Department of Surgery, Northwestern University, Chicago, IL, USA.
Ann Surg Oncol. 2013 May;20(5):1522-9. doi: 10.1245/s10434-012-2771-y. Epub 2012 Dec 7.
The accuracy of breast magnetic resonance imaging (MRI) for detection of ductal carcinoma in situ (DCIS) has prompted recommendations for its routine preoperative use, but its clinical benefit is debated. We reviewed our experience with MRI in DCIS patients to assess the utility of MRI for surgical planning.
DCIS patients (2008-2010) were identified through a prospectively maintained database and grouped into MRI and no-MRI groups. The rates of additional biopsies, altered surgical management, and reoperation were compared. Additionally, DCIS size ascertained by mammography, MRI, and final pathology was compared.
Of 352 DCIS patients, 217 received MRI and 135 did not. The type of initial operation and number of reoperations were similar between the two groups, but successful breast conservation was more frequent in the no-MRI group (p = 0.06). The additional biopsy rate was 38 % in the MRI group versus 7 % in the no-MRI group; ≥2 additional biopsies were performed in 18 % of the MRI group and 2 % of the no-MRI group (p < 0.0001). These yielded a cancer diagnosis in 26 % of MRI and 33 % of no-MRI patients (p = 0.73). MRI was not superior to mammogram in detecting size of DCIS lesions preoperatively; 52 % of mammograms were accurate (within 1 cm) compared with 41 % of MRIs.
DCIS patients who undergo preoperative breast MRI are far more likely to undergo additional biopsies. Unless these can be demonstrated to lead to improved long-term outcomes, the utility of routine preoperative MRI in DCIS patients remains questionable.
乳腺磁共振成像（MRI）在检测导管原位癌（DCIS）方面的准确性促使人们建议将其常规用于术前，但关于其临床获益仍存在争议。我们回顾了我们在 DCIS 患者中应用 MRI 的经验，以评估 MRI 在手术计划中的作用。
通过一个前瞻性维护的数据库，我们确定了 DCIS 患者（2008-2010 年），并将他们分为 MRI 组和非 MRI 组。比较了两组患者的额外活检率、改变手术管理和再次手术率。此外，还比较了乳腺 X 线摄影、MRI 和最终病理学确定的 DCIS 大小。
在 352 例 DCIS 患者中，217 例接受了 MRI 检查，135 例未接受 MRI 检查。两组患者的初始手术类型和再次手术次数相似，但非 MRI 组的保乳成功率更高（p = 0.06）。MRI 组的额外活检率为 38%，而非 MRI 组为 7%；MRI 组中有 18%的患者进行了≥2 次额外活检，而非 MRI 组中则有 2%（p<0.0001）。这些额外活检结果在 MRI 组中有 26%的患者和非 MRI 组中有 33%的患者诊断为癌症（p = 0.73）。MRI 在术前检测 DCIS 病变大小方面并不优于乳腺 X 线摄影；52%的乳腺 X 线摄影结果准确（误差在 1cm 以内），而 MRI 的准确率为 41%。
接受术前乳腺 MRI 检查的 DCIS 患者更有可能接受额外的活检。除非这些活检能够证明可以改善长期结果，否则在 DCIS 患者中常规应用术前 MRI 的效用仍值得质疑。
