Preoperative breast MRI in management of patients with needle biopsy-proven ductal carcinoma in situ (DCIS)

Abstract

Background: In 20e25% of patients with biopsy-proven DCIS underestimation occurs. Sentinel lymph node biopsy (SLNB) is offered to patients with biopsy-proven ductal carcinoma in situ (DCIS) and a high risk of occult invasive cancer. However, assessment of high risk is controversial. We aimed to improve selection of patients for SLNB with preoperative breast magnetic resonance imaging (MRI). Methods: In this prospective observational study, MRI was offered to all subsequent patients with a biopsy-proven DCIS admitted to a large Dutch teaching hospital between April 2012 and March 2017. MRI images were analysed for signs of invasive cancer and the results were compared with the pathologic results after surgical treatment. The diagnostic accuracy of additional MRI in detecting occult invasive cancer was determined. Results: Of 211 patients eligible for additional MRI analysis, 149 underwent breast MRI. The majority (67%) received breast-conserving therapy, and the underestimation rate was 20%. Subsequent to MRI analysis, 20 additional invasive diagnostic procedures were performed. Occult invasive cancer was suspected on MRI in 46 patients (31%) and was confirmed in 18 (12%). In this study, breast MRI had a sensitivity of 67%, a specificity of 77%, and a true negative rate of 91%. Conclusion: Preoperative breast MRI cannot reliably predict the presence of invasive cancer in patients with biopsy proven DCIS. Therefore, it cannot be used to in the selection of patients for a SLNB.

Delayed Sentinel Lymph Node Dissection in Patients with a Preoperative Diagnosis of Ductal Cancer In Situ by Preoperative Injection with Superparamagnetic Iron Oxide (SPIO) Nanoparticles: The SentiNot Study

“…Preoperative magnetic resonance imaging (MRI) has not been found reliable to predict invasive disease in prospective evaluation. 25 Vacuum-assisted biopsies (VAB) lower the rate of postoperative upstaging to invasive cancer to 17-18% in retrospective studies, 26,27 but, in larger cohorts, the rate of underestimation was as high as 25%. 28 In the prospective CINNAMOME trial (patients with VAB diagnosis of DCIS, planned for mastectomy, average DCIS extent: 69 mm, Grade 3: 51%), the underestimation rate as high as 39%, and it was suggested that upfront SLND should be performed when mastectomy is planned.…”

Evaluating Upstaging in Ductal Carcinoma In Situ Using Preoperative MRI‐Based Radiomics

“…The feasibility of traditional clinicopathologic risk factors for the postoperative pathological upstaging of DCIS has been reported, 5,11–13 but the prediction performance was dissatisfactory 14–17 . Against this background, MRI could serve as an effective examination tool for the diagnosis and staging of breast cancer, 18,19 but for radiologists, it is quite challenging to assess whether DCIS has invasive components and to define the nuclear grade based on images 20–22 …”

“…[14][15][16][17] Against this background, MRI could serve as an effective examination tool for the diagnosis and staging of breast cancer, 18,19 but for radiologists, it is quite challenging to assess whether DCIS has invasive components and to define the nuclear grade based on images. [20][21][22] With the emergence of radiomics, medical images can be quantitatively converted into mineable data to improve diagnosis and prognosis assessment and to guide clinical treatment decision-making. 23,24 The feasibility has been demonstrated by predicting the upstaging of DCIS based on single-sequence MRI radiomics.…”