The use of additional magnetic resonance imaging after standard mammography may improve the definition of ductal carcinoma in situ's extension during preoperative planning and potentially reduce the need for additional surgery after breast cancer conservative surgery.

Healthcare question

Should additional magnetic resonance imaging vs. no additional magnetic resonance imaging be used in women with histologically confirmed ductal carcinoma in situ for preoperative planning?

Recommendation

In women with histologically confirmed ductal carcinoma in situ (DCIS), the ECIBC's Guidelines Development Group (GDG) suggests not using additional magnetic resonance imaging (MRI) for preoperative planning.

Recommendation strength ­

  Conditional recommendation against the intervention

  Very low certainty of the evidence

Subgroup considerations

Utility in very extended, suspect multifocal, or multiple disease could not be investigated, but the rationale for better morphological has been considered stronger in these cases.

Low, intermediate and high-grade DCIS.

Monitoring and evaluation

The overuse of MRI should be monitored, especially when there is a very small DCIS mammographically, as it is unlikely that MRI will find a very big one.

Research priorities

The GDG recommends research on other MRI techniques, especially abbreviated protocols. The ideal design would be randomised control trials (RCT) but there are problems with feasibility because of numbers and long term outcomes; alternatively observational studies could be carried out.

The possible utility in specific subgroups (extremely extended, suspect multifocal or multiple lesions) should be investigated. 

Supporting documents