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Is there a Role for MRI in the Preoperative Assessment of Patients with DCIS?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Breast magnetic resonance imaging (MRI) is used to identify residual and additional disease in patients with invasive carcinoma. The use of MRI in assessing extent of disease for ductal carcinoma in situ (DCIS) is less well defined. This study assessed the value of MRI in the preoperative evaluation of DCIS.

Materials and Methods

We identified 98 patients with DCIS in 2007. Of these, 63 underwent stereotactic biopsy, followed by MRI. There were 35 who underwent stereotactic biopsy alone. Concordance between MRI and histopathology was defined as the presence or absence of residual disease.

Results

There was no significant difference in mastectomy rates between the MRI and non-MRI group (20.3% vs 25.7%, P = .62). In patients undergoing breast-conserving surgery (BCS), there were fewer positive margins in the MRI versus the non-MRI group (21.2% vs 30.8%, P = .41). Of the 64 cases that underwent preoperative MRI, 43 (67.2%) were concordant. Also, 15 of 43 cases (34.8%) had MRI results that accurately predicted pathologic size. In 28 of 43 patients (65.2%), MRI overestimated disease in 20, by a mean of 1.97 cm. In patients with MRI tumor size >2 cm, MRI overestimated disease by a mean of 3.17 cm. Of the 64 cases, 21 (32.8%) were discordant. Also, 10 of 21 (47.6%) had a positive MRI and no residual disease on histopathology, and 11 of 21 (52.3%) had negative MRI and residual disease on pathology.

Conclusions

MRI does not accurately predict extent of disease in patients with extensive DCIS. In patients with MRI tumor size ≤2 cm, MRI may assist in surgical planning. MRI results in patients with DCIS should be interpreted with caution; decision for mastectomy should not be made on MRI findings alone.

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Authors and Affiliations

  1. Department of Surgery, Drexel University College of Medicine, Philadelphia, PA, USA

    Lisa R. Allen MD

  2. Department of Breast Surgery, The Bryn Mawr Hospital, Bryn Mawr, PA, USA

    Claudia E. Lago-Toro MD, Jenevieve H. Hughes MD, Eduardo Careaga MD, Anjeanette T. Brown MD, Andrea V. Barrio MD & Thomas G. Frazier MD

  3. Lankenau Institute of Medical Research, Main Line Health Care, Wynnewood, PA, USA

    Michael Chernick MA, PhD

Authors
  1. Lisa R. Allen MD
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  2. Claudia E. Lago-Toro MD
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  3. Jenevieve H. Hughes MD
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  4. Eduardo Careaga MD
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  5. Anjeanette T. Brown MD
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  6. Michael Chernick MA, PhD
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  7. Andrea V. Barrio MD
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  8. Thomas G. Frazier MD
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Correspondence to Lisa R. Allen MD.

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Allen, L.R., Lago-Toro, C.E., Hughes, J.H. et al. Is there a Role for MRI in the Preoperative Assessment of Patients with DCIS?. Ann Surg Oncol 17, 2395–2400 (2010). https://doi.org/10.1245/s10434-010-1000-9

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  • DOI: https://doi.org/10.1245/s10434-010-1000-9

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