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Breast MRI in nonpalpable breast lesions: a randomized trial with diagnostic and therapeutic outcome--MONET-study.

Breast MRI in nonpalpable breast lesions: a randomized trial with diagnostic and therapeutic outcome--MONET-study

Peters N, Borel Rinkes I, Mali W et al.

Trials, 2007, 8, 40

Is magnetic resonance imaging (MRI) an innovative approach to breast imaging that will result in fewer unnecessary interventions for women undergoing breast screening, or is it an expensive white elephant that will achieve the opposite? This is an important question, which unfortunately the trial described here is unlikely to answer. However, it may provide useful information as to whether an operation can be avoided in a proportion of cases.

At present, women with a non-palpable mammographic lesion will undergo image-guided needle biopsy, with subsequent decision-making based upon the findings from that biopsy. The stated primary outcome of this study is to evaluate whether performing pre-operative breast MRI will improve management, and the number of biopsies and surgical procedures that are performed will be compared between MRI and control groups. As management will be directed for all patients by the findings of the needle biopsy, it is extremely difficult to imagine how breast MRI could possibly lead to fewer initial surgical interventions in the study. The authors state that they expect 23% of patients to require more than one surgical procedure to remove all the malignant tissue. This seems an extremely high number, but presumably they anticipate that additional MRI imaging will reduce this number by leading to wider surgical margins in some cases. Any such reduction would have to more than offset the likelihood that there will actually be an excess of primary intervention in the MRI group because of identification of additional lesions requiring investigation and biopsy in the MRI group.

This trial will undoubtedly provide information about how many individuals undergo additional intervention if MRI is performed routinely. It will also contribute to the literature regarding the ability of MRI to distinguish between different types of pathological process. The authors intend a 5-year follow-up so that we may have some information also about recurrence rate between the two groups. However, the randomised trial with long-term follow-up to tell us whether outcomes are usually improved by the addition of subjecting those with possible lesions to an hour in an MRI machine has yet to be performed.
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Title Annotation:Magnetic resonance imaging
Author:Murray, Nick
Publication:Advances in Breast Cancer
Geographic Code:4EUUK
Date:Mar 1, 2008
Words:374
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