From the Department of Radiation Oncology, Albert Einstein Medical Center, Philadelphia, PA
Author's disclosures of potential conflicts of interest are found at the end of this article.
Address reprint requests to Lawrence J. Solin, MD, FACR, Department of Radiation Oncology, Albert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141; e-mail: solin{at}einstein.edu
Overview: The majority of patients with newly diagnosed early-stage breast carcinoma are eligible for breast conservation treatment with radiation. Although standard breast imaging is bilateral mammography, magnetic resonance imaging (MRI) is increasingly being used. Meta-analysis of breast MRI studies demonstrates additional findings of multifocal or multicentric disease in 16% of women, which is higher than the rate of local recurrence after breast conservation treatment with radiation. If there were a benefit for breast MRI relative to long-term outcome, the most sensitive measure would be an improvement in local control. After surgical excision of the primary tumor (lumpectomy), residual microscopic foci of disease in the breast are successfully controlled after radiation in the large majority of patients. In a retrospective study evaluating breast MRI for 756 women with early-stage disease after breast conservation treatment with radiation, Solin et al.1 reported no difference in the 8-year rates of any local failure (3% with breast MRI compared with 4% without breast MRI; p = 0.51). No difference was found for the subsets of patients with ductal carcinoma in situ (p = 0.58) or invasive breast carcinoma (p = 0.62). In a retrospective study of 224 patients reported by Fischer et al.,2 the crude incidence of local recurrence was lower for patients with a breast MRI study compared with patients without a breast MRI study (1.2% compared with 6.5%, respectively; p < 0.001). There is currently no randomized trial evaluating breast MRI relative to long-term outcome after breast conservation treatment with radiation.
