DCIS: preoperative breast MRI linked to fewer surgeries

  • Lam DL & al.
  • Acad Radiol
  • 5 Jul 2019

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Preoperative breast MRI (pMRI) is associated with fewer total surgeries (breast-conserving surgeries [BCS], reexcision, or mastectomy) in a cohort of women newly diagnosed with pure ductal carcinoma in situ (DCIS).

Why this matters

  • pMRI, which is designed to evaluate the extent of DCIS, has been controversial because of limited data on its effect on surgical management.

Study design

  • Retrospective cohort (n=373) of all women with core-needle biopsy (CNB)-diagnosed DCIS 2004-2013 at a single center.
  • Funding: NIH.

Key results

  • No clinical differences were found between pMRI and no-pMRI groups.
  • The pMRI group (vs no-pMRI group) had:
    • Higher rate of additional CNB (30% vs 7%; P=.002).
    • Fewer mean total surgeries (1.2 vs 1.5; P<.001>
  • In the subgroup (n=245) for whom BCS was the initial surgery (rather than mastectomy), the pMRI subgroup (vs no-pMRI) had:
    • Fewer mean total surgeries (1.3 vs 1.7; P<.001>
    • Higher rate of single successful BCS rather than a second BCS or a mastectomy (77% vs 43%; P<.001>
  • Compared with large published cohorts (including the Surveillance Epidemiology and End Results [SEER] database), this pMRI cohort who underwent BCS had:
    • Fewer total mean surgeries (difference, −0.22 vs −0.17; P<.001>
    • Higher rate of single successful BCS (20% vs 14%; P<.001>

Limitations

  • Single-center study.
  • Nonrandomized, retrospective design.