MRI Does Not Improve Staging Compared with Conventional Methods in Early Breast Cancer

The use of magnetic resonance imaging (MRI) prior to breast-conserving surgery does not improve loco-regional staging compared with conventional staging methods among women with early breast cancer. These results were presented at the 2008 San Antonio Breast Cancer Symposium.

Staging for early breast cancer prior to surgery typically involves mammogram, ultrasound, and biopsy. Retrospective data has indicated that MRI used in this staging process may provide more accurate staging information, which may reduce unnecessary mastectomy or re-operation. However, no prospective randomized trials evaluating this issue have been performed until the COMICE trial.

The COMICE trial is the first prospective randomized trial evaluating MRI as a loco-regional staging method for women with breast cancer prior to surgery. The trial included 1,623 women who underwent triple staging assessment including mammogram, ultrasound, and biopsy prior to scheduled wide-excision. Half the women underwent MRI in addition to the other staging assessments, and half did not.

  • MRI did not reduce the need for re-operation. The re-operation rate was 18.75% for those who underwent MRI compared with 19.33% for those who did not undergo MRI.
  • There were no statistically significant differences in disease-free survival or quality of life between the two groups of patients; however, one-third of the patients in the group that did not receive MRI expressed anxiety that they had not undergone the additional screening.

The researchers concluded that the of addition of MRI to other loco-regional staging procedures prior to breast-conserving surgery does not appear to warrant the extra cost as no significant differences in re-operation rates or disease-free survival were achieved compared with standard staging methods.

Reference: Drew PJ, et al. The UK NIHR multicentre randomised COMICE trial of MRI planning for breast conserving treatment for breast cancer. Proceedings from the 2008 San Antonio Breast Cancer Symposium. Abstract 51.

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