Magnetic Resonance Imaging in the Breast Cancer Patient: Curb Your Enthusiasm

摘要: There is no doubt that breast magnetic resonance imaging (MRI) identifies foci of cancer are not evident on physical examination, mammogram, or ultrasound. The documentation in multiple studies MRI additional the ipsilateral 11% to 31% women with unicentric has led increasing use this technology newly diagnosed patient. Advocates cite as potential benefits improvement selection process for conserving surgery, a decrease number surgical procedures required obtain negative lumpectomy margins, and synchronous detection contralateral cancers. These would provide compelling rationale routine MRI, but, unfortunately, there data from prospective randomized trials support these assertions. To date, only information impact local recurrence comes single retrospective study 224 treated breast-conserving therapy (BCT) reported 40-month rate 1.2% those who had preoperative compared 6.5% did (P .001). Unfortunately, failure adjust differences tumor size, nodal status, and, most importantly, systemic between groups render results uninterpretable. In issue Journal Clinical Oncology, Solin et al much-needed outcome after BCT. Although their retrospective, factors known influence such age, margin date treatment, carefully documented, appropriate statistical adjustments were made. Of 756 patients reported, 215 part initial evaluation 541 not. 8-year rates any local-only first 3% 4% without respectively. When invasive carcinoma intraductal analyzed separately, was trend toward either histologic group. noteworthy several reasons. First, radiologists performing at University Pennsylvania (Philadelphia, PA) leaders field, extensive experience standardized technique ability perform MRI-guided biopsies. Yet, despite this, benefit reducing observed. Second, unfavorable findings excluded BCT group, rather than simply observed determine significance mammographically occult cancer. Three examining changes resulting found conversion planned mastectomy be common outcome, performed 15.5% 25% cases because demonstration disease thought too encompassed by lumpectomy. This suggests 81 136 an poor candidates procedure, yet 13 experienced type failure. addition failing show reaffirms extremely uncommon event, 96% undergoing free 8 years. Low limited tertiary-care hospitals staffed specialists. Wapnir 10-year cumulative ranging 4.8% 10.1% across five National Surgical Adjuvant Breast Bowel Project (NSABP) involving 2,669 node-positive 1984 1994, 3.5% node-negative receiving treatment NSABP during same time period. considering failures BCT, it worth remembering isolated 8% chestwall irradiation 27.6% counterparts fashion 10 years follow-up. expectation will eliminate, even significantly reduce, currently fails consider dual nature recurrence. Some recurrences result burden large control radiotherapy, inadequate evidenced increased positive margins radiotherapy. However, detects some but all pathologically evident, clinically breast, cannot expected reduce zero incidence. A direct comparison serial subgross sectioning sensitivity ranged 81% 89%, 40% situ disease. Other really site metastases, characteristics similar chest-wall postmastectomy short interval development risk subsequent distant relapse. It highly unlikely have also interesting difference incidence non-MRI groups, 6% each group developing finding consistent 134,501 JOURNAL OF CLINICAL ONCOLOGY E D I T O R L VOLUME 26 NUMBER 3 JANUARY 2