Breast MRI Screening for High-Risk Patients

Abstract Objectives MRI is an integral part of breast cancer screening in high-risk patients. We investigated whether the application of the Kaiser score, a clinical decision-support tool, may be used to exclude malignancy in contrast-enhancing lesions classified as BI-RADS 4 on breast MRI screening exams. Methods This retrospective study included 183 consecutive, histologically proven, suspicious (MR BI-RADS 4) lesions detected within our local high-risk screening program. All lesions were evaluated according to the Kaiser score for breast MRI by three readers blinded to the final histopathological diagnosis. The Kaiser score ranges from 1 (lowest, cancer very unlikely) to 11 (highest, cancer very likely) and reflects increasing probabilities of malignancy, with scores greater than 4 requiring biopsy. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic accuracy. Results There were 142 benign and 41 malignant lesions, diagnosed in 159 patients (mean age, 43.6 years). Median Kaiser scores ranged between 2 and 5 in benign and 7 and 8 in malignant lesions. For all lesions, the Kaiser score’s accuracy, represented by the area under the curve (AUC), ranged between 86.5 and 90.2. The sensitivity of the Kaiser score was high, between 95.1 and 97.6% for all lesions, and was best in mass lesions. Application of the Kaiser score threshold for malignancy (≤ 4) could have potentially avoided 64 (45.1%) to 103 (72.5%) unnecessary biopsies in 142 benign lesions previously classified as BI-RADS 4. Conclusions The use of Kaiser score in high-risk MRI screening reliably excludes malignancy in more than 45% of contrast-enhancing lesions classified as BI-RADS 4. Key Points • The Kaiser score shows high diagnostic accuracy in identifying malignancy in contrast-enhancing lesions in patients undergoing high-risk screening for breast cancer. • The application of the Kaiser score may avoid > 45% of unnecessary breast biopsies in high-risk patients. • The Kaiser score aids decision-making in high-risk breast cancer MRI screening programs.

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Time-related changes in yield and harms of screening breast MRI.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.1508 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 1508-1508

Author(s):

Holly Jane Pederson ◽

Colin O'Rourke ◽

Lauren D Bolden ◽

Sobia Khan ◽

Manisha Yadav ◽

...

Keyword(s):

High Risk ◽

False Positive ◽

Short Interval ◽

Breast Mri ◽

Patient Characteristics ◽

Screening Mammography ◽

Significance Level ◽

High Risk Patients ◽

Risk Patients ◽

Over Time

1508 Background: MRI has been accepted as a useful adjunct to screening mammography in high-risk women. Concerns remain over false positive findings, however, and little is known about harms and yield over time. Such information will help women decide about enhanced surveillance. Methods: Of 350 high risk patients offered MRI screening, 320 underwent 757 screens with a 1.5 Tesla magnet from 2008 to 2012 alternating (q 6 mo.) with digital mammography. Data collected included patient characteristics, mammographic density, estimated lifetime risk, and need for additional imaging and/or biopsy. Harms were defined as second look ultrasounds, US or MRI guided core biopsies, surgical biopsies or recommendation for short interval follow up. Estimates of harms over time were modeled by logistic regression. A significance level of 0.05 was used for all testing. Results: Compliance with MRI screening as recommended was 91% with the first MRI, and was not associated with age, race or level of risk. Harms were highest with the first MRI and decreased significantly with subsequent MRIs. Of 59 biopsies, 7 were malignant. Two were found in MRI 1, 3 in MRI 3 and 2 in MRI 4. Women with biopsies resulting from false positive findings were significantly younger (median age 44.5 as compared with 48; p=0.049) and were more likely to have extremely dense breast tissue (36% vs 17%; p=0.028.) Conclusions: This study of highly compliant high risk patients supports the use of MRI as an adjunct to mammography for early detection. The rate of harmful events decreased over time, yet cancer detection did not. This information is critical in counseling women who are considering annual screening breast MRI, particularly younger women and those with dense tissue. [Table: see text]

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Breast MRI as an Adjunct to Mammography for Breast Cancer Screening in High-Risk Patients: Retrospective Review

Breast Diseases A Year Book Quarterly ◽

10.1016/j.breastdis.2016.01.015 ◽

2016 ◽

Vol 27 (1) ◽

pp. 41-42

Author(s):

R. Rakow-Penner ◽

H. Ojeda-Fournier

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

High Risk ◽

Breast Cancer Screening ◽

Retrospective Review ◽

Breast Mri ◽

High Risk Patients ◽

Risk Patients

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Breast MRI as an Adjunct to Mammography for Breast Cancer Screening in High-Risk Patients: Retrospective Review

American Journal of Roentgenology ◽

10.2214/ajr.13.12264 ◽

2015 ◽

Vol 204 (4) ◽

pp. 889-897 ◽

Cited By ~ 28

Author(s):

Antony Raikhlin ◽

Belinda Curpen ◽

Ellen Warner ◽

Carrie Betel ◽

Barbara Wright ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

High Risk ◽

Breast Cancer Screening ◽

Retrospective Review ◽

Breast Mri ◽

High Risk Patients ◽

Risk Patients

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Breast MRI Key for High-Risk Patients

Ob Gyn News ◽

10.1016/s0029-7437(05)70429-8 ◽

2005 ◽

Vol 40 (10) ◽

pp. 1-4

Author(s):

GINA SHAW

Keyword(s):

High Risk ◽

Breast Mri ◽

High Risk Patients ◽

Risk Patients

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Detection of new or additional significant breast disease by MRI compared to standard imaging in “high-risk” and “non-high–risk” patients.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.26_suppl.22 ◽

2013 ◽

Vol 31 (26_suppl) ◽

pp. 22-22

Author(s):

Amy Lynn Banks ◽

Rachel Titus ◽

Marianne Melnik

Keyword(s):

Breast Cancer ◽

High Risk ◽

False Positive Rate ◽

Breast Mri ◽

Genetic Mutation ◽

New Disease ◽

High Risk Patients ◽

Risk Patients ◽

Clinically Significant ◽

Significant Disease

22 Background: Mammography is the standard of care for the early detection of breast cancer. Recently, studies have shown that Magnetic Resonance Imaging (MRI) has greater sensitivity in cancer detection. However, there have been reports identifying a high false positive rate. The aim of our study was to determine if breast MRI aids in the detection of new clinically significant disease, even in “low risk” patients, when compared to ultrasound (US) or mammography alone. Methods: A review of all patients who underwent breast MRI under the care of a single surgeon between 1/1/07 through 6/1/11 was conducted. Patients were categorized as high or non-high risk based on a history of breast cancer, genetic mutation, significant family history or >20% lifetime Gail model risk. For this study a clinically significant disease is defined as a new cancer or high-risk lesion that requires close follow-up and monitoring. Results: A total of 163 patients had a breast MRI and all had concerning findings. Compared to US or mammogram, MRI identified new or additional disease that changed plans in 150/159 (94.3%) patients. Of these, MRI added clinically relevant findings in 85 patients (56.7%, p<0.001). In those considered “high risk” MRI detected clinically significant disease in 37/76 (48.7%) and in 46/76 (60.5%) of the non-high risk group. 16 patients were <40 and MRI found new disease in 2/7 (28.6%) high risk patients compared to 3/9 (33.3%) non-high risk patients. 48 patients were 41-50 years old and MRI detected new disease in 12/24 (50%) high risk patients compared to 13/24 (54.2%) non-high risk. Of the 37 patients aged 51-60, MRI found new disease in 11/19 high risk patients (57.9%) compared to 14/18 (77.8%) non-high risk. 50 patients >60 years of age, MRI found new disease in 12/25 (48%) high risk patients compared to 16/25 (64%) who were non-high risk. Conclusions: We confirm that MRI provides extremely relevant data in identifying new or additional disease when compared to US or mammogram. MRI not only aided in finding additional disease in patients that were high risk but more importantly, MRI found pathology-proven new disease in non-high risk patients across all age groups. These results hold a substantial clinical implication in the ability to find new cancers or high-risk lesions early on, especially in non-high risk patients.

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