Summary: The routine use of MRI before or after surgery in women with ductal carcinoma in situ (DCIS) is not likely a sound clinical strategy, as it does not improve long-term outcomes. This is the conclusion of investigators conducting a single-center study.
The Study: A retrospective (looking back) study conducted by researchers from Memorial Sloan-Kettering Cancer Center (New York City) identified 2,321 women who had undergone a lumpectomy for DCIS between 1997 and 2010. Of these, 596 had an MRI either before or immediately after surgery, and 1,725 did not. After 5 years, local recurrence rates were not significantly different between the MRI and non-MRI groups (8.5% versus 7.2%; p=0.52).
The authors also looked at whether the MRI led to an increase in opposite breast cancer diagnoses. Again, they found no differences when comparing the MRI and non-MRI groups at 5 years (3.5% versus 3.5%) and at 8 years (3.5% versus 5.1%).
My Take: This study is not sufficient to drive a nail through the routine use of MRI for breast DCIS. But, the study does ground us, as the routine use of MRI does not appear to change outcomes. I would like to see longer-term follow-up, as late events are not uncommon, particularly if anti-estrogen drugs such as tamoxifen are used, or if the DCIS is low-grade. Currently, there are no guidelines for the routine use of MRI in the work-up of women with DCIS. Still, about 1/3 of surgeons in the USA will order an MRI, even if we have no high-level evidence that it improves long-term outcomes.
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Reference: Breast Cancer Symposium: Abstract 57 (07 September 2013); Medscape Medical News 2013 WebMD, LLC