MRI for every APBI candidate: An open question

In this retrospective study by Godinez et al, 30 (38%) of 79 patients had additional foci on MRI. The researchers suggested that MRI should be used prior to APBI to rule out the presence of multifocal or multicentric disease.

“The authors pointed out that the relatively small number of study subjects precluded the identifi cation of certain subsets of patients who might be more likely to have additional foci (although there was a trend for those younger than age 40),” commented Dr. Taghian, and Dr. Alm El-Din, both from Massachusetts General Hospital and Harvard Medical School.

“We also think that the small number limited the ability to link risk of additional foci with tumor characteristics, eg, tumor size, pathology type (67 invasive carcinoma and 12 in-situ carcinoma), and lymphovascular invasion.”

Furthermore, they pointed out, the 13 patients in the study who received neoadjuvant chemotherapy would usually not be considered candidates for APBI and should not have been included. “Yet the authors concluded that 49 of the 79 patients (62%) were good candidates for APBI,” Drs. Taghian and Alm El-Din said.

They also noted that among the 80 MRI-detected foci, 60 were biopsied (core or excision biopsy), and only 45 (56%) were positive for malignancy.

“Whether this percentage warrants the use of MRI for every woman undergoing APBI is an open question,” they said. “Other factors also need to be considered, including the cost, availability, and sensitivity of MRI in detecting in-situ carcinomas (low) as compared to invasive tumors (very high and might lead to overtreatment).”

Drs. Taghian and Alm El-Din stressed that the role of MRI in selecting patients eligible for APBI should be evaluated prospectively.

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