Place de l’IRM Mammaire dans le bilan d’extension locorégional préthérapeutique du cancer du sein - Rapport d'évaluation - Place of Breast MRI in the pre-treatment locoregional spread assessment of breast cancer - Abstract

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Posted on Mar 31 2010 To evaluate the diagnostic performance of breast MRI and the influence of various factors on it with a view to establishing the value of carrying out breast MRI when assessing the pre-therapy locoregional spread of breast cancer Posted on Mar 31 2010
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01 mars 2010

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Place of Breast MRI in the pre-treatment locoregional spread assessment of breast cancer    Haute Autorité de Santé (HAS), Saint-Denis La Plaine, France Author : Olivier Allaire, HAS, France    Aim To evaluate the diagnostic accuracy of breast MRI and the influence of various factors on it in order to estimate the usefulness of breast MRI in t he pre-treatment locoregional spread assessment of breast cancer.  Conclusions and results The sensitivity of breast MRI in detecting additional lesions, which is greater than that of mammography, comes with false positives in proportions that vary according to the populations studied. These false positives mean that caution is needed when considering any change in therapeutic management on the basis of breast MRI results. Thus, the use of breast MRI in the pre-treatment locoregional spread assessment of breast cancer should be reserved for clearly defined situations.  Recommendations (if any) HAS recommends carrying out breast MRI in pre-treatment locoregional assessment in the following situations :  -difficult treatment choices have to be made (  surgery, conservative oncoplastic When treatment or mastectomy, neoadjuvant treatment) ; - In women under 40 years of age ; - women with a high familial risk of breast cancer. In  There are no data about the contralateral breast to confirm or deny the usefulness of performing breast MRI to examine the contralateral breast.  Methods Critical analysis of the clinical data published from 01/1999 to 09/2009 from a document search made of the MEDLINE and Cochrane Library databases. 103 studies were analysed. The results of this analysis were discussed by a multidisciplinary working group consisting of 6 radiologists, 1 radiotherapist, 1 anatomopathologist, 4 gynaecologists, 2 oncologists and 1 plastic surgeon. Conclusions have been reviewed by the Commission d’Evaluation des Actes Professionnels (CEAP), the HAS specialized appraisal committee.  Further research/reviews required The data currently available are insufficient basis for a ruling on the impact of breast MRI pre-treatment assessment on recurrence and patient survival. Long-term studies are needed before this question can be answered.  
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