Does pre-operative breast MRI have an impact on surgical outcomes in high-grade DCIS?

OBJECTIVES: High-grade DCIS (HG DCIS) is associated with upgrade to invasive disease but few studies evaluate the role of MRI in this subset of DCIS. This study compared surgical outcomes of females with HG DCIS on biopsy who had pre-operative MRI with those that proceeded directly to surgery. METHODS: This single-centre retrospective, observational study identified patients with pure HG DCIS on pre-operative biopsy from the pathology database. Surgical outcomes, clinicopathological and radiological features were obtained for all patients. RESULTS: From August 2015 to February 2020, 217 patients had HG DCIS on biopsy. Pre-operative MRI was performed in 40 (MRI group) and not in 88 (No MRI group) patients. Initial mastectomy was performed in 25/40 (63%) women in the MRI group and 20/88 (23%) women in the no MRI group (p < 0.0001). No difference was observed in re-operation rate between the two groups, 15% in MRI group vs 22% in No MRI group (p = 0.4749). Mean tumour size on histology was larger in mastectomy cases in the MRI group (73.4 mm, range 6-140 mm), than the total MRI group, (58.3 mm, range 0-140 mm) or no MRI group (30.7 mm, range 0-130 mm) (p < 0.0001). CONCLUSIONS: Pre-operative MRI in HG DCIS is associated with higher mastectomy rates, possibly due to patient selection for MRI, as tumours on final histology were significantly larger. Fewer re-operations were observed in the MRI group although this was not significant. ADVANCES IN KNOWLEDGE: Breast MRI performed pre-operatively in HG DCIS is associated with higher mastectomy rates and fewer re-operation rates.

How long are elderly patients followed up with mammography after the diagnosis of breast cancer? A single-centre experience in a developing country.

BACKGROUND: The effect of breast cancer on elderly South African (SA) patients is not well characterised. The lack of data with regard to disease burden, post-treatment surveillance and breast cancer relapse poses a challenge to providing optimum follow-up care to this group of patients. OBJECTIVES: To assess the effect of breast cancer and adherence to post-treatment surveillance programmes among the local elderly population attending the breast oncology clinics at Addington and Inkosi Albert Luthuli Central hospitals in Durban, KwaZulu-Natal, SA. METHODS: A retrospective review was undertaken of all patients aged ≥65 years diagnosed with breast cancer during 2007. Hospital records were reviewed for a period of 5 years to ascertain the stage of the disease, treatment received, adherence to post-treatment surveillance mammograms, incidence of new mammographic findings and recurrence, site of recurrence, mode of detection of recurrence, disease-free survival, and overall survival rates at 5 years. RESULTS: In our study, the incidence of breast cancer in the elderly population was 26.7%. A significant percentage of patients (56.3%) were diagnosed at an advanced stage of disease. Of the 46.9% who had received surveillance mammography, only 6.3% received their post-treatment surveillance mammograms on time, in accordance with international recommendations. New mammographic findings were detected in 26.7% of patients during the 5-year follow-up. During the follow-up period, 15.6% of the total number of study patients presented with disease recurrence. Eighty percent of cases of recurrence were detected clinically. The overall survival at 5 years was 65.6%. CONCLUSION: Our study highlights the significant number of elderly patients with advanced disease at diagnosis, poor compliance with internationally recommended annual post-treatment surveillance mammograms, and the relatively low overall 5-year survival rate compared with that of international studies.