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Addition of Preoperative Breast MRI to Standard Evaluation in Local Ductal Carcinoma in Situ

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Key Points

  • Use of preoperative MRI did not significantly reduce the reintervention rate.
  • Reintervention rates were 20% in the MRI group vs 27% in the control group.

In a French phase III trial reported in the Journal of Clinical Oncology, Balleyguier et al found that the addition of breast magnetic resonance imaging (MRI) to standard radiologic evaluation did not improve surgical reintervention rates in women with ductal carcinoma in situ undergoing breast-conserving surgery.

Study Details

In the multicenter trial, 352 patients with ductal carcinoma in situ corresponding to a unifocal microcalcification cluster or a mass < 30 mm were randomly assigned between March 2010 and June 2014 to undergo MRI plus standard evaluation (n = 178) or standard evaluation alone (n = 174).

The primary endpoint was the reintervention rate for positive or close margins (< 2 mm) in the 6 months after randomization.

Reintervention Rates

Among 345 patients with an assessable endpoint, reintervention occurred in 35 (20%) of 173 patients in the MRI group vs 47 (27%) of 172 in the control group. The absolute difference of 7% corresponded to a relative reduction of 26% (stratified odds ratio [OR] = 0.68, P = .13). In the per-protocol population of 165 MRI group patients and 169 control group patients, the absolute difference in favor of MRI was 9%, corresponding to a relative reduction of 36% (stratified OR = 0.59, P = .05). Total mastectomy rates were 18% in the MRI group and 17% in the control group (P = .93). For 100 lesions identified on MRI, non–mass-like enhancements were more common than mass enhancements (82% vs 20%); however, no specific morphologic or kinetic parameters for ductal carcinoma in situ were identified.

The investigators concluded, “The study did not show sufficient surgical improvement with the use of preoperative MRI to be clinically relevant in ductal carcinoma in situ staging. However, this could be reconsidered with the improvement of new MRI sequences and new modalities in magnetic resonance techniques.”

Corinne Balleyguier, MD, PhD, of the Radiology Department, Gustave Roussy, Villejuif, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by the French Ministry of Health Programme Hospitalier de Recherche Clinique. The study authors' full disclosures can be found at jco.ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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