Submited on: 14 Nov 2016 07:44:11 AM GMT
Published on: 15 Nov 2016 09:51:35 AM GMT
Ductal Carcinoma In Situ--Needs Further Investigation
Posted by Ms. Taylor Wyatt on 21 Nov 2016 02:40:39 PM GMT Reviewed by Interested Peers

  • What are the main claims of the paper and how important are they?

    That MRI provides a clearer and more accurate description of the size and extent of DCIS but also has the greatest likelihood (compared to ultrasound and mammography) to overestimate tumor size

  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.


  • Are the claims properly placed in the context of the previous literature?

    This paper appears to be very well cited.  That said, by broadening their search criteria, the researchers may have been able to find more examples of comparative imaging studies with respect to pathologies other than DCIS.  

  • Do the results support the claims? If not, what other evidence is required?

    While the data seems to point toward the claim that MRI is superior over US and MMG, the retrospective study conducted was quite small, and as the paper admits, there was no form of blind in data analysis.  In light of these two things, much more research with a larger patient population and perhaps several other different disease states in addition to DCIS would be needed before more conclusive claims can be made. Additionally, some form of blind (I understand that this particular study structure could make it difficult) would be incredibly important. 

  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    The methodology seems to be well thought out, but this paper essentially dealt with going through old patient records and images looking for a study population.  Only a handful of doctors conducted this research and they were likely familiar with at least some of the patients and their particular cases.  Because of this and because of study size, it may be difficult to reproduce comparable results about under/overestimating or accurately measuring tumor sizes with the three techniques studied.  A larger study could provide a better idea of standard deviations, reproducibility, etc.   

  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    If the study size were increased 4 to 5 fold and comprised of a more diverse population, the validity of the claims of this paper would be increased.  Therefore, a larger study that explores DCIS (and maybe other related disease states, too) in more types of patients would be beneficial to this research.  Furthermore, different percentage criteria of what constitutes "accurate" tumor size measurement should be explored.  Finally, in statistical and data analysis, the researchers should consider breaking the population into different subsets to see if age makes precision imaging more or less accurate/reliable. This same idea could be extended to different ethnic groups, lifestyles, etc., as well. 

  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    As is, this paper is not outstanding, but its claims are intriguing--specifically in light of the implications of accurate or inaccurate measurement in medical imaging as it applies not just to the breasts but to the entire body.  However, as far as DCIS is concerned, a larger study population would be vital before these results should be presented in an academic setting. 

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  • How to cite:  Wyatt T .Ductal Carcinoma In Situ--Needs Further Investigation[Review of the article 'Ductal Carcinoma In Situ: Comparison of Mammography, Ultrasonography, and MRI in the Evaluation of Disease Extent ' by Kim H].WebmedCentral 2016;7(11):WMCRW003339
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