Brian Dontchos MD, Presenter: Nothing to Disclose

Wendy Burton Demartini MD, Abstract Co-Author: Nothing to Disclose

Habib Rahbar MD, Abstract Co-Author: Nothing to Disclose

Sue Peacock MSC, Abstract Co-Author: Nothing to Disclose

Constance D. Lehman MD,PhD, Abstract Co-Author: Research Consultant, Bayer AG Research Consultant, General Electric Company Research Consultant, Koninklijke Philips Electronics NV

Many facilities limit scheduling of screening breast MRI in pre-menopausal women to the early menstrual cycle, for concerns regarding the impact on diagnostic performance of background parenchymal enhancement (BPE) related to later phase hormones. However, there are very limited data to support this practice. Our purpose was to determine the influence of menstrual cycle timing on MRI performance in this patient population.

Following IRB approval, review of our electronic database identified all screening breast MR examinations from 1/1/2007 to 11/31/2010. Examinations in pre-menopausal women with reported cycle day of 0-35 from last menstrual period were included. MRI BPE and Breast Imaging Reporting and Data Sytem (BI-RADS) assessments were recorded from the database. Outcomes were determined by biopsy, imaging and linkage with the Cancer Surveillance System tumor registry with a minimum of 12 months follow-up. The abnormal interpretation rate (initial BI-RADS 0, 3, 4, or 5), positive biopsy rate (PBR), cancer yield, sensitivity, specificity and degree of BPE were calculated and compared for follicular (day 0-15) vs. luteal (day 16-35) phase and for week in cycle (day 0-7, 8-15, 16-23, 24-35).

From 1950 screening MR examinations (1128 post-menopausal, 316 unknown status, 506 pre-menopausal), 319 examinations in 243 pre-menopausal women had cycle day of 0-35 and comprised the analysis set. Mean patient age was 42 (range 26-56) years. For follicular vs. luteal phase, there were no significant differences in examination abnormal interpretation rate (21.0 vs. 18.1%), PBR (17.4 vs. 33.3%), cancer yield (each 1.9%), specificity (90.0 vs. 93.2%) or degree of BPE (43.9 vs. 42.0% moderate/marked) (all p-values >0.05). A total of seven cancers occurred in the analysis set, with sensitivity 80.0% (4/5) for follicular phase and 100% (2/2) for luteal phase. There were no differences in diagnostic performance or BPE when comparing by week in cycle.

In the largest study to-date in pre-menopausal women, the diagnostic performance of screening breast MRI is not significantly influenced by menstrual cycle timing.

Because diagnostic performance is not limited by cycle timing, screening breast MRI in pre-menopausal women may be safely scheduled throughout the menstrual cycle.

Dontchos, B, Demartini, W, Rahbar, H, Peacock, S, Lehman, C, Influence of Menstrual Cycle Timing on Screening Breast MRI Performance in Pre-Menopausal Women.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12025533.html