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

2015 ◽  
Vol 204 (4) ◽  
pp. 889-897 ◽  
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

scholarly journals The Kaiser score reliably excludes malignancy in benign contrast-enhancing lesions classified as BI-RADS 4 on breast MRI high-risk screening exams

2020 ◽  
Vol 30 (11) ◽  
pp. 6052-6061 ◽  
Author(s):  
Ruxandra Iulia Milos ◽  
Francesca Pipan ◽  
Anastasia Kalovidouri ◽  
Paola Clauser ◽  
Panagiotis Kapetas ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Diagnostic Accuracy ◽  
Breast Mri ◽  
Histopathological Diagnosis ◽  
Risk Screening ◽  
High Risk Patients ◽  
Risk Patients ◽  
Malignant Lesions ◽  
High Risk Screening

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.

Breast cancer screening practices with high-risk women: A cross-sectional survey.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 1550-1550
Author(s):  
Anne Hudson Blaes ◽  
Rachel Isaksson Vogel ◽  
Nancy Raymond ◽  
Kristine Talley ◽  
Alicia Allen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Screening ◽  
High Risk ◽  
Breast Cancer Screening ◽  
Breast Mri ◽  
Primary Care Providers ◽  
Care Providers ◽  
Screening Practices ◽  
High Risk Women

1550 Background: Little literature exists on primary care providers’ knowledge and preferences towards breast cancer screening for high-risk women. While guidelines recommend MRI and mammography, it is unclear how frequently these recommendations are used. Methods: This web-based survey of providers licensed to practice in Minnesota was conducted. This analysis focuses on breast cancer screening practices for high-risk women. Data were summarized using descriptive statistics; professional characteristic comparisons were conducted using Chi-squared tests. Results: 805 of 10,392 (8%) invitees completed the survey. 72.2% were female. 43.9% were physicians (20.8% internists, 71.7% family medicine, 6.3% gynecology), 11.4% physician assistants (PAs), 44.8% advanced practice registered nurses (APRNs). 84.8% were in community practice, 38% > 20 years of experience and 27.1% < 10 years. When asked how effective screening was for reducing cancer mortality in high risk women, mammography was thought to be very effective (48.8%) or effective (46.8%) in women ages 40-49 years, for women ages 50+ years, 60.8% and 35.7%, respectively. 62.4% thought breast MRI was very effective in reducing cancer mortality in high risk women. There was no difference in breast MRI recommendation based on professional background, experience or practice setting. Female practitioners, less experience, and those working in gynecology or women’s health were more likely to recommend breast MRI. A case vignette for high risk screening cancer survivors is provided (Table). Conclusions: Most primary care providers believe mammography is helpful in women at high risk for developing breast cancer. Less than half of practitioners, however, are following guideline specific recommendations of both mammography and MRI for breast cancer screening in high-risk patients. [Table: see text]

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

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.

scholarly journals BREAST CANCER SCREENING;

2017 ◽  
Vol 24 (01) ◽  
pp. 42-46
Author(s):  
Hassan Bukhari ◽  
Asim Shaukat ◽  
Nosheen Ahmad
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
High Risk ◽  
Diagnostic Accuracy ◽  
Breast Cancer Screening ◽  
False Negative ◽  
Breast Mri ◽  
Breast Lesions ◽  
True Positive ◽  
True Negative

Objectives: To compare the efficacy of Magnetic resonance imaging andMammography for Breast-Cancer Screening in high risk Women with a Familial or GeneticPredisposition. Study Design: Cross-sectional study. Setting: Department of Radiology AlliedHospital, Faisalabad. Duration: From January 2012 to December 2014, Sample size: 299.Methods: A total of 299 females at high risk of breast cancer were included in this study andthey underwent screening rounds of Mammogram and contrast enhanced dynamic breastMRI once a year with independent readings. Both the imaging modalities were interpreted byexperience radiologist and all the images were categorized using Breast Imaging Reportingand Data System. In each patient, histopathology results were considered the standard criteriafor the calculation of the sensitivity, specificity for both Mammogram and Breast MRI lesions.Results: Mean age of the patients was 46.69±11.86 years. Mammography revealed 11 (3.68%)true positive breast lesions, 22 (7.36%) false positive lesion, 247 (82.61%) true negative and19 (6.35%) false negative lesions yielding the sensitivity of 36.67% and diagnostic accuracy of86.3%. Dynamic breast MRI revealed 28 (9.36%) true positive breast lesions with 5 (1.67%) falsepositive, 264 (88.29%) true negative and 2 (0.67%) false negative lesions yielding sensitivity of93.3%,specificity of 98.14%,PPV=84.85%,NPV=99.25% and diagnostic accuracy of 97.66%.MRI breast was significantly more sensitive (93.3 vs. 36.67%) and accurate (97.66 vs. 86.3%)than mammography. Conclusion: MRI is more sensitive than mammography in detectingtumors in women with an inherited susceptibility to breast cancer.

Cost-effectiveness of MRI compared to mammography for breast cancer screening in a high risk population

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6060-6060 ◽  
Author(s):  
S. G. Moore ◽  
J. Tumeh ◽  
C. R. Flowers
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
High Risk ◽  
Breast Cancer Screening ◽  
Young Women ◽  
Breast Mri ◽  
Cost Effective ◽  
Net Benefit ◽  
The Cost

6060 Background: Breast magnetic resonance imaging (MRI) is a sensitive method of breast imaging virtually uninfluenced by breast density. Because of the improved sensitivity, breast MRI is increasingly being used for detection of breast cancer among high risk young women. However, the specificity of breast MRI is variable and costs are high. The purpose of this study was to determine if breast MRI is a cost-effective approach for the detection of breast cancer among young women at high risk. Methods: A Markov model was created to compare annual breast cancer screening over 25 years with either breast MRI or mammography among young women at high risk. Data from published studies provided probabilities for the model including sensitivity and specificity of each screening strategy. Costs were based on Medicare reimbursement rates for hospital and physician services while medication costs were obtained from the Federal Supply Scale. Utilities from the literature were applied to each health outcome in the model including a disutility for the temporary health state following breast biopsy for a false positive test result. The analysis was performed from the payer perspective with results reported in 2005 U.S. dollars. Univariate and probabilistic sensitivity analyses addressed uncertainty in all model parameters. Results: Breast MRI provided 23.287 quality-adjusted life-years (QALYs) at a cost of $30,317 while mammography provided 23.141 QALYs at a cost of $7,895 over 25 years of screening. The cost-effectiveness ratios for the two strategies were $1302 and $341, respectively. The incremental cost-effectiveness ratio of breast MRI compared to mammography was $131,376/QALY. In univariate analysis, breast MRI screening became <$50,000/QALY when the cost of the MRI was <$405. In the probabilistic sensitivity analysis, MRI screening produced a net benefit of +0.146 QALYs (95% central range: -0.825 QALYs to +1.378 QALYs). However, breast MRI screening was superior in <1%, <$50,000/QALY in 27%, >$50,000/QALY in 32%, and inferior in 41% of 10,000 probabilistic Monte Carlo simulations. Conclusions: Breast MRI provides a net benefit when compared to mammographic screening for high risk women, however, this approach does not appear to be cost-effective at this time. No significant financial relationships to disclose.

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