Janice S Sung MD, Abstract Co-Author: Nothing to Disclose

Janine T. Katzen MD, Presenter: Nothing to Disclose

Anne S Reiner MPH, Abstract Co-Author: Nothing to Disclose

Jonine L. Bernstein, Abstract Co-Author: Nothing to Disclose

D. David Dershaw MD, Abstract Co-Author: Nothing to Disclose

Elizabeth A. Morris MD, Abstract Co-Author: Nothing to Disclose

To determine the prevalence and risk factors of additional mammographically occult breast cancers detected on preoperative breast MRI in women ≤ 40 years old.

Retrospective IRB approved review of our database identified 194 women ≤ 40 years old who underwent preoperative MRI between December, 2004 to December, 2009. The prevalence of additional mammographically occult cancers was determined, and characterized as multifocal (additional disease within the same quadrant and/or underestimation on mammography by ≥ 2 cm of the size on MRI with pathologic confirmation), multicentric (additional disease within a separate quadrant), or contralateral disease. Potential risk factors, including mammographic density, extent of background parenchymal enhancement (BPE), tumor size, and family history (FH) were also examined.

Median age at preoperative breast MRI was 36 years (range 20-40). Biopsy was recommended for 99 lesions in 76/194 (39%) patients. 3 lesions were not biopsied. 34/96 (35%) lesions that underwent biopsy were malignant in 32/194 patients (17%). 21/34 (62%) cancers detected were invasive cancers, and 13/34 (38%) were DCIS. Of the 34 additional sites of cancer detected, 14/34 (41%) represented multifocal disease, 14/34 (41%) represented multicentric disease, and 6/34 (18%) represented contralateral breast cancers. Contralateral breast cancers were detected in 3% of the study population (6/194 women). Tumor size > 1 cm was associated with additional sites of mammographically occult disease detected on MRI (p=0.02). Features not statistically associated with additional disease included mammographic density (p= 0.83), BPE (p=0.94), and FH (p=0.51).

Preoperative breast MRI in women ≤ 40 years old detected additional sites of mammographically occult malignancy in 17% of patients, which were mostly invasive carcinomas. Preoperative breast MRI should be considered in this population, especially with tumors ≥ 1 cm.

Breast MRI will detect otherwise occult cancers in women ≤ 40 years old with newly diagnosed breast cancer. Preoperative MRI should be considered to evaluate the extent of disease in this population.

Sung, J, Katzen, J, Reiner, A, Bernstein, J, Dershaw, D, Morris, E, Utility of Preoperative Breast MRI in Women ≤ 40 Years Old.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11013772.html