Cancer De Mama

[51] The UK NIHR multicentre randomised COMICE trial of MRI planning for breast conserving treatment for breast cancer.

Drew PJ, Harvey I, Hanby A, Brown S, Olivier C, Napp V, Brown J, Turnbull LW,on Behalf of Comice Trialists Hull York Medical School, Hull, East Yorkshire, United Kingdom; CTIU, Leeds, Yorkshire, United Kingdom; Leeds General Infirmary, Leeds, Yorkshire, United Kingdom; HullRoyal Infirmary, Hull, United Kingdom

The role of the addition of MR imaging (MRI) to routine techniques for loco-regional staging of primary breast cancer is unclear. The UK NIHR HTA multicentreCOMICE trial considered whether adding an MRI scan to conventional triple assessment (mammogram, ultrasound and biopsy) assisted loco-regional staging and thereby reduced re-operation rates, for patientswith primary breast cancer scheduled for wide local excision.
The primary endpoint of the COMICE trial considered the proportion of patients undergoing a repeat operation or mastectomy at furthersurgery within six months of randomisation, or an avoidable mastectomy at initial surgery (re-operation rate). This was compared using logistic regression adjusting for age, breast density, andsurgeon.
Between December 2001 and January 2007 1625 patients were randomised to receive MRI (817) or not (808). Re-operation rate within six months (primary outcome) was 18.8% (MRI) and 19.3% (no MRI). Nosignificant difference between the arms was detected (odds ratio=0.96, 95% CI=[0.75, 1.24], p=0.7691). Secondary endpoints included quality of life, imaging effectiveness and local recurrence.
The results ofthe COMICE trial indicate no significant benefit in terms of reduction in re-operation rates, by the addition of MRI to conventional triple assessment for this patient group. These results haveimportance from both health economic and patient burden perspectives.
This project was funded by the NIHR Health Technology Assessment (HTA) Programme (project number 99/27/05) and will be published in...