• K B I M Keymeulen, S M E Geurts, Lobbes M B I MBI 0000-0002-2103-6956 Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands. , E M Heuts, Duijm L E M LEM 0000-0002-1952-7609 Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands. , L F S Kooreman, A C Voogd, and Tjan-Heijnen V C G VCG 0000-0002-3935-7440 Department of Medical Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands. .
• Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
• Br J Surg. 2019 Oct 1; 106 (11): 1488-1494.

BackgroundDeterminants of the use of breast MRI in patients with ductal carcinoma in situ (DCIS) in the Netherlands were studied, and whether using MRI influenced the rates of positive resection margins and mastectomies.MethodsAll women aged less than 75 years, and diagnosed with DCIS between 2011 and 2015, were identified from the Netherlands Cancer Registry. Multivariable logistic regression analyses were performed, adjusting for incidence year, age, hospital type, DCIS grade and multifocality.ResultsBreast MRI was performed in 2382 of 10 415 DCIS cases (22·9 per cent). In multivariable analysis, patients aged less than 50 years, those with high- or intermediate-grade DCIS and patients with multifocal disease were significantly more likely to have preoperative MRI. Patients undergoing MRI were more likely to have a mastectomy, either as first surgical treatment or following breast-conserving surgery (BCS) in the event of positive margins (odds ratio (OR) 2·11, 95 per cent c.i. 1·91 to 2·33). The risk of positive surgical margins after BCS was similar for those with versus without MRI. The secondary mastectomy rate after BCS was higher in patients who had MRI, especially in women aged less than 50 years (OR 1·94, 1·31 to 2·89). All findings were similar for low- and intermediate/high-grade DCIS.ConclusionAdding MRI to conventional breast imaging did not improve surgical outcome in patients diagnosed with primary DCIS. The likelihood of undergoing a mastectomy was twice as high in the MRI group, and no reduction in the risk of margin involvement was observed after BCS.© 2019 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

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