Quality standard

Quality statement 2: Preoperative MRI scan

Quality statement 2: Preoperative MRI scan

Quality statement

People with biopsy-proven invasive breast cancer or ductal carcinoma in situ (DCIS) are not offered a preoperative MRI scan unless there are specific clinical indications for its use. [new 2016]

Rationale

An MRI scan is not needed to assess a tumour before surgery for people with biopsy-proven invasive breast cancer or DCIS except in specific clinical situations. Carrying out an unnecessary preoperative MRI scan may cause additional stress without any benefit and waste healthcare resources.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that people with biopsy-proven invasive breast cancer or DCIS do not have an MRI scan for preoperative assessment unless there are specific clinical indications for its use.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from local protocols and service specifications.

Process

Proportion of MRI scans for preoperative assessment of people with biopsy-proven invasive breast cancer or DCIS in which there is a specific clinical indication for its use.

Numerator – the number in the denominator in which there is a specific clinical indication for preoperative MRI.

Denominator – the number of MRI scans for preoperative assessment of people with biopsy-proven invasive breast cancer or DCIS.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

Outcome

Patient satisfaction with preoperative treatment of people with biopsy-proven invasive breast cancer or DCIS.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient satisfaction surveys.

What the quality statement means for different audiences

Service providers (such as secondary care services and specialist breast cancer services) ensure that systems are in place so that people with biopsy-proven invasive breast cancer or DCIS are not offered a preoperative MRI scan unless there are specific clinical indications for its use.

Healthcare professionals (such as doctors, nurses and specialists) are aware of local referral pathways for breast cancer to ensure that people with biopsy-proven invasive breast cancer or DCIS are not offered a preoperative MRI scan unless there are specific clinical indications for its use.

Commissioners ensure that they commission services in which people with biopsy-proven invasive breast cancer or DCIS are not offered a preoperative MRI scan unless there are specific clinical indications for its use.

People with invasive breast cancer that has been confirmed by a biopsy of their tumour, and people with a type of cancer called ductal carcinoma in situ (or DCIS), are not usually offered an MRI scan before surgery.

Definitions of terms used in this quality statement

Specific clinical indication for preoperative MRI scan

Offer MRI of the breast to patients with invasive breast cancer:

  • if there is discrepancy regarding the extent of disease from clinical examination, mammography and ultrasound assessment for planning treatment

  • if breast density precludes accurate mammographic assessment

  • to assess the tumour size if breast-conserving surgery is being considered for invasive lobular cancer.

[NICE's guideline on early and locally advanced breast cancer, recommendation 1.1.3]