Breast MRI doubles DCIS detection rate compared with mammography

Magnetic resonance imaging (MRI) of the breast doubles the rate at which ductal carcinoma in situ (DCIS) is detected, and even picks up cases of this early stage tumor that conventional mammography misses.

Reporting their findings in The Lancet, Christiane Kuhl and colleagues from the University of Bonn in Germany comment: "Our study suggests that the sensitivity of film screen or digital mammography for diagnosing DCIS is limited."Of 167 intraductal cancers that had been diagnosed during the study period, 72 (43%) were mammographically occult, but were diagnosed by MRI alone," say Kuhl and team.


They conducted a prospective, observational study that initially involved over 7300 women referred to their institution between 2002 and 2006 for diagnostic assessment and breast screening.Of these women, 193 were given a final surgical pathological diagnosis of DCIS, and 167 of these had both screening mammograms and MRI scans taken before biopsy and were the focus of the team's investigation.Comparing the sensitivities of mammography and MRI to detect all cases of DCIS, Khul and team found that mammography detected 93 (56%) cases and MRI detected 153 (92%) cases (p<0.0001)."of>

Kuhl and team note that while these results support the widespread use of MRI to detect DCIS, their results may not be reproducible in community breast screening services at present."Since breast MRI is currently used only rarely in clinical practice, for the time being, few radiologists can offer a level of expertise for MRI that comes close to that required for diagnostic mammography."They call for a "multi-institutional screening trial" to further investigate the role of MRI for diagnosing DCIS. A comment echoed in an accompanying editorial."These findings can only lead to the conclusion that MRI outperforms mammography in tumor detection and diagnosis," Carla Boetes and Ritse Mann from Radboud University Nijmegen Medical Center in The Netherlands also write in The Lancet."MRI should no longer be regarded as an adjunct to mammography but as a distinct method to detect breast cancer in its earliest stage. A large multicenter breast-screening trial with MRI in the general population is essential."

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