Who had an MRI prior to surgery for DCIS and how helpful was it?

Rosamond

Hospital One, affiliated with a major university: no MRI needed; research consensus says not helpful for DCIS disease extent; too many false positives; may even show a greater extent than is there after all; when we do give them, we don't time them to menstrual cycle as it's not very helpful; we used to do a lot of MRIs for DCIS, but stopped this practice as it was not helpful



Hospital Two, at a different university/teaching hospital that is also a National Cancer Institute: you are "young" (49) with heterogeneously dense breasts (so, about 50% dense); there could be a lot more or even less DCIS; you must have it days 7-10 of period; there may be false positives, but this procedure is necessary according to our conferencing recommendations



Who among you had an MRI pre-surgery, and what was the result? Was it helpful or unhelpful prior to surgery? Was it accurate or near-accurate to your surgical pathology? Were there false findings? Did you have more biopsies that were negative? Did you find it helpful for your surgical decision making? Was it timed to your cycle?



I am definitely going to get the MRI as Hospital 2 really laid a compelling case for me based on my own individual case, but I am wondering why there is not a consensus in the medical community regarding standard practice for DCIS re MRI. By the way, my stereo showed Grade 2, solid type, no central necrosis. My periomenopausal period was late, dragging the diagnostics out even longer.




Thanks and all the best to those who took time to read and respond!

UPDATE 7/27: I had the MRI and it showed .5cm more non-mass enhancement than mammogram. Having an MRI guided biopsy on 7/29 on this larger boundary as I am still in borderline territory between lumpectomy and mastectomy. Good news is that no other suspicious findings found by MRI in either breast. I think the MRI has been helpful.

Update 8/1: My MRI biopsy came up as invasion. Now Stage 1 and moving with treatments in that direction. SNB and then mastectomy next week. Not sure yet about rads or chemo. The MRI found the invasion. It was definitely worth it!

Rosamond, my Calico cat, was a breast cancer survivor for 8 years. ^=.=^
Dx 6/12/2013, DCIS, Stage 0, Grade 2, ER+/PR+

BayouBabe

Rosamond - I did not have DCIS, however I can add this. I had regular mammograms and an ultrasound. They followed this with an MRI. The MRI found a lump that was not visible on any of the other imaging. (I had two lumps - one found by ultrasound/mammograms and the one found with MRI). Glad I went ahead with both.

proudtospin

I had DCIS grade 3 and was treated at the hospital ranked #1 in NJ and #4 in the NYC area (but actually located in NJ).    Never had an MRI and I was of the impression the reason was related to my health insurance (Aetna at the time)

all came out fine, ending my AL this year, did lumpies and rads

CTMOM1234

Yes, I had an MRI prior to surgery at the directive of my conservative BS, who also sent me for genetic testing. My annual routine mammo. picked up the micro-calcs and the stereo.biopsy confirmed grade 2 dcis. BS wouldn't support my having a lumpectomy (rather than mx) unless all came back fine from the mri and genetic testing. I am grateful for the favorable test results.

I will confess that the mri did lead to a false positive, oddly enough on the GOOD side, so I did have an mri-guided biopsy. Knew that was a risk. Despite that, I am glad I had the mri (and genetic testing)! It is a very good idea to get as much information as you can before dcis surgery because the BS cannot see it and is relying on these images. Mammo, ultrasound, and MRI don't always all pick up bc, but together they are more useful than just one. 

edited to add the following: Just saw previous poster's Aetna comment: I also have Aetna insurance, they were not a problem at all paying for the mri or BRCA testing. But my BS ordered everything and he was the chair of the BC center so maybe that's why everything went through easily? Surgery at top ranked hospital in CT btw.

kdh

I also had a MRI after my biopsy diagnosis of DCIS. I had chosen to do a BMX instead of a lumpectomy to avoid the radiation and to avoid my worry about the remaining breast. The surgeon wanted a MRI which was negative. But the pathology of the good breast showed LCIS with margins close but ok. So LCIS is precancerous and usually only shows up by biopsy. So MRIs show some things and don't show some things. It's hard to second guess. You don't want to do too much or too little but you need to be ok with your choices no matter what they are or who thinks you're crazy our not. I'm happy with my choice and some people thought I was overdoing it. It just cut my worry rate down. Good luck Rosamond.

juniper17

I had an MRI (timed to my cycle) after a diagnosis of DCIS only from a biopsy. The MRI showed 3 areas of probable malignancy - the area of DCIS, a palpable lump that hadn't yet been biopsied but was thought to be a cyst, and another spot not seen on mammography. All three ended up being IDC. It didn't show another 4 tumors that were found after surgery, but they were all pretty small - less than a cm.

It definitely changed my surgery decision. I had planned on a lumpectomy, but with the three tumors showing up on the MRI, mastectomy was recommended by 3 different surgeons. Good thing, too.

cheryl1946

My mri was what showed the tumors; they were never seen on mammograms. I had one dcis and 2 solid tumors that were found to be idc's. I had an mri, ultrasound, stereotactic biopsy of the dcis, followed by 2 core needle biopsies. Then had a pet/ct, then had a cat scan biopsy of the humerus that showed several bone mets. Was stage IV from the start. No surgery, rads, or chemo. Hormonal therapy got rid if the solid tumors.

Laurie08

I too had DCIS and had an MRI.  I was warned of false positives etc.  I had mine times with my cycle as well and it did not show any other areas of concern or false positives.  I had a BMX and the path report showed the same as the MRI.  I also had dense breasts and was very large chested.  They had found cancer on my right side but had been going for mammos every 6 months for 4 years for a site they were watching in my left side.  I recommend the MRI- just keep in mind it might have false negatives and stay positive.  It will give you a better idea of what you are dealing with prior to surgery. 

danawp

Diagnosed with suspected DCIS on a mammogram, confirmed with 2 biopsies (sterotactic & US guided for 2 different areas.  DCIS was suspected to be very wide spread (15 cm) in one breast based on mammogram.  Dr recommended MRI on both breasts.  I did the MRI and it showed the same as the mammograms -- nothing in one breast, very wide spread DCIS in the other.  I had a BMX (MX on one side required).  Surgery confirmed same findings -- nothing in one breast and approx 15 - 16 cm of DCIS in other breast (if that 15 cm sounds shocking...I was a double DD...that measurement was  shocking to me).

Early diagnosis done at local breast center in NJ.  Surgery done at Sloan (a top rated center in the US, located in NY).  

Good luck!

ballet12

Hi Rosamond, I had an MRI done after my first surgery, which was an extensive excisional biopsy which found DCIS, high grade (3) with central necrosis, multifocal and to all surgical margins.  The MRI was not particularly helpful for the DCIS breast, showing only nonspecific inflammation, but it did trigger an area of concern in the other breast.  This was rated a BIRADS4.  I subsequently went to an NCI-designated hospital (ranked #2 in nation currently--now that we are giving rankings here).  They reviewed the MRI and then actually had me repeat it.  After repeating it, they downgraded to a BIRADS3, and then repeated it in 6 months, and downgraded to a BIRADS 2 (benign).  Had I stayed with the first hospital, I would have had to have a biopsy, and now it's just history.  As I said, the MRI wasn't helpful for the DCIS, but they don't just do it to look at extent of DCIS, they are also looking for potential IDC.  It does make sense to do it.  I'd like to use it for follow-up screening, but this hospital won't be doing that.  I'll be having annual mammos and sonos (although now on a 6 month follow-up post biopsy of contralateral-non treated breast).

Janetanned

A routine mammogram found an area of DCIS in my right breast.  A biopsy confirmed this finding.  My BS ordered an MRI on both breasts eventhough my left side looked clear on the mammogram.  The MRI found two areas that looked suspicious on the left side.  An MRI guided biopsy  confirmed ILC and LCIS in left breast.  If this cancer had not been found (by the MRI) and treated I would have been in great trouble by the time it was found be exam or mammogram according to my BS.  I am very glad I had the MRI.

Myna

Dear Rosamond,

I was diagnosed in Jan of 2012 with DCIS, grade 2/3 with comedonecrosis via a 9 gauge stereo core biopsy.  Due to wanting to find whether there was more disease, the radiologist and my surgeon had recommended doing an MRI even though they are known to show false positive readings for things like inflammation due to fibrocystic disease (which I have had since I was young).  The resuts were very worrisome as they showed enhancement in a large area of the breast - from the nipple almost to the chest wall centrally.  The radiologist strongly suggested this was more cancer and that I should consider mastectomy.  I was floored!  My surgeon, a fantastic doctor as well as a caring person, suggested we do the MRI biopsy of the area anyway before proceeding with any surgery.

Turns out that when they did the core biopsy during another MRI, they only found inflammation not DCIS or any invasive disease.  I then had a lumpectomy to remove the approx 2.75 cm of DCIS originally identified in the mammogram that led to the first biopsy.  If it was not for my surgeon and her pushing me to get another biopsy I would have ended up having more significant surgery. 

Please be aware that in some cases women benefit a great deal from having an MRI as it can show true extent of disease in some women and can help someone make decisions.  In others, it appears that it picks up inflammation that looks like more cancer.  Please be careful. Ask a lot of questions before you proceed with any decisions.  In my case, the MRI picked up every little thing and it appeared to be more cancer but was not.  

You do need to know that you may end up with one or more core biopsies as you proceed if the MRI shows suspicious areas.  It may be worth it to do them as it was in my case because I avoided a mastectomy.  Of course, the biopsies are not fun at all.  It depends on your case.  Just find a really good surgeon who really is interested in their patient and knows about the limits of the various scans.  By the way, my scan was timed to a specific time in my cycle.

If you want to talk, you can PM me.  I can tell you more. 

Good luck,

Myna

deb1973

I was also diagnosed with DCIS after having an MRI. I was having bloody nipple discharge so my surgeon planned to do an excisional biopsy no matter what, but ordered the MRI too. The mammogram and ultrasound were both clear. but the MRI showed a huge area of concern in the breast. My surgeon took out the whole area that was identified on the MRI and it turned out that not only was it DCIS, but there was additional residual DCIS that didn't show on the MRI. I am glad I had the MRI, but all screening tests are imperfect so keep in mind what others have said about false results. And drink lots of water afterward to flush out the dye:-)

kathy1925

I was diagnosed with DCIS grade 3 in my right breast, after a core needle biopsy. Scheduled for a lumpectomy with radiation to follow. My breast surgeon, conservative and one of the best in the area, ordered a bilateral MRI prior to surgery, even though the left breast had appeared to be clear after a digital mammogram. The MRI showed a suspicious area in the left breast. The surgeon performed an excisional biopsy on the left breast, at the same time as the lumpectomy on my right(DCIS) breast. The biopsy showed the left breast had a small area of IDC, stage 1, grade 1.  After that near miss, I chose to have a bilateral mastectomy. I am fortunate I had the pre surgical MRI. 3 years out and all is well.

Rosamond

I appreciate all these stories as I can definitely see that the risks of false-positives do not outweigh the potential benefits of finding invasion or adding another set of imaging to rule it out. It sounds prudent to prevent potentially more difficult problems down the road in many, but not all, cases.

azul115817

I also had a false positive.  After being diagnosed via mammogram, my BS ordered an MRI, which showed suspicious activity in another quadrant of my breast.  After an MRI guided biopsy, which involved multiple pokes (ouch!) because they couldn't get the needle placed correctly, the results came back as benign.

As an added MRI-related problem, scans picked up my microcalcifications, but showed only a very small area of DCIS.  In the end, they found over 2 cm., which didn't show on scans.

I'm very happy to have had a mastectomy, as I could never trust that scans would fully pick up my disease.

Best of luck.

Staple

I was diagnosed and told by my surgeon I could have a lumpectomy, but he would like to do an MRI first.  I have very dense breast tissue.  The MRI showed significantly more DCIS than was shown on the mammogram and I needed a mastectomy.   The pathology matched and the DCIS area was much larger than the mammogram indicated.   I'm glad I got it and wish I had one a long time ago.

Blogger

I am forever grateful I had an MRI before my surgery. The biopsy I had first confirmed DCIS but the MRI was the only thing that showed the actual size of my tumor which was over 7 cc's. Neither I or the BS felt a lump and the MRI showed in was in the form of a lesion contained in a milk duct. We tried a lumpectomy first but, after getting the pathology report, it showed both breasts peppered with non-invasive cancer cells. I chose to have a BMX and have never regretted my decision. The MRI was invaluable and I am very, very glad I did it. I hope this helps you. Good luck in any decision you will make.

lane4

I was treated in  2009 and I, too, had an MRI prior to surgery. I was diagnosed after a stereotactic core biopsy and my surgeon wanted the MRI to see if there was any more disease and to check the other breast. The MRI showed numerous cysts bilaterally, but no suspicious areas on the healthy breast. The DCIS breast showed another suspicious area in a different quadrant, so I went for a "second-look" ultrasound. That area was determined to be "probably benign." Because of the MRI, my surgeon was comfortable in moving forward with a partial mastectomy (I did not want a complete mastectomy unless it was absolutely necessary). My DCIS was grade 2 solid and cribriform with central necrosis.

I know there are false positives with MRI's, but I've heard of many instances where cancers were missed by mammo and ultrasound, including two of my relatives. It's hard to know what to do when doctors can't reach a consensus on the value of something like preoperative MRI. I personally think it's best to go into surgery knowing as much as possible and it appears that MRI is the most sensitive tool they have.

sandraboyd

I did have an MRI at the beginning of this little adventure way back in 2008.  This was Feb. after another doctor did a CT scan for something else.  The CT scant showed something suspicious so my doc ordered the MRI.  unfortunately she did not read it until July of that year where the report said possible malignancy (with the MRI).  The doctor did a biopsy of the wrong area, which of course came back as great news.  With next years check up i went to another doctor not trusting the original doctor.  After the routine mamogram i realized i was the only one sitting in the waiting room after sitting for hours.  I was called back my the new radiologist who showed my the mamogram and said i need to be biopsied right away and have another MRI done.  All pointed to breast cancer.  Took two years to get that far.  The MRI was pretty good as it did show 3 problem areas. when the original MRI was compared to the new MRI only on area showed up on the original MRI. 

Aslo, if DCIS does not spread, why did I go from one area of DCIS on the original MRI to 3 areas of DCIS on the second MRI and mamogram?

I supposedly do not have an invasion of cancer.

signed sick of  this and no longer seeing an oncologist for followups since they really do nothing.

kittymama

Yes, I had an MRI pre-surgery, which showed more extensive DCIS than previously thought. It was very helpful because originally I would have had a lumpectomy, but the MRI indicated that a mastectomy was in order. The MRI findings were very accurate, except that the final pathology detected some invasion, which was not indicated by the radiologist. The MRI also showed a small area of concern in my "good breast," which was subsequently biopsied and determined to be an abnormal, but benign finding (can't recall the exact medical term). The MRI was not timed to my cycle.

nesw

I had MRI of both breasts because mammo and u/s saw a spot (that turned out to be a fibrocystic area).  However, MRI lit up other regions that turned out to be DCIS, none of which look unusual in the mammo and u/s images.  I had to have four biopsies guided by MRI and two of them were grade 3.  Post BMX pathology found microinvasive DCIS beneath one nipple that wasn't seen in any of the imaging. I just find that kind of scary.

Beesie

"Aslo, if DCIS does not spread, why did I go from one area of DCIS on the original MRI to 3 areas of DCIS on the second MRI and mamogram?"

DCIS cells are cancer cells, and like all cancer cells, they multiply.  DCIS cannot move into the open breast tissue and spread out into the nodes or into the body but as DCIS cells multiply, they can spread out within the ductal system of the breast. That's not unusual at all.  But if the cancer is still pure DCIS, then all the DCIS cancer cells are completely contained within the milk ducts and therefore, within the breast.

I had an MRI after my excisional biopsy.  It showed significantly more DCIS - spread through out my breast - than what had been seen on my mammo.  I was resisting having a MX (I had dirty margins all around after the excisional biopsy) and the MRI convinced me that it was necessary. The MRI was proved to be right since my MX pathology did show that I had DCIS through out my breast.   On the other hand, the MRI showed my other breast to be clear, despite having had 4 previous biopsies, including one just a few weeks earlier for calcifications (all the biopies were benign). So I made the decision to have a single MX.  7 1/2 years later, my other breast is still with me and so far so good.  

So I'm glad that I had the MRI and it was very helpful in my decisions.

shorfi

I was being followed with mammogram and MRI for the past 8 1/2 years. If I remember correctly, I had my mammogram in December and MRI this past June. Unfortunately, they found DCIS in the opposite breast. I was devastated. Had SNB which was negative...thank goodness. I am scheduled to have bilateral mastectomies with immediate reconstruction on August 1st.

I felt like I did everything right, and this happened again. My BS says this is a "good" cancer to have. I told her, no cancer is "good". But it is a new primary and I am thankful it is not a recurrence.

So for me, in the span of 6 months, the MRI picked it up and I am thankful. It was found very early and the prognosis looks good. Even still, I wish I didn't have it

lane4

shorfi - Are you saying that your DCIS was picked up on your MRI in June, but not seen on your mammo in December? I'm asking because I've been questioning the need for annual MRIs in addition to annual mammograms 6 months apart.

Mgster

I had an MRI before surgery for my DCIS.  It showed "something" so they scheduled me for an MRI biopsy.  Much more DCIS was found...too much for a lumpectomy, so I did have to have a mastectomy.  My doctor requested that they do the MRI on both breasts and luckily the other one showed nothing at all. 

shorfi

Yes it was. I was stunned that nothing was seen on the mammogram six months prior. For me, the careful screening worked and I am forever grateful.

sunny1157

Shorfi - did you have another mammogram after your MRI in June? If so did it show anything abnormal? So sorry you have to go through this again!

shorfi

No I didn't have another mammogram. After I had the ultrasound needle core biopsy I did at that time, but only on the right breast. I'm just happy that it was found early and was very small. SNB was negative also. And, it's not a recurrence. So all those things were in my favor.

lovestorun

I had an MRI after a diagnosis of DCIS; I have dense tissue. I was warned and given a handout about false positives.  The MRI picked up something suspicious in my other breast, and I had an MRI biopsy - that turned out to be benign.  The MRI biopsy was not fun physically or emotionally, but I don't regret it. I felt as though I had as much information as I could to make treatment decisions, and my doctors had the best information they could going into surgery. 

Good luck with your decision. 

Rosamond

I posted a little update on original post. Had the MRI and was very comfortable through procedure. Went by quickly. It showed 5cm enhancement, as opposed to mammography showing 2.5-4.4cm, so not that much more. I suggested performing an MRI guided biopsy on the far end of the enhancement to see if it was accurate as the near end of the area matched the titanium marker from biopsy #1. I am still in the borderline area for a lumpectomy vs. mastectomy. If the second biopsy shows DCIS, I feel as if I can go forward with the mastectomy with the knowledge that, given all evidence available pre-surgery, it will be the best course of action to achieve wide margins and removal. If it is benign, I will feel more confident about lumpectomy.



I am also pleased that nothing else of immediate suspicion appeared in either breast, just a cyst and some nodularity to monitor in the future. And, the MRI enhancement was consistent with the inflammation of DCIS. I have also come to accept that a mastectomy may be necessary and will be grateful for it if it means the cancer will be gone.



I will update this thread once I have more info, and, most importantly, after my surgical pathology results to see how well all the imaging evidenced the actual situation.



Thank you, everyone, for posting. It never ceases to amaze me how unique each person's experience is, was, and continues to be with breast cancer.