Another small single institution study of 281 patients with ductal carcinoma in situ, of which 144 underwent postexcision preirradiation mammography, found postexcision preirradiation mammography resulted in a change in surgical management in 7% (10/144) and removal of residual ductal carcinoma in situ in 4% (6/144) of patients. More importantly there was no significant change in 10-year local recurrence-free survival (95% versus 92%, with and without postexcision preirradiation mammography) [25]. Mammography Screening There is no relevant literature to support the use of screening mammography in this clinical scenario. MRI Breast Without and With IV Contrast There is insufficient evidence to support the routine use of MRI breast without and with IV contrast in this clinical scenario. MRI, when performed, is generally done before initial surgery. However, it may be performed following initial surgery in the setting of unsuspected positive margins. Evaluating residual disease in the surgical cavity is limited with MRI because of associated benign enhancement of the borders of the resection cavity obscuring residual disease. MRI may be helpful in identification of more widespread disease or remote disease [26,27]. This information can guide surgical planning for re-excision or need for mastectomy. One small retrospective study evaluated postexcision mammography and MRI to assess for residual disease in 51 patients with malignant calcifications (32 with and 19 without residual disease). MRI was better than mammography, especially in the setting of low background parenchymal enhancement, where sensitivity, specificity, and accuracy were 88.8%, 57.1%, and 76.5%, respectively. However higher background parenchymal enhancement did reduce sensitivity and accuracy [24]. MRI Breast Without IV Contrast There is no relevant literature to support the use of MRI breast without IV contrast for screening in this clinical scenario.
Imaging after Breast Surgery. Another small single institution study of 281 patients with ductal carcinoma in situ, of which 144 underwent postexcision preirradiation mammography, found postexcision preirradiation mammography resulted in a change in surgical management in 7% (10/144) and removal of residual ductal carcinoma in situ in 4% (6/144) of patients. More importantly there was no significant change in 10-year local recurrence-free survival (95% versus 92%, with and without postexcision preirradiation mammography) [25]. Mammography Screening There is no relevant literature to support the use of screening mammography in this clinical scenario. MRI Breast Without and With IV Contrast There is insufficient evidence to support the routine use of MRI breast without and with IV contrast in this clinical scenario. MRI, when performed, is generally done before initial surgery. However, it may be performed following initial surgery in the setting of unsuspected positive margins. Evaluating residual disease in the surgical cavity is limited with MRI because of associated benign enhancement of the borders of the resection cavity obscuring residual disease. MRI may be helpful in identification of more widespread disease or remote disease [26,27]. This information can guide surgical planning for re-excision or need for mastectomy. One small retrospective study evaluated postexcision mammography and MRI to assess for residual disease in 51 patients with malignant calcifications (32 with and 19 without residual disease). MRI was better than mammography, especially in the setting of low background parenchymal enhancement, where sensitivity, specificity, and accuracy were 88.8%, 57.1%, and 76.5%, respectively. However higher background parenchymal enhancement did reduce sensitivity and accuracy [24]. MRI Breast Without IV Contrast There is no relevant literature to support the use of MRI breast without IV contrast for screening in this clinical scenario.