results.Results:Of 1268 exams performed in this population, 272 (21.5%) patients with suspicious MRI findings underwent needle biopsy. Malignancy was found in 114 (42%), benign findings in 127 (47%), and atypia in 31 (11%). Of the malignancies, 83 were in the ipsilateral breast and 31 in the contralateral breast to the original diagnosis. Of the ipsilateral findings, 47 were in the same quadrant as the primary diagnosis, 28 in a different quadrant, and 8 were metastatic lymph nodes. Of the 31 atypical findings, 14 were contralateral to the primary diagnosis and 17 were ipsilateral. Two hundred and thirty-three patients underwent surgical excision; 111 changed their surgical management as a lesion was seen on MRI and was diagnosed as cancer on needle biopsy.Conclusions:Among the patients aged 60 years and above who had presurgical bilateral breast MRI, we found additional cancers in 9.0% (n = 114/1268) and atypia in 2.4% (n = 31/1268). A change in management as a result of the MRI-detected lesion occurred in 8.8% (n = 111/1268). These results demonstrate that performing presurgical bilateral breast MRI is of value in women 60 years of age and above.

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“…But median volumes of excised tissue were lower in the MRI group and the authors postulated the higher rate of re-excision was due to surgeons being inappropriately reassured by small lesion size on MRI. This suggests that the sensitivity of MRI in showing extent of in situ disease is less than standard imaging, in contrast to others 28,29 where MRI better depicted the extent of than mammography. A more recent randomised controlled trial (RCT) of 440 women, selected by young age alone 25 found the MRI group had higher BCS planned and a change to mastectomy occurred in 15%, but a lower overall re-operation rate in the MRI group (5% vs. 15%) (P < 0.0001).…”

Section: Mri In Assessing Disease Extent and Guiding Surgerymentioning

confidence: 85%

“…But median volumes of excised tissue were lower in the MRI group and the authors postulated the higher rate of re‐excision was due to surgeons being inappropriately reassured by small lesion size on MRI. This suggests that the sensitivity of MRI in showing extent of in situ disease is less than standard imaging, in contrast to others where MRI better depicted the extent of than mammography.…”

Section: Mri In Assessing Disease Extent and Guiding Surgerymentioning

confidence: 90%

Expanding the indications for MRI in the diagnosis and treatment of breast cancer: what is best practice?

Saunders

Taylor

2015

J of Medical Radiation Sci

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Breast magnetic resonance imaging (MRI) now has an accepted place in screening younger women at high risk of breast cancer, and is increasingly used in a number of other settings including assessment of response to neo-adjuvant therapy and local staging of cancer. Although the evidence for its general use in these settings is very limited, in highly selected patients, especially where discordance with conventional measurements occurs, MRI can have a place in assessing extent of disease, both whether operable and how operable, and guiding surgery. These scenarios and future indications and alternative technologies are explored in this paper.

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MRI of the Breast for the Detection and Assessment of the Size of Ductal Carcinoma in Situ

Cited by 63 publications

References 19 publications

Magnetic resonance imaging in patients with newly diagnosed breast cancer: A review of the literature

Magnetic resonance imaging in patients with newly diagnosed breast cancer: A review of the literature

Importance of Presurgical Breast MRI in Patients 60 Years of Age and Older

Expanding the indications for MRI in the diagnosis and treatment of breast cancer: what is best practice?

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