Article

Magnetic resonance imaging of ductal carcinoma in situ: what is its clinical application? A review.

Department of Surgical Oncology, Radboud University Nijmegen, The Medical Center, Nijmegen, the Netherlands.
American journal of surgery (impact factor: 2.36). 05/2009; 198(2):262-9. DOI:10.1016/j.amjsurg.2009.01.010 pp.262-9
Source: PubMed

ABSTRACT After breast-conserving surgery of ductal carcinoma in situ (DCIS) of the breast or invasive breast carcinoma with an extensive intraductal component, tumor-positive surgical margins are frequently found. Therefore, the extent of the intraductal disease needs to be accurately determined preoperatively.
Data for this review were identified by search of PubMed. Reference lists of selected articles were cross-searched for additional literature.
DCIS is accurately detected with magnetic resonance imaging (MRI), but the typical malignant features are inconsistently seen and most often in high-grade DCIS or in DCIS with a small invasive component. The histopathologic extent of DCIS is more accurately demonstrated with MRI. However, overestimation due to benign proliferative lesions does frequently occur. An improved depiction of DCIS could lead to improved preoperative staging. Conversely, the identification of more extensive disease on MRI could give rise to unnecessary interventions. Therefore, MRI should be used carefully and preferable in specialized and experienced centers. CONCLUSSION: To date, there is no evidence that the use of MRI improves outcomes (ie, decreases recurrence rates) in patients with DCIS.

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    Article: Effect of MRI on the Management of Ductal Carcinoma In Situ of the Breast.
    Melissa Pilewskie, Carlie Kennedy, Claire Shappell, Irene Helenowski, Denise Scholtens, Nora Hansen, Kevin Bethke, Jacqueline Jeruss, Patricia Karstaedt, Seema A Khan
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    ABSTRACT: INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
    Annals of Surgical Oncology 12/2012; · 4.17 Impact Factor
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    Article: Current and future applications of magnetic resonance imaging (MRI) to breast and ovarian cancer patient management.
    Jim Klostergaard, Kenia Parga, Raphael G Raptis
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    ABSTRACT: Magnetic resonance imaging (MRI) is occupying an increasing niche in the clinical diagnostic workup of several cancers, including breast cancers. Despite the high level of implementation of mammography, it has become apparent that MRI can play at least a complementary role in the imaging and diagnosis of primary breast cancers, including ductal carcinoma in situ, the earliest stage of breast cancer that is associated with an increased risk of invasive breast cancer. This can also be said of inflammatory breast cancer, of low incidence but with high impact on overall breast cancer mortality rates, and for which mammography is not ideal due to the typically diffused nature of this disease. Much of the value of breast MRI is dependent on its high sensitivity, resulting from the use of contrast agent enhancement in the detection of breast cancer. Interest has also increased in the application of diffusion-weighted MRI for early assessment of treatment response in this disease. Regarding ovarian and other gynecological cancers, MRI has already demonstrated value in the evaluation of patients with ovarian masses, uterine leiomyoma, endometrioma, and cervical cancer. Features on MRI suggestive of malignant ovarian tumors are varied, and span irregular or solid components to a cystic mass, prominent septations, evidence of peritoneal, hematogenous, or lymphatic spread, or local invasion. The majority of ovarian malignancies are diagnosed in advanced, incurable stages, where exploratory laparotomy provides the opportunity for maximal debulking. Although a role for MRI has yet to be established in this initial setting or in staging, some studies have shown that high sensitivity may be achieved with contrast agent-enhanced MRI for detection of recurrent disease, including demonstration of macroscopic intraabdominal dissemination and the hallmark omental "cake". Efforts in recent years have been focused on design of MRI contrast agents (MRI-CAs), which either target biomarkers, or take advantage of the different physiology of cancerous cells. MRI-CAs based on gadolinium complexes, ferrumoxides, or other metallic nanoparticles have been investigated. This review will focus on the recent progress in the application of MRI to the imaging of breast and ovarian cancers, and present a possible role for molecularly-targeted contrast agents in enriching the context for MRI-based diagnosis.
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Keywords

additional literature
 
benign proliferative lesions
 
breast-conserving surgery
 
centers
 
Conversely
 
DCIS
 
decreases recurrence rates
 
extensive intraductal component
 
high-grade DCIS
 
histopathologic extent
 
improved depiction
 
intraductal disease
 
invasive breast carcinoma
 
magnetic resonance imaging
 
MRI
 
patients
 
Reference lists
 
small invasive component
 
typical malignant features
 
unnecessary interventions