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MRI did not improve outcomes for patients with DCIS
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The use of perioperative MRI was not associated with reduced rates of local recurrence or contralateral breast cancer among women with ductal carcinoma in situ who underwent lumpectomy, according to results of a large retrospective study presented at the Breast Cancer Symposium.
Researchers observed the association even among women who did not receive radiation therapy.
“About 30% of physicians currently obtain a perioperative MRI to look for areas of additional disease,” Melissa Louise Pilewskie, MD, a breast surgeon at Memorial Sloan-Kettering Cancer Center, said during a press conference. “Theoretically, treating this additional disease found by MRI could result in lower rates of local recurrence or contralateral breast cancer down the road; however, the addition of a perioperative MRI in patients with ductal carcinoma in situ has not been well studied.”
Because there are no published guidelines related to the use of MRI in women with newly diagnosed breast cancer, the use of MRI varies significantly, according to researchers.
Pilewskie and colleagues evaluated data from 2,321 women who underwent lumpectomy for ductal carcinoma in situ (DCIS) between 1997 and 2007 at Memorial Sloan-Kettering Cancer Center. Of them, 596 underwent MRI and 1,725 did not. The majority of MRI (81%) occurred prior to surgery; the remainder occurred immediately after surgery.
About 58.5% of the cohort (n=1,359) underwent radiation therapy.
Women who underwent MRI tended to be younger, premenopausal, have a family history of breast cancer, have clinical presentation and have fewer close/positive margins than those who did not undergo MRI, according to researchers. Those in the MRI cohort also were more likely to have received radiation and endocrine therapy.
Median follow-up was 59 months. Researchers reported 184 incidences of ipsilateral breast tumor recurrence.
Results showed the rates of 5-year locoregional recurrence (8.5% vs. 7.2%; P=.52) and 8-year recurrence (14.6% vs. 10.2%) were higher among women who underwent MRI. Researchers observed that trend even after adjusting for patient characteristics and other factors associated with recurrence risk, such as family history, age, menopausal status, and use of adjuvant endocrine therapy or radiation.
The differences in contralateral breast cancer at 5 years (3.5% in both groups) and 8 years (3.5% for MRI vs. 5.1% for no MRI) were not statistically significant, Pilewskie and colleagues wrote.
“We now have a lot of evidence that indicates that MRI isn’t necessary for every patient with DCIS,” Pilewskie said in a press release. “Aside from the cost of the test, MRI has a rather high false-positive rate, which may result in additional biopsies and a delay in surgery. We need to focus on spending money and time on tests that we know are going to provide benefit.”
Disclosure: The researchers report no relevant financial disclosures.
For more information:
Pilewskie ML. Abstract #57. Presented at: Breast Cancer Symposium; Sept. 7-9, 2013; San Francisco.
Perspective
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Steven O’Day, MD
There’s been a tremendous increase in the use of MRI perioperatively and postoperatively in invasive as well as noninvasive breast cancers. As new technology and new imaging is used, this grounds us to continue to want to be sure that we’re actually making a difference. The two important endpoints in this study were local regional recurrence in the breast involved with DCIS, and then of course in the contralateral breast. MRI did not improve either the outcomes of local regional recurrence or contralateral cancer. It’s not that MRI cannot be used — there are cases in which it is important to obtain the information perioperatively or postoperatively with the added sensitivity that MRI may give. But its routine use, certainly in the use for DCIS from this large retrospective study, has not shown as an independent predictor to improve local regional or contralateral recurrence outcomes. This is an important study to ground us and to want us to study MRI further prospectively, both in DCIS and invasive cancer.
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