Benjamin Mark Schneider MD, Presenter: Nothing to Disclose

Sughra Raza MD, Abstract Co-Author: Research grant, Hitachi, Ltd

Dianne Georgian-Smith MD, Abstract Co-Author: Nothing to Disclose

Lester Leong MMed, Abstract Co-Author: Nothing to Disclose

Robyn L. Birdwell MD, Abstract Co-Author: Nothing to Disclose

To evaluate the risks and benefits of contrast enhanced MRI in the post mastectomy reconstructed breast.

IRB approved retrospective review of women with a history of mastectomy and reconstruction (neobreast) including muscle flap and/or implant who had at least one MRI of the neobreast was performed over the period of 4/1/05 – 4/31/09.

190 women had an MRI of their neobreast (8 with known malignancies excluded) for a total of 182 women (209 breasts). Indications for the MRI were symptoms referable to the neobreast (n= 76, 36%) and neobreast surveillance (asymptomatic) (n=133, 64%); each neobreast was categorized by the highest BIRADS assigned over the study period. For the 76 symptomatic neobreasts BIRADS were: 1 or 2 (n=55), 3 (n=17), 4 (n=2), and 0 (n=2). For the 133 asymptomatic neobreasts BIRADS were: 1 or 2 (n=119), 3 (n=6), 4 (n= 7), and 0 (n=1). Of 13 total biopsies, 7 (54%) were in symptomatic neobreasts and 6 (46%) in asymptomatic neobreasts. Four of 13 (31%) biopsies were malignant. (See flow chart.) Three of the 4 (75%) malignancies were in asymptomatic breasts (2% [4 of 133] of the asymptomatic breasts). The 4 malignancies were all invasive tumors in women who were ≤ 45 years old and with invasive tumors ≥ 1.5 cm at the time of initial diagnosis. Of 23 breasts assigned BIRADS 3, 15 (65%) had at least one follow-up MRI and of those 12 were downgraded to BIRADS 1 or 2. Of 3 breasts assigned BIRADS 0, two were downgraded to BIRADS 1or 2 after correlative ultrasound or mammogram.

Despite the risk of false positive findings (defined here as benign biopsies and additional imaging) this study demonstrates a benefit of surveillance MRI in the asymptomatic neobreast. The positive predictive value for symptomatic breasts was 4% (1 of 24) and for asymptomatic breasts was 21% (3 of 14), p =0.13. Three of 4 invasive recurrences were detected in asymptomatic breasts of women ≤ 45 years old with invasive tumors ≥ 1.5 cm at the time of the primary diagnosis.

More cancers and fewer false positives were found in asymptomatic as compared with symptomatic neobreasts suggesting a role for surveillance MRI in the appropriate patient population.

Schneider, B, Raza, S, Georgian-Smith, D, Leong, L, Birdwell, R, MRI of the Reconstructed Breast after Mastectomy: Does It Do More Harm Than Good?.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9008898.html