Population-based study of the effect of preoperative breast MRI on the surgical management of ductal carcinoma <i>in situ</i>

Keymeulen, K.B.I.M.; Geurts, S.M.E.; Lobbes, Marc; Heuts, E. M.; Duijm, Luciën E. M.; Kooreman, Loes; Voogd, Adri C.; Tjan-Heijnen, V. C. G.

doi:10.1002/bjs.11299

Cited by 17 publications

(15 citation statements)

References 33 publications

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“…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%

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

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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.

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Section: Discussionsupporting

confidence: 88%

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

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“…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%

“…Of the 18 comparative cohorts included [11,12,[22][23][24][25][26][27][28][29][30][31][32][33][34], 16 were retrospective analyses of medical records or population registries [11,12,[22][23][24][25][26][27][29][30][31][32][33][34][35][36], three of them comparing different time periods (pre-and post-implementation of MRI) [23,24,26]. Three cohort studies had larger sample sizes, one used the Breast Cancer Surveillance Consortium registry data with 2437 patients with DCIS from 2010 to 2014 [27], another study included data of 2319 patients from a cancer centre in New York (USA) from 1997 to 2010 [28] and the last study used the Netherlands Cancer Registry (NCR) including 10,415 clinical records [33] (Table 1 and Supplementary table S3).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The results from 91 patients in one RCT suggested that MRI may increase the risk of positive margins in the excised lesion (RR of 1.58; 95% CI 0.88 to 2.92) (very low certainty) [20]. However, from observational studies, the pooled analysis including 9126 patients suggested that MRI pre-operative assessment may have little to no difference in this outcome (OR 0.91; 95% CI 0.85 to 1.21) [11,22,25,26,28,32,33,35] (very low certainty). It is noteworthy that the definitions for positive margins across studies were heterogenous (i.e.…”

Section: Proportion Of Positive Margins (After Undergoing Bcs)mentioning

confidence: 99%

“…Eight observational studies suggested that MRI may increase the odds of total mastectomies (OR 1.58; 95% CI 1.00 to 2.48) (very low certainty) (Fig. 4b) [12,22,23,25,[32][33][34][35], with a larger but imprecise effect observed in studies providing adjusted results (aOR 1.74; 95% CI 0.53 to 5.68) [32,35].…”

Section: Total Mastectomymentioning

confidence: 99%

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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

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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.

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Clinical value of contralateral breast cancers detected by pre-operative MRI in patients diagnosed with DCIS: a population-based cohort study

et al. 2022

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Objectives For patients with ductal carcinoma in situ (DCIS), data about the impact of breast MRI at primary diagnosis on the incidence and characteristics of contralateral breast cancers are scarce. Methods We selected all 8486 women diagnosed with primary DCIS in the Netherlands in 2011–2015 from the Netherlands Cancer Registry. The synchronous and metachronous detection of contralateral DCIS (cDCIS) and contralateral invasive breast cancer (cIBC) was assessed for patients who received an MRI upon diagnosis (MRI group) and for an age-matched control group without MRI. Results Nineteen percent of patients received an MRI, of which 0.8% was diagnosed with synchronous cDCIS and 1.3% with synchronous cIBC not found by mammography. The 5-year cumulative incidence of synchronous plus metachronous cDCIS was higher for the MRI versus age-matched control group (2.0% versus 0.9%, p = 0.02) and similar for cIBC (3.5% versus 2.3%, p = 0.17). The increased incidence of cDCIS was observed in patients aged < 50 years (sHR = 4.22, 95% CI: 1.19–14.99), but not in patients aged 50–74 years (sHR = 0.89, 95% CI: 0.41–1.93). Conclusions MRI at primary DCIS diagnosis detected additional synchronous cDCIS and cIBC, and was associated with a higher rate of metachronous cDCIS without decreasing the rate of metachronous cIBC. This finding was most evident in younger patients. Key Points • Magnetic resonance imaging at primary diagnosis of ductal carcinoma in situ detected an additional synchronous breast lesion in 2.1% of patients. • In patients aged younger than 50 years, the use of pre-operative MRI was associated with a fourfold increase in the incidence of a second contralateral DCIS without decreasing the incidence of metachronous invasive breast cancers up to 5 years after diagnosis. • In patients aged over 50 years, the use of pre-operative MRI did not result in a difference in the incidence of a second contralateral DCIS or metachronous invasive breast cancer.

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Population-based study of the effect of preoperative breast MRI on the surgical management of ductal carcinoma in situ

Cited by 17 publications

References 33 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)

Clinical value of contralateral breast cancers detected by pre-operative MRI in patients diagnosed with DCIS: a population-based cohort study

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