title: Is there a role for MRI in the preoperative assessment of patients with DCIS?
abstract: BACKGROUND
  Breast magnetic resonance imaging (MRI) is used to identify residual and additional disease in patients with invasive carcinoma. The use of MRI in assessing extent of disease for ductal carcinoma in situ (DCIS) is less well defined. This study assessed the value of MRI in the preoperative evaluation of DCIS.
  
  
  METHODS
  We identified 98 patients with DCIS in 2007. Of these, 63 underwent stereotactic biopsy, followed by MRI. There were 35 who underwent stereotactic biopsy alone. Concordance between MRI and histopathology was defined as the presence or absence of residual disease.
  
  
  RESULTS
  There was no significant difference in mastectomy rates between the MRI and non-MRI group (20.3% vs 25.7%, P = .62). In patients undergoing breast-conserving surgery (BCS), there were fewer positive margins in the MRI versus the non-MRI group (21.2% vs 30.8%, P = .41). Of the 64 cases that underwent preoperative MRI, 43 (67.2%) were concordant. Also, 15 of 43 cases (34.8%) had MRI results that accurately predicted pathologic size. In 28 of 43 patients (65.2%), MRI overestimated disease in 20, by a mean of 1.97 cm. In patients with MRI tumor size >2 cm, MRI overestimated disease by a mean of 3.17 cm. Of the 64 cases, 21 (32.8%) were discordant. Also, 10 of 21 (47.6%) had a positive MRI and no residual disease on histopathology, and 11 of 21 (52.3%) had negative MRI and residual disease on pathology.
  
  
  CONCLUSIONS
  MRI does not accurately predict extent of disease in patients with extensive DCIS. In patients with MRI tumor size < or = 2 cm, MRI may assist in surgical planning. MRI results in patients with DCIS should be interpreted with caution; decision for mastectomy should not be made on MRI findings alone.
authors.affiliation: Department of Surgery, Drexel University College of Medicine, Philadelphia, PA, USA. lisa.weisfelner@drexelmed.edu
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Allen
authors.forename: Claudia E
authors.initials: CE
authors.lastname: Lago-Toro
authors.forename: Jenevieve H
authors.initials: JH
authors.lastname: Hughes
authors.forename: Eduardo
authors.initials: E
authors.lastname: Careaga
authors.forename: Anjeanette T
authors.initials: AT
authors.lastname: Brown
authors.forename: Michael
authors.initials: M
authors.lastname: Chernick
authors.forename: Andrea V
authors.initials: AV
authors.lastname: Barrio
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Frazier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008327:Mammography; D008408:Mastectomy; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000175:diagnosis* / Q000601:surgery; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies