Comparative effectiveness of magnetic resonance imaging in breast cancer (COMICE trial)

Relationship of Breast Magnetic Resonance Imaging to Outcome After Breast-Conservation Treatment With Radiation for Women With Early-Stage Invasive Breast Carcinoma or Ductal Carcinoma in Situ

Purpose

To determine the relationship of breast magnetic resonance imaging (MRI) to outcome after breast-conservation treatment (BCT) with radiation for women with early-stage invasive breast carcinoma or ductal carcinoma in situ.

Patients and Methods

A total of 756 women with early stage invasive breast carcinoma or ductal carcinoma in situ underwent BCT including definitive breast irradiation during 1992 to 2001. At the time of initial diagnosis and evaluation, routine breast imaging included conventional mammography. Of the 756 women, 215 women (28%) had also undergone a breast MRI study, and 541 women (72%) had not undergone a breast MRI study. The median follow-up after treatment was 4.6 years (range, 0.1 to 13.5 years).

Results

For the women with a breast MRI study compared with the women without a breast MRI study, there were no differences in the 8-year rates of any local failure (3% v 4%, respectively; P = .51) or local-only first failure (3% v 4%, respectively; P = .32). There were also no differences between the two groups for the 8-year rates of overall survival (86% v 87%, respectively; P = .51), cause-specific survival (94% v 95%, respectively; P = .63), freedom from distant metastases (89% v 92%, respectively; P = .16), or contralateral breast cancer (6% v 6%, respectively; P = .39).

Conclusion

The use of a breast MRI study at the time of initial diagnosis and evaluation was not associated with an improvement in outcome after BCT with radiation.

Additional breast lesions in patients eligible for breast-conserving therapy by MRI: Impact on preoperative management and potential benefit of computerised analysis

This study was conducted to assess the incidence and impact of additional findings from magnetic resonance imaging (MRI) on the workup of patients eligible for breast-conserving therapy (BCT) and to optimise the specificity of further workup by combining radiological reading with computerised analysis. One hundred and sixteen patients eligible for BCT underwent preoperative MRI where the gold standard was histology or follow-up (median 35 months, range 23-48). The incidence of additional findings and impact on treatment (wider excision/conversion to mastectomy) were assessed. The specificity of referral to further workup was also assessed without and with computerised analysis. Additional findings from MRI occurred in 41% of patients, requiring workup in 78%. In 22% the findings were malignant, causing change in treatment. Specificity was 33% (10/30) for radiological reading alone, and 97% (29/30) combined with computer analysis. Our findings show that additional findings preoperative MRI required workup in approximately one-third of patients and we suggest that combining radiological reading with computer analysis has the potential to accurately exclude benign lesions from further workup.