By using MRI (magnetic resonance imaging) it may be possible to prevent the development of invasive cancer by diagnosing breast caner in its intraductal stage, according to an article in The Lancet. A Comment in The Lancet believes that these findings demonstrate that MRI should now be used as another method, in its own right, to detect early stage breast cancer.
Professor Christiane Kuhl, Department of Radiology, University of Bonn, Germany, and team examined details on 7,319 women over a period of five years. They had all been referred to an academic breast center. As well as conventional mammography for diagnostic assessment and screening they all received MRI as well. The aim here being to find out how sensitive each method was in diagnosing DCIS (ductal carcinoma in situ). Different radiologists then assessed the mammograms and MRI scans. They assessed the relative sensitivity of each detection method by comparing the biological profiles of mammography-detected DCIS with those of MRI-detected DCIS.
The scientists found that:
— Of 167 women who had a DCIS diagnosis, 92% were diagnosed with MRI
— Of 167 women who had a DCIS diagnosis, 56% were diagnosed by mammography
— MRI sensitivity for diagnosing DCIS increased with nuclear grade
— Mammography sensitivity for diagnosing DCIS decreased with nuclear grade
— Of 89 women with high grade DCIS diagnosis, 98% were diagnosed by MRI
— Of 89 women with high grade DCIS diagnosis, 52% were diagnosed by mammography
— 48% were missed by mammography but diagnosed by MRI alone
The MRI’s higher sensitivity was not linked to a significantly higher number of false positive diagnoses.
“Our study suggests that the sensitivity of film screen or digital mammography for diagnosing DCIS is limited. MRI could help improve the ability to diagnose DCIS, especially DCIS with high nuclear grade,” the authors conclude.
“These findings can only lead to the conclusion that MRI outperforms mammography in tumour detection and diagnosis. MRI should thus no longer be regarded as an adjunct to mammography but as a distinct method to detect breast cancer in its earliest stage. A large-scale multicentre breast-screening trial with MRI in the general population is essential,” Dr Carla Boetes and Dr Ritse Mann, Radboud University Nijmegen Medical Centre, Netherlands, wrote in the accompanying Comment.
Written by: Christian Nordqvist