Rationale and Objectives
To determine the cancer detection rate and abnormal interpretation rate of screening breast magnetic resonance imaging (MRI) in previously treated breast cancer patients.
Materials and Methods
Institutional review board–approved retrospective review of the breast MRI database from 2009 to 2011 identified a total of 3297 screening examinations. After excluding genetic mutation carriers, untested first-degree relatives of known mutation carriers, and patients with a history of chest irradiation, there were 1194 (36.2%) examinations in 691 patients previously treated for breast cancer. MRI reports were reviewed to determine MRI findings and breast imaging reporting and data system (BI-RADS) assessments. The longitudinal medical record was reviewed to determine patient demographics and outcomes of imaging surveillance and biopsy.
Results
Mean patient age at initial cancer diagnosis was 46.1 years, and mean patient age during the study interval was 52 years. Cancer detection rate was 10 per 1000 (1%; 95% confidence interval [CI], 0.5%–1.8%]; 12 of 1194 examinations). Overall 10.7% (128 of 1194) of examinations received an abnormal interpretation, including 5.4% (65 of 1194) BI-RADS 4 or 5 and 5.3% (63 of 1194) BI-RADS 3 assessments with a 9.4% positive predictive value (PPV1; 12 of 128 examinations) and a 17.9% PPV3 (12 malignancies per 67 biopsies).
Conclusions
Screening breast MRI in women previously treated for breast cancer detected cancer in 1.0% of examinations, with a 10.7% abnormal interpretation rate, and a PPV for malignancy of 17.9%.
Breast magnetic resonance imaging (MRI) is recommended as a supplemental screening examination for women at an increased (at least 20%–25%) lifetime risk of developing breast cancer because of its high sensitivity for the detection of invasive malignancies. Groups recommended for supplemental MRI screening include genetic mutation carriers and first-degree untested relatives of genetic mutation carriers; women with Li-Fraumeni, Cowden, Bannayan-Riley-Ruvalcaba syndromes and their untested first-degree relatives; and women with a history of chest irradiation. Evidence supporting supplemental breast MRI screening has been considered to be insufficient to justify routine MRI surveillance for women with a lesser lifetime risk (15%–20%) of developing breast cancer and for women with a previous history of breast cancer .
Breast cancer survivors remain at risk for recurrent or new breast cancer, and they warrant careful clinical and mammographic follow-up. The 10-year incidence of ipsilateral breast cancer recurrence after lumpectomy and radiation therapy has been reported to be 6.4% in node-negative disease and 8.7% in node-positive disease . In another study reporting 20-year follow-up results in women who had undergone prior breast conservation and radiation therapy, a 14.3% local recurrence rate was reported . Women treated with mastectomy for breast cancer have been reported to develop contralateral breast malignancies ranging from 8.9% to 12% at 20-year follow-up.
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Materials and methods
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Results
Patient Demographics
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Screen-Detected Malignancies
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Table 1
Comparison of Women with Cancer-Detected on MRI Compared to Women without Cancer
Demographic Women with Cancer Women without Cancer_P_ Value Family history of breast cancer in first degree relative .19 Positive 5 167 Negative 7 504 Menopausal status at time of diagnosis .53 Premenopausal 7 451 Postmenopausal 5 204 Perimenopausal 21 Mean age at initial breast cancer diagnosis 48.9 years 46.9 years Mean age at MRI screening 56.7 years 53.0 years
BIRADS, breast imaging reporting and data system; MRI, magnetic resonance imaging.
Table 2
Twelve Malignancies Detected on Screening Breast MRI
Malignancy Age at Screening MR Diagnosis Age at Initial Cancer Diagnosis Side of Lesion MRI Finding Pathology 1 49 43 Ipsilateral Nonmass enhancement DCIS 2 76 61 Ipsilateral Nonmass enhancement DCIS 3 46 44 Ipsilateral Nonmass enhancement DCIS 4 64 61 Ipsilateral Nonmass enhancement DCIS 5 47 38 Contralateral Mass DCIS 6 48 46 Contralateral Focus IDC, Stage 1A 7 64 59 Ipsilateral Mass IDC 8 26 22 Ipsilateral Mass IDC 9 47 41 Ipsilateral Mass IDC 10 72 41 Ipsilateral Nonmass enhancement IDC 11 59 55 Contralateral Focus IDLC, Stage 1B 12 82 76 Contralateral Mass ILC, Stage 1B
DCIS, ductal carcinoma in situ; IDC, invasive ductal carcinoma; IDLC, invasive ductal and lobular carcinoma; ILC, invasive lobular carcinoma; MRI, magnetic resonance imaging.
Ipsilateral lesions were considered breast cancer recurrences, and therefore, no staging is given.
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Abnormal Screening MRI Interpretations
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Discussion
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