MRI important in reducing re-excision rates in surgical management of HG DCIS

A study in the European Journal of Radiology suggests MRI could be an important tool in reducing the re-excision rates in the management of high grade (HG) ductal carcinoma in situ (DCIS), when used in preoperative diagnosis and evaluation.

The authors of the study, led by Mohamad Hajaj of the University Hospitals of Leicester in the U.K., said their research demonstrated that the need for a mastectomy or re-excision was three times higher when images from a mammography were used in the preoperative assessment of patients with HG DCIS.

In the study, data was collected on 91 patients (only 70 patients were included in the data analysis) with HG DCIS between April 2011 through Dec. 2015. All patients participated in standard breast imaging and a preoperative MRI scan. Data on the patients were compared to 52 patients part of a control group. Impact on surgical planning and number of surgeries for each patient was compared.

• The overall sensitivity of MRI to detect HG DCIS was 77 percent, with a false negative rate of 23 percent.
• Re-excision rates were higher by 26 percent in mammography images compared to 8 percent in the MRI group.
• The MRI results converted the initial plan of breast conservation to mastectomy in 13 percent of patients.

“Although still controversial, selective MRI imaging can be useful in the preoperative diagnosis and evaluation of HG DCIS,” the authors wrote. “Case by case discussion at MDT is crucial. Wider adaptation of MRI when indicated in the assessment of breast lesions with proper correlation to histology post-operatively is a key in improving our MRI interpretation skills, helping us to exploit the full scope of this useful tool.”