MRI to screen preoperatively for DCIS

Most guidelines recommend breast MRI for screening in women with genetically high-risk of developing breast cancer and to clarify diagnostic uncertainties after mammography and ultrasound. As use of MRI has increased, many other situations for which, MRI might be helpful came to the fore. Unfortunately, literature support for most of them, is still lacking.

One of these new situations is the use of MRI to decide between a mastectomy and the lumpectomy. In the presence of DCIS lumpectomy also leaves behind disease, requiring re-resections. It might, therefore, be useful to know about the presence of the CAS before lumpectomy. Some physicians adopt the strategy of using MRI to identify DCIS and to eschew lumpectomy based on results. The reasoning is that if widespread DCIS is found, a mastectomy would be performed rather than a lumpectomy. This strategy has not been formally evaluated and is not currently recommended by guidelines. A clinical trial is ongoing: Breast MRI as a Preoperative Tool for DCIS, NCT00605982. The purpose of this study is to see how often MRI can find other areas of cancer in women with one area of breast cancer, and to determine how having the MRI test affects their treatment.  The study also aims to follow women who enter the study over a 10-year period to determine how often the breast cancer comes back.

American College of radiology (ACR) says: ” Invasive carcinoma and ductal cardinoma in situ (DCIS) – Breast MRI may be useful to determine the extent of disease and the presence of multifocality and multicentricity in patients with invasive carcinoma and ductal carcinoma in situ (DCIS). MRI can detect occult disease up to 15% to 30% of the time in the breast containing the index malignancy. MRI determines the extent of disease more accurately than standard mammography and physical examination in many patients. It remains to be conclusively shown that this alters recurrence rates relative to modern surgery, radiation, and systemic therapy.”

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