Vivianne Freitas MD, Presenter: Nothing to Disclose

Anabel Medeiros Scaranelo MD, PhD, Abstract Co-Author: Nothing to Disclose

Supriya Ravindra Kulkarni MD, Abstract Co-Author: Nothing to Disclose

Pavel Crystal MD, Abstract Co-Author: Nothing to Disclose

To evaluate added cancer yield of screening breast MRI in women with a prior history of chest radiation therapy. 

With IRB approval, a retrospective review of the radiology department database and cancer registry identified 98 women with a prior history of chest radiation therapy who had screening mammography and screening MRI performed at our institution between January 2004 and July 2010. Medical records of these patients and results of 556 screening studies (296 mammograms and 260 MRI) were reviewed. PPV (positive predictive value), cancer detection rate, and added cancer yield were calculated. Statistical analysis was performed with the Fisher exact test.  

The mean age at the time of screening round was 37 (range, 19-65) years. The median latency from completion of radiation to screening breast MRI was 13 (range, 2-34) years. Malignancy was diagnosed in 13 women, 10 were diagnosed with invasive cancers and 3 with ductal carcinoma in situ (DCIS); none of them presented as an interval cancer. The median latency from completion of radiation to detection of the breast cancer was 18 (range, 8-37) years. BI-RADS 1 or 2 assessment categories were given in 202 (77.7%) of MRI studies and in 275 (92.9%) of mammograms. Six-month follow-up was recommended in 41 (15.7%) of MRI studies and in 10 (3.4%) mammograms. Suspicious lesions were reported in 17 (6.5%) of MRI studies and in 11 (3.7%) mammograms. Of the 13 cancers, 12 (92%) were detected by MRI and 9 (69%) by mammography. MRI detected 10 invasive cancers and two DCIS. Mammography detected 7 invasive cancers and two DCIS. PPV of MRI (71%) did not change significantly (p>0.05) from PPV (82%) of mammography. Cancer detection rate of MRI was 4.6% (12/260 studies) comparing with 3% (9/296) cancer detection rate of mammography (p>.05). In 4 of 98 patients cancer was diagnosed on MRI only resulting in 4.1% incremental cancer detection rate.

MR imaging is a useful adjunct modality to screen high-risk women with a prior history of chest radiation therapy, resulting in a 4.1% (4/98) added cancer detection rate. Both MRI and mammography should be used to screen women in this high risk group.

The results of this study support expert consensus opinion based American Cancer Society recommendations that advise breast MRI screening in patients with a prior history of chest radiation therapy.

Freitas, V, Scaranelo, A, Kulkarni, S, Crystal, P, Added Cancer Yield of Breast MRI Screening in Women with a Prior History of Chest Radiation Therapy.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11006691.html