Comparative effectiveness of MRI in breast cancer (COMICE) trial: a randomised controlled trial

Turnbull, Lindsay W.; Brown, Sarah; Harvey, Ian; Olivier, C; Drew, Phil; Napp, Vicky; Hanby, Andrew M.; Brown, Julia

doi:10.1016/s0140-6736(09)62070-5

Cited by 556 publications

(416 citation statements)

References 17 publications

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“…31 These findings raised concerns about "overdiagnosis and overtreatment" in the absence of long-term benefits of the routine use of pre-operative breast MRI. [19][20][21][22][23] In our series, nearly half of the patients with additional malignancy found on MRI did not have surgical plan changes, suggesting potential "overdiagnosis" but not "overtreatment".…”

Section: Discussionmentioning

confidence: 58%

“…As a result, we had a disproportionately high percentage of patients with dense breasts and with invasive lobular carcinoma in our cohort as a result of our imaging protocol. This contrasts with patients in the COMICE trial, 19 the MONET trial 20 and the series reported by Berg et al, 4 in which breast MRI was performed in consecutive patients with both fatty and dense breast parenchyma. The fact that the ICDR of DCE MRI in our patient cohort was still much lower than that reported in the literature further supports the value of high-quality BWBUS in the pre-operative staging of breast cancer.…”

Section: Discussionmentioning

confidence: 83%

“…[19][20][21][22][23] Two randomized controlled trials [comparative effectiveness in MRI in breast cancer (COMICE) and MR mammography of nonpalpable breast tumours (MONET)] have shown that adding breast MRI to conventional assessment (clinical examination, diagnostic mammography and breast ultrasonography) did not significantly reduce the reoperation rate and, rather, increased the re-excision rate in patients with non-palpable breast cancer. 19,20 In addition, the routine use of breast MRI for pre-operative staging has been associated with increased ipsilateral and bilateral mastectomy rates, leading to concerns of overdiagnosis and overtreatment. Furthermore, adding breast MRI to the staging work-up may increase cost and patient anxiety and cause undue delays in definitive treatment.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Incremental cancer detection using breast ultrasonographyversusbreast magnetic resonance imaging in the evaluation of newly diagnosed breast cancer patients

He¹,

Plaxco²,

Wei³

et al. 2016

BJR

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Objective: To compare the incremental cancer detection rate (ICDR) using bilateral whole-breast ultrasonography (BWBUS) vs dynamic contrast-enhanced MRI in patients with primary breast cancer. Methods: A retrospective database search in a single institution identified 259 patients with breast cancer diagnosed from January 2011 to August 2014 who underwent mammography, BWBUS and MRI before surgery. Patient characteristics, tumour characteristics and lesions seen on each imaging modality were recorded. The sensitivity, specificity and accuracy for each modality were calculated. ICDRs according to index tumour histology and receptor status were also evaluated. The effect of additional cancer detection on surgical planning was obtained from the medical records. Results: A total of 266 additional lesions beyond 273 index malignancies were seen on at least 1 modality, of which 121 (45%) lesions were malignant and 145 (55%) lesions were benign. MRI was significantly more sensitive than BWBUS (p 5 0.01), while BWBUS was significantly more accurate and specific than MRI (p , 0.0001). Compared with mammography, the ICDRs using BWBUS and MRI were significantly higher for oestrogen receptorpositive and triple-negative cancers, but not for human epidermal growth factor receptor 2-positive cancers. 22 additional malignant lesions in 18 patients were seen on MRI only. Surgical planning remained unchanged in 8 (44%) of those 18 patients. Conclusion: MRI was more sensitive than BWBUS, while BWBUS was more accurate and specific than MRI. MRIdetected additional malignant lesions did not change surgical planning in almost half of these patients. Advances in knowledge: BWBUS may be a cost-effective and practical tool in breast cancer staging.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Incremental cancer detection using breast ultrasonographyversusbreast magnetic resonance imaging in the evaluation of newly diagnosed breast cancer patients

He¹,

Plaxco²,

Wei³

et al. 2016

BJR

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show abstract

“…Few months ago the results of the COMICE trial came to publication [15]. The investigators enrolled more than 1,800 women with a a newly diagnosed breast cancer randomized into two groups, with (n=816) and without (n=807) preoperative MRI.…”

Section: Additional Findings At Preoperative Mri a Simple Golden Rulmentioning

confidence: 99%

Additional findings at preoperative MRI: a simple golden rule for a complex problem?

Sardanelli

2010

Breast Cancer Res Treat

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“…Several reviews by Houssami et al [11][12][13] argued that consistently, MRIs changed surgical management, usually from breast conservation to more radical surgery, but there was no evidence of associated improved surgical outcomes or prognosis. More importantly, the recent randomised COMICE trial 14 concluded that MRI might be unnecessary as a means of reducing reoperation rates.…”

Section: Introductionmentioning

confidence: 99%

Impact of magnetic resonance imaging on preoperative planning for breast cancer surgery

Law

Cheung²,

Lau³

et al. 2013

Hong Kong Med J

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ResultsThe most common indication for breast magnetic resonance imaging was the presence of multiple indeterminate shadows on ultrasound scans (53%), followed by ill-defined border of the main tumour on ultrasound scans (19%). In 66% (97 out of 147) of the patients, the extent of the operation was upgraded. Upgrading entailed: lumpectomy to wider lumpectomy (23 out of 97), lumpectomy to mastectomy (47 out of 97), lumpectomy to bilateral lumpectomy (15 out of 97), and other (12 out of 97). Mostly, these management changes were because magnetic resonance imaging showed more extensive disease (n=29), additional cancer foci (n=39), or contralateral disease (n=24). In five instances, upgrading was due to patient preference. In 34% (50 out of 147) of the patients, there was no change in the planned operation. Regarding 97 of the patients having altered management, in 12 the changes were considered inappropriately extensive (due to false-positive magnetic resonance imaging findings). In terms of magnetic resonance imaging detection of more extensive, multifocal, multicentric, or contralateral disease, the false-positive rate was 13% and false-negative rate 7%. Corresponding rates for sensitivity and specificity were 95% and 81%, using the final pathology as the gold standard.Conclusions Preoperative magnetic resonance imaging had a clinically significant and mostly correct impact on management plans. Magnetic resonance imaging should be included as part of the preoperative investigation in patients planned for breastconserving surgery, in whom there are doubts about the extent of the tumours based on conventional assessment. • MRI demonstrated high sensitivity and moderate specificity in detecting additional cancer foci. Impact of magnetic resonance imaging on preoperative planning for breast cancer surgery O R I G I N A L A R T I C L E Implications for clinical practice or policy• Preoperative MRI should be considered in patients with suspected additional disease foci or indeterminate tumour margins, in addition to conventional imaging by mammography and ultrasonography. CME # Preoperative planning for breast cancer surgery #

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Comparative effectiveness of MRI in breast cancer (COMICE) trial: a randomised controlled trial

Cited by 556 publications

References 17 publications

Incremental cancer detection using breast ultrasonographyversusbreast magnetic resonance imaging in the evaluation of newly diagnosed breast cancer patients

Incremental cancer detection using breast ultrasonographyversusbreast magnetic resonance imaging in the evaluation of newly diagnosed breast cancer patients

Additional findings at preoperative MRI: a simple golden rule for a complex problem?

Impact of magnetic resonance imaging on preoperative planning for breast cancer surgery

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