Breast MRI Shows Promise for High-Risk Women

Abstract Objective To compare cancer detection rate (CDR), patient recall, and interpretation time of a full protocol MRI (fpMRI) to an abbreviated MRI protocol (abMRI) in high-risk women. Methods This retrospective study was approved by the IRB. All sequential high-risk screening MRI examinations performed between January 1, 2013, and December 31, 2016, were included. Breast radiologists reviewed patient history, prior images, and abMRI images and recorded their interpretation. Time for interpretation reflected review of the MRI study but not dictation or report generation. Following a minimum 30-day washout period, radiologists interpreted the fpMRI, with interpretation and timing recorded. Data collected included CDR, interpretation time, and patient recall rate. Statistical analyses utilized were Cohen’s kappa coefficient, Student’s t-test, and McNemar’s test. Results Included were 334 MRI examinations of 286 women. Interpretation time was 60.7 seconds for the abMRI compared to 99.4 seconds for the fpMRI, with an average difference of 38.7 ± 5.4 seconds per patient (P < 0.0001). Recall rates were comparable: the abMRI recall rate was 82/334 (24.6%) and the fpMRI 81/334 (24.3%). All five cancers included were detected by both protocols with equal recall rate. However, there were more recommendations for biopsy with the fpMRI, although this difference was not statistically significant. Conclusion The abMRI demonstrated comparable CDR to fpMRI, with shortened interpretation time and similar recall rates. Implementing an abMRI to screen high-risk women reduces imaging and interpretation time, thereby improving cost-effectiveness and the patient experience without reduction in cancer detection.

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Primary Studies on Breast MRI Screening of High-Risk Women

Breast MRI for High-risk Screening ◽

10.1007/978-3-030-41207-4_9 ◽

2020 ◽

pp. 131-151

Author(s):

Francesco Sardanelli ◽

Franca Podo

Keyword(s):

High Risk ◽

Breast Mri ◽

High Risk Women

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A PRELIMINARY STUDY OF RISK FACTORS OF BREAST CANCER AND THE USEFULNESS OF BREAST MRI AS AN ADDITION TO MAMMOGRAPHY IN DETECTING BREAST CANCER IN HIGH RISK WOMEN

Jurnal Teknologi ◽

10.11113/jt.v78.9867 ◽

2016 ◽

Vol 78 (11-3) ◽

Author(s):

Noor Khairiah A. Karim ◽

Rohayu Hami ◽

Nur Hashamimi Hashim ◽

Nizuwan Azman ◽

Ibrahim Lutfi Shuaib

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

High Risk ◽

Cancer Detection ◽

Significant Risk ◽

Breast Mri ◽

Breast Cancer Detection ◽

P Value ◽

High Risk Women ◽

History Of

The risk factors of breast cancer among women, such as genetic, family history and lifestyle factors, can be divided into high-, intermediate- and average-risk. Determining these risk factors may actually help in preventing breast cancer occurrence. Besides that, screening of breast cancer which include mammography, can be done in promoting early breast cancer detection. Breast magnetic resonance imaging (MRI) has been recommended as a supplemental screening tool in high risk women. The aim of this study was to identify the significant risk factor of breast cancer among women and also to determine the usefulness of breast MRI as an addition to mammography in detection of breast cancer in high risk women. This retrospective cohort study design was conducted using patients’ data taken from those who underwent mammography for screening or diagnostic purposes in Advanced Medical and Dental Institute, Universiti Sains Malaysia, from 2007 until 2015. Data from 289 subjects were successfully retrieved and analysed based on their risk factors of breast cancer. Meanwhile, data from 120 subjects who had high risks and underwent both mammography and breast MRI were further analysed. There were two significant risk factors of breast cancer seen among the study population: family history of breast cancer (p-value=0.012) and previous history of breast or ovarian cancer (p-value <0.001). Breast MRI demonstrated high sensitivity (90%) while mammography demonstrated high specificity (80%) in detection of breast cancer in all 120 subjects. The number of cases of breast cancer detection using breast MRI [46 (38.3%)] was higher compared to mammography [24 (20.0%)]. However, breast MRI was found to be non-significant as an adjunct tool to mammography in detecting breast cancer in high risk women (p-value=0.189). A comprehensive screening guideline and surveillance of women at high risk is indeed useful and should be implemented to increase cancer detection rate at early stage

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Comparison of false positive rates for screening breast MRI in high risk women when studies are done stacked versus alternating.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.1512 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 1512-1512

Author(s):

Edress Othman ◽

Jue Wang ◽

Brian Sprague ◽

Yongli Ji ◽

Sally D. Herschorn ◽

...

Keyword(s):

Breast Cancer ◽

High Risk ◽

False Positive ◽

Brca Mutation ◽

False Positive Rate ◽

Menopausal Status ◽

Breast Mri ◽

High Risk Women ◽

Increased Risk ◽

Optimal Screening

1512 Background: Screening breast MRI added to mammography increases screening sensitivity for high risk women. However, false positive rates are high for MRI and the optimal screening schedule is unclear. In this study we compare rates of false positive MRI when studies were performed on a stacked or alternating schedule. Methods: We reviewed charts for women at increased risk for breast cancer who had screening breast MRI between 2004 - 2012 at the University of Vermont. Eligible women had at least 1 MRI and 1 mammogram performed within one year. Charts were abstracted for clinical, radiological, and biopsy data. Screening was considered stacked if both studies were performed within 90 days and alternating if studies were 4-8 months apart. False positive was defined as MRI result of BI-RADS 3-4-5-0 with additional negative imaging within 12 months or benign biopsy. Results: 143 women had screening which met inclusion criteria; 45 per stacked schedule, 52 alternating, 40 mixed and 6 neither. Women in this study had similar characteristics with respect to age, ethnicity, menopausal status and indications for MRI (i.e. family history, BRCA mutation, biopsy history and prior chest irradiation). 371 MRIs were reviewed (165 stacked and 206 alternating). The overall false positive rate was higher in the stacked group vs. alternating [30(18.2%) vs. 21(10.2%), p=0.0264]. Using only BI-RADS 4-5-0 as a positive result that difference was lost. There were significantly more BI-RADS category 3 interpretations in the stacked vs. alternating MRIs [16(9.7%) vs. 6(2.9%), p=0.006]. The rate of BI-RADS category 4-5-0 was not different between the two groups [16(9.7%) vs. 17(8.3%), p= 0.6272]. A similar number of biopsies were performed in both groups Conclusions: MRI added to mammography for women at increased risk for breast cancer was associated with higher rates of false positive interpretations when studies were done on a stacked compared to alternating schedule. In this study the greater number of BI-RADS 3 interpretations with a stacked schedule accounted for this difference. Further studies are needed to identify the optimal screening schedule when adding MRI to mammography.

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Determination of recall rates for assessment in high-risk women undergoing annual surveillance breast MRI

Clinical Radiology ◽

10.1016/j.crad.2016.07.011 ◽

2016 ◽

Vol 71 (11) ◽

pp. 1143-1147 ◽

Cited By ~ 3

Author(s):

N.A. Healy ◽

S.A. O'Keeffe

Keyword(s):

High Risk ◽

Breast Mri ◽

High Risk Women

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Efficacy of Screening Breast MRI for High-Risk Women

10.1093/med/9780190223700.003.0039 ◽

2016 ◽

Author(s):

Christoph I. Lee

Keyword(s):

High Risk ◽

Breast Magnetic Resonance Imaging ◽

Breast Mri ◽

Resonance Imaging ◽

Additional Information ◽

High Risk Women ◽

Study Methodology ◽

Breast Magnetic Resonance ◽

Magnetic Resonance Imaging Mri ◽

Higher Sensitivity

This chapter, found in the cancer screening and management section of the book, provides a succinct synopsis of a key study examining the efficacy of screening breast magnetic resonance imaging (MRI) for high-risk women. This summary outlines the study methodology and design, major results, limitations and criticisms, related studies and additional information, and clinical implications. Breast MRI screening has higher sensitivity than mammography for high-risk women, but both the specificity and positive predictive value are lower than for mammography screening. In addition to outlining the most salient features of the study, a clinical vignette and imaging example are included in order to provide relevant clinical context.

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