MRI underutilized in scrutinizing DCIS, national scientific panel concludes

MRI, possibly employing higher field strengths and dedicated breast coils, should be used more often for detecting ductal carcinoma in situ, according to a panel convened by the National Institutes of Health.

DCIS is the most common noninvasive lesion of the breast and presents unique challenges for patients and clinicians because the natural course of the untreated disease is not well understood. In DCIS, abnormal cells are found in the breast duct and have not spread outside the duct to other tissues in the breast. This may or may not be a precursor to invasive cancer.

MRI is used as an adjunct screening test in women at high risk, but could gain greater significance when diagnosing DCIS, according to a Sept. 24 statement issued by the panel.

"We're beginning to use MR more commonly in the context of DCIS, with mixed results," said Dr. Denise R. Aberle, a professor of radiology at the University of California, Los Angeles.

MRI is more sensitive than mammography, but there are also issues of under- and over-estimation of size of the carcinoma, involvement of other breast regions, and contralateral breast disease, she said.

The comments came in a conference the NIH Office of Medical Applications of Research and the National Cancer Institute sponsored in Bethesda, MD, Sept. 22-24.

The panel recommended looking at whether higher field strength magnets, dedicated breast coils, and different pulse sequences would improve detection. In addition, there is a strong need to do comparative effectiveness studies in individuals who do and do not undergo MRI, Aberle said.

DCIS is associated with a 10-year survival rate of nearly 100% when treated. Given its nature, and that it may or may not be a precursor for invasive cancer, panelists discussed whether "carcinoma" should be part of its name.

"Although DCIS is relatively indolent in nature, its name includes ‘carcinoma,' so receiving this diagnosis carries with it a substantial negative connotation for both patients and their providers," said Dr. Carmen Allegra, panel chair and chief of hematology and oncology at the University of Florida in Gainesville.

Though pathologists can easily endorse a new name, it's important to keep in mind DCIS cells are both histologically and molecularly identical to invasive cancer cells, according to Dr. Arnold Schwartz, a professor in the pathology department at George Washington University in Washington, DC. Plus, there are many other precursor cancers in the body also called carcinoma in situ, so a name change could affect those as well.

The panel could not say what a new name for DCIS might be as that is a job for pathologists. The panel instead recommended the scientific community take up the issue.