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Ultrafast Imaging Helps Predict Upgrade from DCIS to Invasive Cancer During Breast Surgery

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Breast cancer remains a prevalent concern for women, with statistics showing it as one of the top contributors to cancer-related fatalities. However, the good news is that recent breakthroughs in research offer promising prospects for better outcomes and lower risk.

One such development is the use of ultrafast (UF) MRI, as found in a study published in the American Journal of Roentgenology. This cutting-edge technology provides crucial data that can assist in surgical planning, including determining the need for a sentinel lymph node biopsy.

UF-MRI is a type of magnetic resonance imaging (MRI) that is capable of capturing images of the body in real-time. It works by using advanced technology that allows for faster image acquisition and processing, resulting in highly detailed images that can be obtained in a matter of seconds.

This type of MRI is particularly useful in surgical planning, as it provides valuable information that can help doctors make informed decisions about the best course of treatment.

“Preoperative UF-MRI, time to enhancement, and lesion size on conventional dynamic contrast-enhanced (DCE) MRI and mammography show potential in predicting upgrade of ductal carcinoma in situ (DCIS) to invasive cancer at surgery,” wrote first author Rachel Miceli, MD, of NYU Langone Health.

Researchers identified consecutive women with biopsy-proven pure DCIS lesions who underwent UF-MRI with DCE-MRI and had subsequent surgery between August 2019 and January 2021. To determine predictors of upgrade to invasive cancer, patient and lesion characteristics; biopsy method and pathology; as well as lesion features on mammography, ultrasound, DCE-MRI, and UF-MRI were assessed.

Ultimately, at surgery, 38% of lesions diagnosed as DCIS at percutaneous biopsy were upgraded to invasive cancer. Time to enhancement on UF-MRI was associated with an upgrade from DCIS to invasive cancer (p=.03) with an optimal threshold of 11 seconds (specificity, 50%; sensitivity, 76%).

One key area where UF-MRI can be beneficial is in determining the need for a sentinel lymph node biopsy. This is a type of biopsy that is used to identify the first lymph node that a cancerous tumour is likely to spread to. By using ultrafast MRI, doctors can quickly and accurately identify the location of the sentinel lymph node and determine if a biopsy is necessary. This can help reduce the need for more invasive procedures and minimise the risks associated with surgery.

In addition to its usefulness in surgical planning, UF-MRI can also be used to monitor the effectiveness of cancer treatment, track the progression of the disease, and detect any recurrence. With its ability to provide detailed images in real-time, ultrafast MRI is becoming an increasingly important tool in the field of medical imaging and cancer diagnosis and treatment.

Reiterating that short time to enhancement can assist prediction of lesions diagnosed as DCIS at percutaneous biopsy that will be upgraded to invasive cancer at surgery, “further studies with larger cohorts will be helpful in assessing the contribution of UF-MRI for the prediction of upgrade in clinical practice,” Miceli concluded.

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