Preoperative breast magnetic resonance imaging in women with local ductal carcinoma in situ to optimize surgical outcomes: Results from the randomized Phase III Trial IRCIS

Corinne Balleyguier, Ariane Dunant, Luc Ceugnart, Marguerite Kandel, Marie Pierre Chauvet, Pascal Chérel, Chafika Mazouni, Philippe Henrot, Philippe Rauch, Jocelyne Chopier, Sonia Zilberman, Isabelle Doutriaux-Dumoulin, Isabelle Jaffre, Aurélie Jalaguier, Gilles Houvenaeghel, Nicole Guérin, Françoise Callonnec, Claire Chapellier, Ines Raoust, Marie Christine MathieuFrançoise Rimareix, Julia Bonastre, Jean Rémi Garbay

    Résultats de recherche: Contribution à un journalArticleRevue par des pairs

    37 Citations (Scopus)

    Résumé

    PURPOSE We evaluated the addition of breast magnetic resonance imaging (MRI) to standard radiologic evaluation on the re-intervention rate in women with ductal carcinoma in situ (DCIS) undergoing breastconserving surgery. PATIENTS AND METHODS Women with biopsy-proven DCIS corresponding to a unifocal microcalcification cluster or a mass less than 30 mm were randomly assigned to undergo MRI or standard evaluation. The primary end point was the re-intervention rate for positive or close margins (, 2 mm) in the 6 months after randomization (ClinicalTrials.gov identifier: NCT01112254). RESULTS A total of 360 patients from 10 hospitals in France were included in the study. Of the 352 analyzable patients, 178 were randomly assigned to theMRI arm, and 174 were assigned to the control arm. In the intentto- treat analysis, 82 of 345 patients with the assessable end point were reoperated for positive or closemargins within 6 months, resulting in a re-intervention rate of 20% (35 of 173) in the MRI arm and 27% (47 of 172) in the control arm. The absolute difference of 7% (95% CI, 22% to 16%) corresponded to a relative reduction of 26% (stratified odds ratio, 0.68; 95% CI, 0.41 to 1.1; P = .13). When considering only the per-protocol population with an assessable end point, the difference was 9% (stratified odds ratio, 0.59; 95% CI, 0.35 to 1.0; P = .05). Totalmastectomy rates were 18% (31 of 176) in theMRI arm and 17% (30 of 173) in the control arm (stratified P = .93). For 100 lesions seen on MRI, nonmass-like enhancement was more predominant (82%) than mass enhancement (20%). Nevertheless, no specific morphologic and kinetic parameters for DCIS were identified. CONCLUSION The study did not show sufficient surgical improvement with the use of preoperative MRI to be clinically relevant in DCIS staging. However, this could be reconsidered with the improvement of new MRI sequences and new modalities in magnetic resonance techniques.

    langue originaleAnglais
    Pages (de - à)885-892
    Nombre de pages8
    journalJournal of Clinical Oncology
    Volume37
    Numéro de publication11
    Les DOIs
    étatPublié - 1 janv. 2019

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