Efficacy of breast MRI for surgical decision in patients with breast cancer: ductal carcinoma in situ versus invasive ductal carcinoma

Abstract

Background Preoperative breast magnetic resonance imaging (MRI) provides more information than mammography and ultrasonography for determining the surgical plan for patients with breast cancer. This study aimed to determine whether breast MRI is more useful for patients with ductal carcinoma in situ (DCIS) lesions than for those with invasive ductal carcinoma (IDC). Methods A total of 1113 patients with breast cancer underwent mammography, ultrasonography, and additional breast MRI before surgery. The patients were divided into 2 groups: DCIS (n = 199) and IDC (n = 914), and their clinicopathological characteristics and oncological outcomes were compared. Breast surgery was classified as follows: conventional breast-conserving surgery (Group 1), partial mastectomy with volume displacement (Group 2), partial mastectomy with volume replacement (Group 3), and total mastectomy with or without reconstruction (Group 4). The initial surgical plan (based on routine mammography and ultrasonography) and final surgical plan (after additional breast MRI) were compared between the 2 groups. The change in surgical plan was defined as group shifting between the initial and final surgical plans. Results Changes (both increasing and decreasing) in surgical plans were more common in the DCIS group than in the IDC group (P < 0.001). These changes may be attributed to the increased extent of suspicious lesions on breast MRI, detection of additional daughter nodules, multifocality or multicentricity, and suspicious findings on mammography or ultrasonography but benign findings on breast MRI. Furthermore, the positive margin incidence in frozen biopsy was not different (P = 0.138). Conclusions Preoperative breast MRI may provide more information for determining the surgical plan for patients with DCIS than for those with IDC.

The Role of Magnetic Resonance Imaging in Surgical Decision Making of Suspicious Breast Lesions in Dense Breast

“…In current study, there is a positive role of MRI at surgical plan (66.6%) at surgical plan according to the type of surgery after pathological correlation by identifying additional occult malignant findings (20 cases are converted from breast conserving surgery and oncoplastic technique to extreme oncoplastic technique or mastectomy). Likewise, another recent study conducted by Lee and Colleagues [16] , on a total of 1113 cases with breast cancer who were undergone mammography, US, and breast MRI prior to surgical procedure. They have concluded that, changes (either by increase or by decrease) in surgical approaches were very common in the ductal carcinoma in situ group in comparison with the invasive ductal carcinoma group, subsequent to increase in the size of suspicious lesions on breast MRI, recognition of further daughter nodules, multifocality or multicentricity, and suspicious signs on mammography or US but benign signs on breast MRI.…”

Preoperative Evaluation of Non-Mass-Like Enhancement on Magnetic Resonance Imaging for Measuring Tumor Extent and Affecting Surgical Margin Status in Breast Cancer Patients

“…[18,19]. However, several studies have investigated and proved the efficacy of MRI in detecting and assessing the size of DCIS [20,21]. The sensitivity of MRI in the detection of DCIS was approximately 77%-96% in those studies.…”

The Role of Breast Imaging in Pre- and Post-Definitive Treatment of Breast Cancer

“…While DCIS is literally an 'in situ neoplastic proliferation of ductal-lobular epithelial cells', its ability to be invasive ductal carcinoma (IDC) should always be considered. A suspicious DCIS features on mammogram should be sufficient for the physician to consider MRI or MFBI before any histopathological measures are taken (38)(39)(40). Special cases such as metastatic disease or elevated liver function biomarkers, should warrant contrast-enhanced MRI on the respective area of suspicious metastatic foci (7).…”