Preoperative breast MRI and long-term survival in ductal carcinoma in situ: a propensity score-weighted analysis
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Published on: December 15, 2014
Hee Jeong Kim1, Woo Jung Choi2, Ga Young Yoon3
1Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Objectives:
To assess the impact of preoperative MRI on long-term survival outcomes in women with ductal carcinoma in situ (DCIS).
Materials And Methods:
This retrospective study included women diagnosed with DCIS between January 2007 and December 2016. Propensity scores based on 25 demographic and clinicopathologic covariates were used to generate an overlap-weighted cohort, balancing patient groups according to MRI use. Recurrence-free survival (RFS) and overall survival (OS) were compared using Kaplan-Meier estimates with log-rank test and Cox proportional hazards models.
Results:
Among 1003 eligible women (mean age, 48.6 years ± 9.4 [SD]), 624 (62.2%) underwent MRI. During a median follow-up of 9.5 years, 122 (12%) experienced recurrence, including 75 (61%) invasive events. The 15-year recurrence rates did not differ between the MRI and no-MRI groups (27% vs 23%; p = 0.77). Preoperative MRI was not associated with recurrence in the overlap-weighted cohort (hazard ratio (HR), 0.88 [95% CI: 0.60, 1.30]; p = 0.53). The 15-year overall mortality rate was 7% in both groups (p = 0.93), and preoperative MRI was not associated with overall mortality in the overlap-weighted cohort (HR, 1.21 [95% CI: 0.55, 2.66]; p = 0.64). Preoperative MRI was not an independent factor for RFS (HR, 0.99 [95% CI: 0.71, 1.39]; p = 0.95) or OS (HR, 1.11 [95% CI: 0.52, 2.37]; p = 0.78).
Conclusion:
Preoperative breast MRI was not associated with improved RFS or OS among women with DCIS.
Key Points:
Question The impact of preoperative MRI on long-term outcomes in women with ductal carcinoma in situ (DCIS) remains uncertain. Findings In this retrospective propensity score-weighted analysis, preoperative breast MRI was not associated with improved recurrence-free survival or overall survival in women with DCIS. Clinical relevance Routine preoperative MRI may not improve long-term outcomes in DCIS. Prospective multicenter studies are warranted to identify subgroups that may derive meaningful survival benefits.