Srigouri Yalamanchili MD, Presenter: Nothing to Disclose

Basak Erguvan Dogan MD, Abstract Co-Author: Nothing to Disclose

Inanc Guvenc MD, Abstract Co-Author: Nothing to Disclose

Elizabeth Mittendorf MD, Abstract Co-Author: Nothing to Disclose

Wei Wei, Abstract Co-Author: Nothing to Disclose

Deanna Lane MD, Abstract Co-Author: Nothing to Disclose

Wei Tse Yang MD, Abstract Co-Author: Consultant, Naviscan, Inc

To determine the value of dynamic contrast-enhanced (DCE) MRI in the preoperative evaluation of patients with newly diagnosed ductal carcinoma in situ (DCIS).

A database search was performed for all patients with pure ductal carcinoma DCIS who underwent surgery, and who had preoperative mammography (M), ultrasound (US), and MRI available for review. Between November 2009 and January 2011, 83 patients with DCIS who underwent triple modality (TM) preoperative evaluation with M, US, and MRI were compared with 94 patients who underwent dual modality (DM) preoperative M and US evaluation, in a retrospective review. The frequency of positive margins at initial surgery, re-excision rate, and the rate of breast conserving surgery versus mastectomy were compared between the TM and DM groups. The size of DCIS on TM versus DM was compared with histopathology. The percentage of multifocal/multicentric DCIS indentified on each imaging modality was noted. The time from initial diagnosis to the date of surgery was also compared between TM and DM. Fisher’s exact test and Wilcoxon rank test were used for statistical analysis.

The median age was 53 years for both the TM and the DM groups, p=0.99. MRI showed the highest correlation with size at histopathology, r=0.78. At surgery, the positive margin rate was higher in the DM (26%) than the TM (9%) group (p=0.007) as was the re-excision rate (p=0.01). There was no difference in segmental mastectomy rates (p=0.06), and time to surgery from diagnosis between both groups median 7 weeks for DM, 8 weeks for TM, p=0.34). MRI revealed multifocal disease not evident on M and US (p<0.0001).

MRI resulted in decreased margin positivity and re-excision rates in newly-diagnosed DCIS patients, when compared to M and US, without impact on mastectomy rates.

MRI has a synergistic value with DM evaluation of newly-diagnosed DCIS patients, facilitating improved surgical outcomes without significant increase in mastectomy rates or delay in time to surgery.

Yalamanchili, S, Dogan, B, Guvenc, I, Mittendorf, E, Wei, W, Lane, D, Yang, W, The Role of MRI in the Management of Patients with Newly Diagnosed Ductal Carcinoma in Situ.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11005771.html