Screening for recurrences in patients treated with breast-conserving surgery: is there a role for MRI?
BACKGROUND
Although it has been shown that magnetic resonance imaging (MRI) is more sensitive than mammography in the detection of breast cancer in high-risk populations, there is little data on the use of MRI as a screening tool to detect recurrence after breast-conserving surgery. Our objective was to determine the potential role of MRI in the screening of breast cancer patients treated with breast-conserving surgery.


METHODS
Retrospective chart review of all patients undergoing margin-negative lumpectomy and adjuvant radiation therapy for infiltrating breast carcinoma between 1(st) January 1993 and 1(st) January 2004. Patients were followed for recurrence in the ipsilateral or contralateral breast by physical exam and mammography.


RESULTS
Four hundred and seventy-six primary tumor excisions were performed. Patients were followed for a median of 5.4 years. Ipsilateral breast recurrences developed in eight patients (1.7%) with a mean diameter of 1.6 cm. All of these women are alive and free of metastases. Contralateral cancers developed in 11 patients (2.3%) with a mean diameter of 1.5 cm. Ten of these 11 women are alive and free of disease.


CONCLUSIONS
In a contemporary patient population the risk of local recurrence after lumpectomy and radiation therapy is very low. If screening MRI had been a part of annual follow-up, a total of 2570 MRIs would have been performed. Given the small tumor size at detection and the excellent survival of those who recurred, annual screening MRI would have incurred significant cost and would have been unlikely to improve overall survival.
Gorechlad
John W
JW
Department of Surgery, Dartmouth-Hitchcock Medical Center and Norris Cotton Cancer Center, Lebanon, NH 03756, USA.
McCabe
Elizabeth B
EB
Higgins
John H
JH
Likosky
Donald S
DS
Lewis
Petra J
PJ
Rosenkranz
Kari M
KM
Barth
Richard J
RJ
D001943:Breast Neoplasms / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008403:Mass Screening; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D012189:Retrospective Studies