MRI staging likely to play an increasing role in breast cancer care: definitive trials underway.(Gynecology)

SAN ANTONIO -- One of the most promising emerging indications for breast MR/is in staging the contralateral breast in newly diagnosed breast cancer patients according to Dr. Bruce L. Daniel.

Three preliminary studies totalling more than 500 patients have demonstrated that staging MR/detects clinically occult cancer in the contralateral breast in 3%-5% of breast cancer patients who are mammographically negative in that breast, he said at a breast cancer symposium sponsored by the Cancer Therapy and Research Center.

"Biopsies confirmed that staging MR/had a positive predictive value in an acceptable range for an imaging study--and all of the cancers round in these studies were either in situ or early stage. So there are now two ongoing, major multicenter trials looking at this issue," said Dr. Daniel, a radiologist at Stanford (Calif.) University

MRI staging of the ipsilateral breast in newly diagnosed breast cancer patients, while often performed, is controversial. The issue here isn't whether MRI can detect occult disease, but whether that makes a significant difference in outcome. After all, lumpectomy with adjuvant radiotherapy to the ipsilateral breast has been shown to result in survival equal to that obtained with mastectomy.

What's needed now, but is not yet even being planned, is a randomized outcome trial to establish whether MRI staging of the ipsilateral breast improves other clinically relevant outcomes, such as local recurrence rate and need for reexcision, he said.

Many claims are being made for breast MRI--sometimes in direct-to-consumer advertising. But at this point the indications that are solidly evidence ...