Wendie A. Berg MD, PhD, Presenter: Consultant, Naviscan, Inc

Zheng Zhang PhD, Abstract Co-Author: Nothing to Disclose

Jean B. Cormack PhD, Abstract Co-Author: Nothing to Disclose

Roberta A. Jong MD, Abstract Co-Author: Research Consultant, General Electric Company

Richard Gary Barr MD, PhD, Abstract Co-Author: Consultant, Siemens AG Consultant, Koninklijke Philips Electronics NV Research grant, Siemens AG

Daniel E. Lehrer MD, Abstract Co-Author: Nothing to Disclose

Etta D. Pisano MD, Abstract Co-Author: Institutional research agreement, General Electric Company Institutional contract, Konica Minolta Group Institutional contract, VuCOMP, Inc Institutional contract, Real Imaging Institutional contract, Sectra AB

W. Phil Evans MD, Abstract Co-Author: Scientific Advisory Board, Hologic, Inc

Mary C. Mahoney MD, Abstract Co-Author: Consultant, Johnson & Johnson Speakers Bureau, Johnson & Johnson Consultant, SenoRx, Inc Speakers Bureau, SenoRx, Inc Scientific Advisory Board, Hologic, Inc

Linda Hovanessian-Larsen MD, Abstract Co-Author: Nothing to Disclose

Helga Marques MS, Abstract Co-Author: Nothing to Disclose

Amanda Adams MPH, Abstract Co-Author: Nothing to Disclose

Glenna Gabrielli BS, Abstract Co-Author: Nothing to Disclose

00030490-DMT et al, Abstract Co-Author: Nothing to Disclose

To determine the supplemental cancer detection rate (yield) of screening contrast-enhanced MRI after combined mammography (M) and ultrasound (US) in women at elevated risk of breast cancer.

2809 women at elevated risk of breast cancer enrolled in the ACRIN 6666 screening US protocol at 21 institutions. Fourteen institutions met technical and experience requirements for a substudy of supplemental screening MRI. Women who completed 0, 12, and 24 month M+US screens were considered for a single contrast-enhanced MRI after the 24 month M+US screen (from 8/06 through 4/08). Of 1215 women approached, 705 enrolled, and 627 eligible women completed an MRI within 91 days of M+US. Reference standard is based on biopsy and/or 12 month follow-up.

Reference standard was available for 463 participants [mean age 55 yrs , range 26-85] at elevated risk due to: personal history of breast cancer (39.5%); familial high risk by Gail or Claus models (56.6%); prior ADH/ALH/LCIS/atypical papilloma (3.0%); BRCA-1 or -2 mutation (0.7%); prior chest/mediastinal radiation therapy (0.2%). Sixteen women were diagnosed with breast cancer: 5 (31%) DCIS and 11 invasive cancer, with 1/9 (11%) node positive among those staged. Based on BI-RADS score ≥ 4a, 2 participants’ cancers were seen only on M; 2 on M and MRI; 2 only on US; 1 on M and US; 8 (50%) only on MRI; one DCIS was BI-RADS 3 on MR, recommended for 6 month follow-up, but biopsied. Of 8 cancers credited to MRI only, 1 (13%) was DCIS and 7 were invasive, with all 6 staged having negative nodes. Supplemental yield of MRI after M+US was 15.1/1000 [95% CI 0.33 to 29.9, p = .039]. AUC for M+US+MRI was 0.95 [95% CI 0.90 to 0.98] compared to 0.68 for M+US [95% CI 0.43 to 0.86, p = .024] and 0.94 for M+MRI [95% CI 0.87 to 0.97, p=0.26]. AUC for MR alone: 0.87 [95% CI 0.74 to 0.94], sensitivity 63%. Among 93 participants recommended for additional imaging or biopsy on MRI, 13 had cancer (PPV1 = 14%, 95% CI 8 to 23). Of 52 participants with biopsy recommended based on MRI, 11 had cancer (PPV2 = 21%, 95% CI 11 to 35).

After 3 years’ screening with M+US, adding MRI increased the cancer detection rate among women at elevated risk of breast cancer. [Support from The Avon Foundation and NCI (CA079778, CA800980.]

Detection of node-negative breast cancers occult to M+US is improved by supplemental contrast-enhanced MRI. MRI increases the rates of additional imaging and biopsy, with acceptable PPV.  

Berg, W, Zhang, Z, Cormack, J, Jong, R, Barr, R, Lehrer, D, Pisano, E, Evans, W, Mahoney, M, Hovanessian-Larsen, L, Marques, H, Adams, A, Gabrielli, G, et al, 0, Supplemental Yield and Performance Characteristics of Screening MRI after Combined Ultrasound and Mammography: ACRIN* 6666 *American College of Radiology Imaging Network.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8002965.html