Association of Magnetic Resonance Imaging and a 12-Gene Expression Assay With Breast Ductal Carcinoma In Situ Treatment
| Autor: | Ruth C. Carlos, Derrick W. Spell, Lawrence J. Solin, Sunil Badve, John R. Bumberry, Worta McCaskill-Stevens, Constance D. Lehman, Ralph L. Corsetti, Kathy D. Miller, Justin Romanoff, Ilana F. Gareen, Joseph A. Sparano, Constantine Gatsonis, Bradley S. Snyder, Jennifer L Sabol, Habib Rahbar, Lynne I. Wagner, Kenneth Bruce Blankstein, Christopher Comstock, Linda K. Han, Seema A. Khan |
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| Rok vydání: | 2019 |
| Předmět: |
Cancer Research
medicine.medical_specialty Breast surgery medicine.medical_treatment Decision Making Breast Neoplasms 03 medical and health sciences 0302 clinical medicine Breast-conserving surgery Clinical endpoint Medicine Breast MRI Humans 030212 general & internal medicine Mastectomy Aged Original Investigation Cross-Over Studies medicine.diagnostic_test business.industry Wide local excision Carcinoma Ductal Breast Magnetic resonance imaging Middle Aged Patient Acceptance of Health Care Magnetic Resonance Imaging Clinical trial Oncology 030220 oncology & carcinogenesis Female Radiology business Transcriptome |
| Zdroj: | JAMA oncology. 5(7) |
| ISSN: | 2374-2445 |
| Popis: | IMPORTANCE: Advanced diagnostics, such as magnetic resonance imaging (MRI) and gene expression profiles, are potentially useful to guide targeted treatment in patients with ductal carcinoma in situ (DCIS). OBJECTIVES: To examine the proportion of patients who converted to mastectomy after MRI and the reasons for those conversions and to measure patient adherence to radiotherapy guided by the 12-gene DCIS score. DESIGN, SETTING, AND PARTICIPANTS: Analysis of a prospective, cohort, nonrandomized clinical trial that enrolled women with DCIS on core biopsy who were candidates for wide local excision (WLE) from 75 institutions from March 25, 2015, to April 27, 2016, through the Eastern Cooperative Oncology Group–American College of Radiology Imaging Network trial E4112. INTERVENTIONS: Participants underwent breast MRI before surgery, and subsequent management incorporated MRI findings for choice of surgery. The DCIS score was used to guide radiotherapy recommendations among women with DCIS who had WLE as the final procedure and had tumor-free excision margins of 2 mm or greater. MAIN OUTCOMES AND MEASURES: The primary end point was to estimate the conversion rate to mastectomy and the reason for conversion. RESULTS: Of 339 evaluable women (mean [SD] age, 59.1 [10.1] years; 262 [77.3%] of European descent) eligible for WLE before MRI, 65 (19.2%; 95% CI, 15.3%-23.7%) converted to mastectomy. Of these 65 patients, conversion was based on MRI findings in 25 (38.5%), patient preference in 25 (38.5%), positive margins after attempted WLE in 10 (15.4%), positive genetic test results in 3 (4.6%), and contraindication to radiotherapy in 2 (3.1%). Among the 285 who had WLE performed after MRI as the first surgical procedure, 274 (96.1%) achieved successful breast conservation. Of 171 women eligible for radiotherapy guided by DCIS score (clear margins, absence of invasive disease, and score obtained), the score was low ( |
| Databáze: | OpenAIRE |
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