Rationale and Objectives
Six-month short-interval follow-up is recommended for probably benign findings on breast magnetic resonance imaging (MRI). We wanted to examine patient adherence to follow-up recommendation for Breast Imaging-Reporting and Data System (BI-RADS) category 3 lesions at a tertiary care medical center.
Materials and Methods
We performed a retrospective review of frequency and adherence rates to follow-up recommendation for women with an initial BI-RADS 3 breast MRI between 2005 and 2007.
Results
A total of 132 women with BI-RADS 3 breast MRI recommendations were included. Ninety-six of 132 (72.7%) women adhered to the first follow-up recommendation or elected to have tissue diagnosis; 78/132 (59.1%) had follow-up MRI and 18/132 (13.6%) had tissue diagnosis. Thirty-six of 132 (27.3%) women did not return for follow-up. Nine of nine (100%) of BRCA carriers returned for follow-up or had tissue diagnosis, compared to 87/123 (70.7%) of non-BRCA carriers. A total of 35/41 (85.4%) of patients with a prior history of breast cancer returned for follow-up or had tissue diagnosis, compared to 61/91 (67%) of patients without a history of breast cancer. Only 5/15 (33%) of patients undergoing MRI for symptom alone adhered to follow-up recommendations.
Conclusion
Adherence to BI-RADS category 3 follow-up recommendation is often low. Women with a history of breast cancer or who were BRCA carriers were significantly more likely to adhere to follow-up recommendation than women without a history of breast cancer or women undergoing MRI for symptoms alone. Strategies to improve adherence should be developed.
Breast cancer is the most commonly diagnosed female malignancy in the United States with the exception of non-melanoma skin cancer, with an estimated incidence of 209,060 new cases in 2010 . Mammography is currently the accepted standard for the detection of early breast cancers . However, sensitivity of mammography varies significantly with breast density . The sensitivity of breast magnetic resonance imaging (MRI) approaches 100% for invasive breast cancer. Breast MRI is highly sensitive even for mammographically occult invasive breast malignancies , and sensitivity of MRI is superior to mammography in women with dense breasts .
Because of its high sensitivity for invasive breast cancer, breast MRI is used as a screening tool in high-risk patients. Several studies of women at more than 20%–25% risk of breast cancer demonstrated that MRI has superior sensitivity compared to mammography, without a significant decrease in specificity . Breast MRI is currently recommended by the American Cancer Society as an adjunct to mammography in women at high risk for developing breast cancer, including women with BRCA mutations, women with a lifetime risk of 20%–25% or higher based on risk assessment models, or those with a history of chest irradiation.
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Materials and methods
Study Population
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MRI Technique, Interpretation, and Reporting
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Data Collection
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Statistical Analysis
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Results
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Table 1
Patient Characteristics
Number Percent Total number of patients 132 Length of follow-up (months) Mean 34.8 Median 37 Range 4–65 Age Mean 51.9 Median 51 Range 25–81 Prior history of breast cancer Yes 41 31.06 No 91 68.94 Indication for magnetic resonance imaging Abnormal mammogram 28 21.21 BRCA, no history of cancer 7 5.3 BRCA, history of cancer 2 1.52 Clinical symptom 15 11.36 History of breast cancer 34 25.76 History of breast cancer plus other risk factor 5 3.79 Other high risk patient 29 21.97 Other/combined 12 9.09 History of BRCA mutation Yes 9 6.82 No 123 93.18
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Adherence with Follow-up Breast MRI
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Outcomes of Follow-up Breast MRI
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Discussion
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