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Potential Role of MRI In the Diagnosis of Recurrent Breast Cancer
John W Gorechlad, Elizabeth McCabe, John H Higgins, Donald Likosky, Petra Lewis, Richard J Barth
Dartmouth-Hitchcock Medical Center, Lebanon, NH
Objective: Although it has been shown that MRI can help detect additional foci of cancer in the ipsilateral and contralateral breast at the time of initial diagnosis of breast cancer, the use of MRI as a screening tool to detect recurrence is controversial. Our objective was to determine the potential role of MRI in the diagnosis of locally recurrent breast cancer.
Design: Retrospective chart review done independently by two separate investigators.
Setting: Academic tertiary care referral hospital.
Patients: All patients undergoing margin negative lumpectomy and adjuvant radiation for infiltrating carcinoma of the breast at our institution between 1/1/1993 and 1/1/2004.
Main Outcome Measures: Recurrence in the ipsilateral breast.
Results: 534 women were treated and ipsilateral breast invasive local recurrences developed in 8 patients (1.5%). The mean follow up time was 4.8 years. The mean diameter of the recurrent cancers was 1.6 cm. Seven of the 8 patients were treated with mastectomy and are free of local or distant recurrence. One patient who presented with distant metastases was later found to have a small ipsilateral recurrence and died. The local recurrence rate per 100 woman years of observation was 0.35 (CI 0.18 to 0.69).
Conclusions: In a contemporary patient population the risk of local recurrence after lumpectomy and radiation therapy is very low and recurrences were detected when they were of a small size. If MRI had been done annually, a total of 2570 MRIs would have been performed in this population. Even if MRI had detected recurrences at a smaller size this would not have led to any changes in therapy and would not have changed the survival of any of our cohort of patients.
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