Perioperative MRI of Uncertain Benefit for Women with DCIS

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(ChemotherapyAdvisor) – The benefit of perioperative MRI for women with ductal carcinoma in situ (DCIS) is “uncertain,” results of an analysis reported during the 2013 Breast Cancer Symposium held in San Francisco, CA has found.

The reason? A study of patients who underwent breast-conserving surgery for DCIS found no association between perioperative MRI and locoregional recurrence rates, “even when radiation therapy was not given,” reported Melissa L. Pilewskie, MD, a breast surgeon at Memorial Sloan-Kettering Cancer Center in New York, NY.

“Theoretically, treating additional disease found by MRI could result in lower rates of local recurrence or contralateral breast cancer,” she said. In addition, “this effect would be most pronounced in women treated with excision alone.”

Dr. Pilewskie and colleagues conducted a retrospective review on a prospectively maintained database at Memorial Sloan-Kettering Cancer Center. Women with DCIS who were treated with breast-conserving surgery, with or without radiation, between 1997 and 2010 were included; those with invasive pathology were excluded.

Among the 2,321 women, 1,725 had conventional imaging alone and 596 also had a perioperative MRI. Patient characteristics and rates of locoregional recurrence were compared in women with and without an MRI.

Women who had MRI were younger, more likely to be premenopausal, have a family history of breast cancer, have a clinical presentation, receive radiation and endocrine therapy, be treated in later years, and have fewer close/positive margins.

At median follow-up of 59 months, 5-year locoregional recurrence rates were 8.5% with MRI and 7.2% in patients who did not receive MRI, and 8-year rates were 14.6% and 10.2%, respectively.

“No association was found between perioperative breast MRI and decreased rates of locoregional recurrence or contralateral breast cancer development,” she reported. “This was true for both the entire cohort and the subgroup of women with no radiation therapy,” including after adjustment for age, menopausal status, family history, presentation, adjuvant therapy, margin status, number of excisions, and year of surgery.

“In the absence of evidence that MRI improves surgical management or long-term outcomes, the routine use of this test for DCIS should be questioned,” Dr. Pilewskie reported.

Future research should focus on areas where use of MRI is likely to improve patient care and outcomes, such as monitoring the response to neoadjuvant chemotherapy, rather than in routine preoperative management of patients, she concluded.

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