Clinical application of preoperative MRI examination in breast-conserving surgery for ductal carcinoma in situ

doi:10.16139/j.1007-9610.2023.04.015

Abstract

Abstract:

Objective: To evaluate the relationship between preoperative magnetic resonance imaging (MRI) examination and the success rate and prognosis of breast-conserving surgery in ductal carcinoma in situ (DCIS) patients. Methods: Patients with DCIS received surgery between January 2009 and January 2017 in the breast cancer medical record database of Shanghai Jiao Tong University were retrospectively analyzed. Patients who received preoperative MRI was defined as MRI group, who did not receive preoperative MRI was defined as non-MRI group. Results: A total of 210 DCIS patients were included, of which 167 cases in the MRI group and 43 cases in the non-MRI group, respectively. Initial negative resection margin rates were similar between MRI and non-MRI groups undergoing breast-conserving surgery (91.0% vs. 97.7%, P=0.142). There was also no significant difference in the success rate of breast-conserving surgery between MRI and non MRI groups (95.2% vs. 100.0%, P=0.143). In terms of prognosis, there was no significant difference in 10-year loco-regional recurrence rate (4.8% vs. 2.3%, P=0.426) and breast cancer related mortality (0.9% vs. 0.5%, P=0.668) between MRI and non-MRI groups. Conclusions: Preoperative breast MRI examination in patients with DCIS had no effect on the rate of negative resection margin, success rate of breast preservation and the prognosis of the patients.

Key words: Breast cancer, Ductal carcinoma in situ, Magnetic resonance imaging, Breast-conserving surgery, Prognosis

CLC Number:

R737.9

YANG Yi, YANG Xingxia, JIN Sili, ZHANG Xu, ZHU Juanying, CHEN Xiaosong. Clinical application of preoperative MRI examination in breast-conserving surgery for ductal carcinoma in situ[J]. Journal of Surgery Concepts & Practice, 2023, 28(04): 378-382.

Figures/Tables 3

Tab 1

Tab 2

Fig 1

References 28

[1]	GREENWOOD H I, HELLER S L, KIM S, et al. Ductal carcinoma in situ of the breasts: review of MR imaging features[J]. Radiographics, 2013, 33(6):1569-1588. doi: 10.1148/rg.336125055 URL
[2]	TAN P H, ELLIS I, ALLISON K, et al. The 2019 World Health Organization classification of tumours of the breast[J]. Histopathology, 2020, 77(2):181-185. doi: 10.1111/his.v77.2 URL
[3]	CUZICK J, SESTAK I, PINDER S E, et al. Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long-term results from the UK/ANZ DCIS trial[J]. Lancet Oncol, 2011, 12(1):21-29. doi: 10.1016/S1470-2045(10)70266-7 URL
[4]	WÄRNBERG F, GARMO H, EMDIN S, et al. Effect of radiotherapy after breast-conserving surgery for ductal carcinoma in situ: 20 years follow-up in the randomized SweDCIS trial[J]. J Clin Oncol, 2014, 32(32):3613-3618. doi: 10.1200/JCO.2014.56.2595 URL
[5]	MCCORMICK B, WINTER K, HUDIS C, et al. RTOG 9804: a prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation[J]. J Clin Oncol, 2015, 33(7):709-715. doi: 10.1200/JCO.2014.57.9029 URL
[6]	IZUMORI A, TAKEBE K, SATO A. Ultrasound findings and histological features of ductal carcinoma in situ detected by ultrasound examination alone[J]. Breast Cancer, 2010, 17(2):136-141. doi: 10.1007/s12282-009-0134-8 URL
[7]	STARK T, DI BARTOLOMEO M, DI MARCO R, et al. Altered dopamine D3 receptor gene expression in MAM model of schizophrenia is reversed by peripubertal cannabidiol treatment[J]. Biochem Pharmacol, 2020, 177:114004. doi: 10.1016/j.bcp.2020.114004 URL
[8]	KUHL C K, SCHRADING S, BIELING H B, et al. MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study[J]. Lancet, 2007, 370(9586):485-492. doi: 10.1016/S0140-6736(07)61232-X URL
[9]	MENELL J H, MORRIS E A, DERSHAW D D, et al. Determination of the presence and extent of pure ductal carcinoma in situ by mammography and magnetic resonance imaging[J]. Breast J, 2005, 11(6):382-390. doi: 10.1111/tbj.2005.11.issue-6 URL
[10]	BERG W A, GUTIERREZ L, NESSAIVER M S, et al. Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer[J]. Radiology, 2004, 233(3):830-849. doi: 10.1148/radiol.2333031484 pmid: 15486214
[11]	BILIMORIA K Y, CAMBIC A, HANSEN N M, et al. Evaluating the impact of preoperative breast magnetic resonance imaging on the surgical management of newly diagnosed breast cancers[J]. Arch Surg, 2007, 142(5):441-445. doi: 10.1001/archsurg.142.5.441 URL
[12]	KUMAR A S, CHEN D F, AU A, et al. Biologic significance of false-positive magnetic resonance imaging enhancement in the setting of ductal carcinoma in situ[J]. Am J Surg, 2006, 192(4):520-524. doi: 10.1016/j.amjsurg.2006.07.003 URL
[13]	SILVERSTEIN M J. The University of Southern California/van Nuys prognostic index for ductal carcinoma in situ of the breast[J]. Am J Surg, 2003, 186(4):337-343. doi: 10.1016/S0002-9610(03)00265-4 URL
[14]	WOLFF A C, HAMMOND M E H, ALLISON K H, et al. Human epidermal growth factor receptor 2 testing in breast cancer: American Society of clinical oncology/College of American pathologists clinical practice guideline focused update[J]. J Clin Oncol, 2018, 36(20):2105-2122. doi: 10.1200/JCO.2018.77.8738 pmid: 29846122
[15]	ALLISON K H, HAMMOND M E H, DOWSETT M, et al. Estrogen and progesterone receptor testing in breast cancer: ASCO/CAP guideline update[J]. J Clin Oncol, 2020, 38(12):1346-1366. doi: 10.1200/JCO.19.02309 pmid: 31928404
[16]	MORROW M, WATERS J, MORRIS E. MRI for breast cancer screening, diagnosis, and treatment[J]. Lancet, 2011, 378(9805):1804-1811. doi: 10.1016/S0140-6736(11)61350-0 pmid: 22098853
[17]	HOUSSAMI N, TURNER R, MORROW M. Preoperative magnetic resonance imaging in breast cancer: meta-analysis of surgical outcomes[J]. Ann Surg, 2013, 257(2):249-255. doi: 10.1097/SLA.0b013e31827a8d17 pmid: 23187751
[18]	HOUSSAMI N, TURNER R, MACASKILL P, et al. An individual person data meta-analysis of preoperative magnetic resonance imaging and breast cancer recurrence[J]. J Clin Oncol, 2014, 32(5):392-401. doi: 10.1200/JCO.2013.52.7515 pmid: 24395846
[19]	IKEDA D M, ANDERSSON I. Ductal carcinoma in situ: atypical mammographic appearances[J]. Radiology, 1989, 172(3):661-666. doi: 10.1148/radiology.172.3.2549563 URL
[20]	STOMPER P C, CONNOLLY J L, MEYER J E, et al. Clinically occult ductal carcinoma in situ detected with mammography: analysis of 100 cases with radiologic-pathologic correlation[J]. Radiology, 1989, 172(1):235-241. doi: 10.1148/radiology.172.1.2544922 URL
[21]	LEHMAN C D. Magnetic resonance imaging in the evalua-tion of ductal carcinoma in situ[J]. J Natl Cancer Inst Monogr, 2010, 2010(41):150-151. doi: 10.1093/jncimonographs/lgq030 URL
[22]	BAE M S, MOON W K, CHO N, et al. Patient age and tumor size determine the cancer yield of preoperative bila-teral breast MRI in women with ductal carcinoma in situ[J]. Am J Roentgenol, 2013, 201(3):684-691. doi: 10.2214/AJR.12.10167 URL
[23]	EORTC Breast Cancer Cooperative Group, EORTC Radiotherapy Group, BIJKER N, et al. Breast-conserving treatment with or without radiotherapy in ductal carcinoma-in-situ: ten-year results of European Organisation for research and treatment of cancer randomized phase Ⅲ trial 10853-a study by the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group[J]. J Clin Oncol, 2006, 24(21):3381-2287. doi: 10.1200/JCO.2006.06.1366 URL
[24]	TUNON-DE-LARA C, ANDRÉ G, MACGROGAN G, et al. Ductal carcinoma in situ of the breast: influence of age on diagnostic, therapeutic, and prognostic features. Retrospective study of 812 patients[J]. Ann Surg Oncol, 2011, 18 (5):1372-1379. doi: 10.1245/s10434-010-1441-1 URL
[25]	CLARKE M, COLLINS R, DARBY S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials[J]. Lancet, 2005, 366(9503):2087-2106. doi: 10.1016/S0140-6736(05)67887-7 pmid: 16360786
[26]	TAJIMA C C, DE SOUSA L L C, VENYS G L, et al. Magnetic resonance imaging of the breast: role in the evaluation of ductal carcinoma in situ[J]. Radiol Bras, 2019, 52(1):43-47. doi: 10.1590/0100-3984.2018.0058 URL
[27]	FANCELLU A, TURNER R M, DIXON J M, et al. Meta-analysis of the effect of preoperative breast MRI on the surgical management of ductal carcinoma in situ[J]. Brit J Surg, 2015, 102(8):883-893. doi: 10.1002/bjs.9797 URL
[28]	DONKER M, LITIÈRE S, WERUTSKY G, et al. Breast-conserving treatment with or without radiotherapy in ductal carcinoma in situ: 15-year recurrence rates and outcome after a recurrence, from the EORTC 10853 rando-mized phase Ⅲ trial[J]. J Clin Oncol, 2013, 31(32):4054-4059. doi: 10.1200/JCO.2013.49.5077 URL

Characteristics	Non-MRI	MRI	Total	P
Age (years)				0.397
<40	7(3.3)	27(12.9)	34(16.2)
40~59	25(11.9)	112(53.3)	137(65.2)
≥60	11(5.2)	28(13.3)	39(18.6)
Family history of breast cancer				0.132
No	43(20.5)	155(73.8)	198(94.3)
Yes	0	12(5.7)	12(5.7)
Manifestation at diagnosis				0.607
Mass	30(14.3)	123(58.6)	153(72.9)
Calcification	6(2.8)	26(12.4)	32(15.2)
Others	7(3.3)	18(8.6)	25(11.9)
Tumor size (cm)				0.873
≤1.5	28(13.3)	114(54.3)	142(67.6)
1.6~4.0	14(6.7)	48(22.8)	62(29.5)
> 4.0	1(0.5)	5(2.4)	6(2.9)
Lesion patterns				0.691
Unifocal	42(20.0)	158(75.2)	200(95.2)
Multifocal	1(0.5)	9(4.3)	10(4.8)
Comedo necrosis				1.000
No	43(20.5)	165(78.5)	208(99.0)
Yes	0	2(1.0)	2(1.0)
Nuclear grade				0.139
Ⅰ	22(10.5)	62(29.5)	84(40.0)
Ⅱ	13(6.2)	78(37.1)	91(43.3)
Ⅲ	8(3.8)	27(12.9)	35(16.7)
ER status				0.400
Positive	9(4.3)	26(12.4)	35(16.7)
Negative	34(16.2)	141(67.1)	175(83.3)
PR status				0.592
Positive	12(5.7)	40(19.0)	52(24.7)
Negative	31(14.8)	127(60.5)	158(75.3)
HER2 status (IHC)				0.424
0~1+	27(12.9)	88(41.9)	115(54.8)
2+	11(5.2)	48(22.9)	59(28.1)
3+	5(2.4)	31(14.7)	36(17.1)
Ki-67				0.229
≤14%	26(12.4)	117(55.7)	143(68.1)
>14%	17(8.1)	50(23.8)	67(31.9)

Characteristics	Non-MRI	MRI
Ipsilateral breast tumor recurrence	1	8
Contralateral breast cancer	0	2
Regional lymph node metastasis	0	1
Distant metastasis	1	0
Death
Breast cancer-related	1	1
Others causes	2	0