title: The true impact of breast magnetic resonance imaging on the management of in situ disease: more is not better.
abstract: BACKGROUND
  The optimal role of breast magnetic resonance imaging (MRI) in the management of ductal carcinoma in situ (DCIS) remains controversial. We sought to better define the impact of breast MRIs when utilized during the workup of DCIS.
  
  
  METHODS
  Patients with biopsy-proven DCIS without any additional invasive disease were prospectively enrolled in the multidisciplinary breast cancer pathway and comprised the study group. Patients who met any additional criteria for MRI screening were excluded.
  
  
  RESULTS
  From 2008 to 2014, 93 women met the inclusion criteria. 81 patients underwent MRI as part of their workup. One patient benefited from MRI via identification of occult malignancy not previously identified. 35 MRIs identified no additional information whereas 46 had additional findings. These findings led to 23 procedures and 16 negative biopsies; recommendations for 16 radiographic studies that were normal; and influenced nodal sampling in 7 women with 1 positive metastatic focus.
  
  
  CONCLUSIONS
  The routine use of breast MRI for women diagnosed with DCIS has limited benefit. Often, it leads to multiple procedures and studies that are clinically insignificant and delays surgical treatment.
authors.affiliation: Department of General Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Dr., Joint Base Lewis-McChord, Tacoma, WA 98431, USA. Electronic address: Michael.s.lallemand.mil@mail.mil.
authors.forename: Michael
authors.initials: M
authors.lastname: Lallemand
authors.affiliation: Department of General Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Dr., Joint Base Lewis-McChord, Tacoma, WA 98431, USA.
authors.forename: Morgan
authors.initials: M
authors.lastname: Barron
authors.affiliation: Department of General Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Dr., Joint Base Lewis-McChord, Tacoma, WA 98431, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Bingham
authors.affiliation: Department of Radiology, Madigan Army Medical Center, Tacoma, WA, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Mosier
authors.affiliation: Department of General Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Dr., Joint Base Lewis-McChord, Tacoma, WA 98431, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Hardin
authors.affiliation: Department of General Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Dr., Joint Base Lewis-McChord, Tacoma, WA 98431, USA.
authors.forename: Vance
authors.initials: V
authors.lastname: Sohn
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging* / Q000628:therapy*; D000066491:Clinical Decision-Making; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008875:Middle Aged; D011237:Predictive Value of Tests
keywords: DCIS; Ductal carcinoma in situ; MRI; Screening