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Breast MRI and Ductal Carcinoma in Situ

New data from Germany demonstrated the value of MRI in detecting DCIS, particularly the high-grade variant of this common breast lesion.

Ductal carcinoma in situ (DCIS) — in particular, high-grade DCIS — often is a direct precursor of invasive breast cancer. With widespread use of screening mammography, about one in five breast cancers is now diagnosed at this preinvasive stage. Therefore, screening for DCIS followed by appropriate treatment has the potential to reduce the incidence of invasive breast cancer. However, the best imaging strategy for diagnosing DCIS is uncertain.

The study population was drawn from a group of 7319 women who were seen from 2002 through 2006 at a tertiary care breast center in Germany that serves women at high risk for breast cancer. Participants had an abnormal screening mammogram, clinical symptoms of breast cancer, or concerns about breast cancer; all underwent both mammography and intravenous contrast-enhanced breast magnetic resonance imaging. Mammograms and MRI scans were reviewed independently by different radiologists. Tissue was obtained if indicated by either of the imaging modalities or on clinical grounds. The final study population consisted of 167 women (mean age, 54) who were diagnosed with DCIS only (i.e., no accompanying invasive cancer) by biopsy. Overall, the sensitivity in diagnosing DCIS was 92% with MRI and 56% with mammography (P<0.0001). For high-grade DCIS, the sensitivity was 98% and 52%, respectively (P<0.0001).

Comment: These data were derived from a generally high-risk population of women seen at a tertiary care center in Germany, where breast MRI is used more widely than in the U.S., radiologists have more experience with breast MRI, and the procedure is more accessible. The ability to detect DCIS at screening — particularly high-grade DCIS, which is most likely to progress to invasive cancer — represents a tantalizing possibility that could lead to better prevention of invasive breast cancer. Because these findings raise the prospect of incorporating contrast-enhanced breast MRI into screening programs, a logical next step would be a large multicenter trial designed to assess the effect of breast MRI on breast cancer outcomes. Until we know more about the pros and cons of breast MRI, use of this expensive technology should be restricted to screening high-risk women such as those known to carry BRCA mutations (Journal Watch Women’s Health Nov 23 2004).

— Andrew M. Kaunitz, MD

Published in Journal Watch Women's Health September 27, 2007

Citation(s):

Kuhl CK et al. MRI for diagnosis of pure ductal carcinoma in situ: A prospective observational study. Lancet 2007 Aug 11; 370:485.

• Medline abstract (Free)

Boetes C and Mann RM. Ductal carcinoma in situ and breast MRI. Lancet 2007 Aug 11; 370:459.

• Medline abstract (Free)