Abstract
Introduction
The accuracy of breast magnetic resonance imaging (MRI) for detection of ductal carcinoma in situ (DCIS) has prompted recommendations for its routine preoperative use, but its clinical benefit is debated. We reviewed our experience with MRI in DCIS patients to assess the utility of MRI for surgical planning.
Methods
DCIS patients (2008–2010) were identified through a prospectively maintained database and grouped into MRI and no-MRI groups. The rates of additional biopsies, altered surgical management, and reoperation were compared. Additionally, DCIS size ascertained by mammography, MRI, and final pathology was compared.
Results:
Of 352 DCIS patients, 217 received MRI and 135 did not. The type of initial operation and number of reoperations were similar between the two groups, but successful breast conservation was more frequent in the no-MRI group (p = 0.06). The additional biopsy rate was 38 % in the MRI group versus 7 % in the no-MRI group; ≥2 additional biopsies were performed in 18 % of the MRI group and 2 % of the no-MRI group (p < 0.0001). These yielded a cancer diagnosis in 26 % of MRI and 33 % of no-MRI patients (p = 0.73). MRI was not superior to mammogram in detecting size of DCIS lesions preoperatively; 52 % of mammograms were accurate (within 1 cm) compared with 41 % of MRIs.
Conclusions
DCIS patients who undergo preoperative breast MRI are far more likely to undergo additional biopsies. Unless these can be demonstrated to lead to improved long-term outcomes, the utility of routine preoperative MRI in DCIS patients remains questionable.
Similar content being viewed by others
References
Burstein HJ, Polyak K, Wong JS, et al. Ductal carcinoma in situ of the breast. N Engl J Med. 2004;350:1430–41.
NIH State-of-the-Science Conference Statement on: diagnosis and management of ductal carcinoma in situ. NIH Consensus and State-of-the-Science Statements Volume 26, Number 2, 2009.
Holland R, Hendriks JH. Microcalcifications associated with ductal carcinoma in situ: mammographic-pathologic correlation. Semin Diagn Pathol. 1994;11:181–92.
Yamada T, Mori N, Watanabe M, et al. Radiologic-pathologic correlation of ductal carcinoma in situ. Radio Graphics. 2010;30:1183–98.
Lehman CD. Magnetic resonance imaging in the evaluation of ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010;41:150–51.
Oshida K, Nagashima T, Ueda T, et al. Pharmacokinetic analysis of ductal carcinoma in situ of the breast using dynamic MR mammography. Eur Radiol. 2005;15:1353–60.
Rosen EL, Smith-Foley SA, DeMartini WB. BI-RADS MRI enhancement characteristics of ductal carcinoma in situ. Breast J. 2007;13:545–50.
Mossa-Basha M, Fundaro GM, Shah BA, Ali S, Pantelic MV. Ductal carcinoma in situ of the breast: MR imaging findings with histopathologic correlation. Radio Graphics. 2010;30:1673–87.
Liu H, Peng W. MRI morphological classification of ductal carcinoma in situ (DCIS) correlating with different biological behavior. Eur J Radiol. 2011. doi:10.1016/j.ejrad.2010.12.084.
Raza S, Vallejo M, Chikarmane SA, Birdwell RL. Pure ductal carcinoma in situ: a range of MRI features. AJR. 2008;191:689–99.
Facius M, Renz DM, Neubauer H, et al. Characteristics of ductal carcinoma in situ in magnetic resonance imaging. Clin Imaging. 2007;31:394–400.
Rahbar H, Partridge SC, Eby PR, et al. Characterization of ductal carcinoma in situ on diffusion weighted breast MRI. Eur Radiol. 2011;21:2011–19.
Fischer U, Kopka L, Grabbe E. Breast carcinoma: effect of preoperative contrast-enhanced MR imaging on the therapeutic approach. Radiology. 1999;213:881–88.
Esserman L, Hylton N, Yassa L, et al. Utility of magnetic resonance imaging in the management of breast cancer: evidence for improved preoperative staging. J Clin Oncol. 1999;17:110–19.
Bleicher RJ, Ciocca RM, Egleston BL, et al. Association of routine pretreatment MRI with time to surgery, mastectomy rate, and margin status. J Am Coll Surg. 2009;209:180–95.
Bilimoria KY, Cambic A, Hansen NM, Bethke KP. Evaluating the impact of preoperative breast magnetic resonance imaging on the surgical management of newly diagnosed breast cancers. Arch Surg. 2007;142:441–47.
Turnbull L, Brown S, Olivier C, et al. Comparative effectiveness of MRI in breast cancer (COMICE) trial: a randomized controlled trial. Lancet. 2010;375:563–71.
Houssami N, Ciatto S, Macaskill P, et al. Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol. 2008;26:3248–58.
Braun M, Polcher M, Schrading S, et al. Influence of preoperative MRI on the surgical management of patients with operable breast cancer. Breast Cancer. Res Treat. 2008;111:179–87.
Bedrosian I, Mick R, Orel SG, et al. Changes in the surgical management of patients with breast carcinoma based on preoperative magnetic resonance imaging. Cancer. 2003;98:468–73.
Tillman GF, Orel SG, Schnall MD, et al. Effect of breast magnetic resonance imaging on the clinical management of women with early-stage breast carcinoma. J Clin Oncol. 2002;30:3413–23.
Kuhl C, Khun W, Braun M, Schild H. Pre-operative staging of breast cancer with breast MRI: one step forward, two steps back? Breast. 2007;16:S34–44.
Morrow M. Magnetic resonance imaging in breast cancer one step forward, two steps back? JAMA. 2004;292:2779–80.
Houssami N, Hayes D. Review of preoperative magnetic resonance imaging (MRI) in breast cancer: should MRI be performed on all women with newly diagnosed, early stage breast cancer? CA Cancer J Clin. 2009;59:290–302.
Adkisson CD, Vallow LV, Kowalchik K., et al. Patient age and preoperative breast MRI in women with breast cancer: biopsy and surgical implications. Ann Surg Oncol. 2011;18:1678–83.
Allen LR, Lago-Tora CE, Hughes JH, et al. Is there a role for MRI in the preoperative assessment of patients with DCIS? Ann Surg Oncol. 2010;17:2395–2400.
Itakura K, Lessing J, Sakata T, et al. The impact of preoperative magnetic resonance imaging on surgical treatment and outcomes for ductal carcinoma in situ. Clin Breast Cancer. 2011;11:33–8.
Kropcho LC, Steen ST, Chung AP, et al. Preoperative breast MRI in the surgical treatment of ductal carcinoma in situ. Breast J. 2012;18:151–6.
Katipamula R, Degnim AC, Hoskin T, et al. Trends in mastectomy rates at the Mayo Clinic Rochester: effect of surgical year and preoperative magnetic resonance imaging. J Clin Oncol. 2009;27:4082–88.
Schouten van der Velden AP, Schlooz-Vries MS, Boetes C, Wobbes T. Magnetic resonance imaging of ductal carcinoma in situ: what is its clinical application? A review. Am J Surg. 2009;198:262–9.
Chung A, Saouaf R, Scharre K, Phillips E. The Impact of MRI on the treatment of DCIS. Am Surg. 2005;71:705–10.
Lehman CD, Gatsonis C, Kuhl CK, et al. MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med. 2007;356:1295–303.
Berg WA, Gutierrez L, NessAiver MS, et al. Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology. 2004;233:830–49.
Brennan ME, Houssani M, Lord S, et al. Magnetic resonance imaging screening of the contralateral breast in women with newly diagnosed breast cancer: systemic review and meta-analysis of incremental cancer detection and impact on surgical management. J Clin Oncol. 2009;27:5640–49.
Gao X, Fisher S, Emami B. Risk of second primary cancer in the contralateral breast in women treated for early-stage breast cancer: a population-based study. Int J Radiat Oncol Biol Phys. 2003;56:1038–45.
Morrow M. Magnetic resonance imaging for screening, diagnosis, and eligibility for breast-conserving surgery: promises and pitfalls. Surg Oncol Clin North Am. 2010;19:475–92.
Solin LJ, Orel SG, Hwang W, Harris EE, Schnall MD. Relationship of breast magnetic resonance imaging to outcome after breast-conservation treatment with radiation for women with early stage invasive breast carcinoma or ductal carcinoma in situ. J Clin Oncol. 2008;26:386–91.
Hwang N, Schiller DE, Crystal P, Maki E, McCready DR. Magnetic resonance imaging in the planning of initial lumpectomy for invasive breast carcinoma: its effect on ipsilateral breast tumor recurrence after breast-conservation therapy. Ann Surg Oncol. 2009;16:3000–09.
Acknowledgment
We acknowledge the support of the Lynn Sage Cancer Research Foundation for the support of the Lynn Sage database.
Disclosure
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pilewskie, M., Kennedy, C., Shappell, C. et al. Effect of MRI on the Management of Ductal Carcinoma In Situ of the Breast. Ann Surg Oncol 20, 1522–1529 (2013). https://doi.org/10.1245/s10434-012-2771-y
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-012-2771-y