Addition of magnetic resonance imaging (MRI) scans to conventional triple assessment* techniques for diagnosis of breast cancer has no effect on the reoperation rate**. This is the conclusion of the COMICE study, published in an Article in this week's edition of The Lancet, and written by Professor Lindsay Turnbull, University of Hull and Hull Royal Infirmary, UK, and colleagues.
This randomised controlled study took place in 45 UK centres, recruiting 1623 women aged 18 years or older with biopsy-proven primary breast cancer—who were scheduled for surgery to remove their tumours after triple assessment. Patients were randomly assigned to receive either MRI (816) or no further imaging (807). The primary endpoint was the proportion of patients undergoing a repeat operation or further mastectomy within 6 months of randomisation, or a pathologically avoidable mastectomy at initial operation.
The researchers found that addition of MRI to conventional triple assessment was not significantly associated with reduced a reoperation rate, with 153 (19%) needing reoperation in the MRI group versus 156 (19%) in the no MRI group.
The authors say: "In the analysis, we identified no difference in health-related quality of life between groups 12 months after initial surgery. However, in terms of total costs, results suggested a difference between the two trial groups, with the MRI group costing more than the no MRI group, although the difference was not statistically significant. In view of the similar clinical and health related quality-of-life outcomes of patients in both groups, we conclude that the addition of MRI to the conventional triple assessment might result in extra use of resources at the initial surgery period, with few or no benefits to saving resources or health outcomes, and the additional burden on patients to attend extra hospital visits."
They conclude: "Our results have important implications in routine clinical practice for the appropriate use of health-service resources and patient burden on health services. MRI is an expensive procedure. Because surgical use of MRI data to direct wide local excision is similar worldwide, we believe that our findings are generalisable to all healthcare providers, and show that MRI might not be necessary in this population of patients in terms of reduction of reoperation rates."
In an accompanying Comment, Dr Elizabeth A Morris, Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, USA, says: "It is too early to completely dispense with preoperative breast MRI. Importantly, COMICE has shown that preoperative breast MRI might not be for all women and that routine breast MRI in the evaluation of early breast cancer, as managed by those participating in this study, does not decrease reoperation rates."
Professor Lindsay Turnbull, Hull Royal Infirmary, UK. T) +44 (0) 1482 674092 E) l.w.turnbull@hull.ac.uk / C.Mulley@hull.ac.uk
Dr Elizabeth A Morris, Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, USA. T) +1 646-888-4510 / +1 917-655-5414 E) morrise@mskcc.org
For full Article and Comment see: http://press.thelancet.com/mribc.pdf
Note to editors: * Triple assessment is the combination of 3 modes of assessment - 1) clinical examination 2) imaging of the breast (by X-ray mammography and/or ultrasound), and 3) pathological assessment of the "lump" (by either fine needle aspiration cytology or core biopsy).
** About 20% of women will go back to surgery for "re-operation" because their tumour has not been completely removed. The hope with COMICE was that by better delineating the extent of tumour present the "re-operation" rate would be minimised, however although MRI did delineate the tumour better than other imaging techniques this was not translated into better surgery.
Journal
The Lancet