Grace Mariko Kalish MD, Abstract Co-Author: Nothing to Disclose

Wendy Burton Demartini MD, Presenter: Nothing to Disclose

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

Peter R. Eby MD, Abstract Co-Author: Research grant, General Electric Company, Milwaukee, WI Research grant, Johnson & Johnson, Cincinnati, OH Equipment support, Koninklijke Philips Electronics NV

Robert Lee Gutierrez MD, Abstract Co-Author: Nothing to Disclose

Constance D. Lehman MD, PhD, Abstract Co-Author: Research Consultant, General Electric Company Research grant, General Electric Company

Annual screening MRI is recommended by the American Cancer Society as an adjunct to mammographic screening for individuals who have sufficient genetic or family history (GFH), as defined by a greater than 20% lifetime risk of developing breast cancer. There is currently insufficient evidence to support screening MRI for women with a personal history (PH) of treated breast cancer. The purpose of this study was to compare the diagnostic performance of screening MRI in women with GFH versus PH of breast cancer.

Following IRB approval, retrospective review of screening MR examinations from 1/04 to 6/09 was performed. Final assessments of BI-RADS 4 or 5 were considered positive and final assessments of 1, 2 or 3 were considered negative. Benign versus malignant outcomes were determined by biopsy performed within one year of MRI, and/or linkage with the regional tumor registry. Chi-square analysis, Fisher’s Exact Test, and Z-score calculations were used to compare diagnostic performance of screening MRI in women with PH compared to those with a GFH of breast cancer.

Of 1,025 women undergoing their first screening MR examination in the study interval, 327 had a GFH and 646 had a PH of breast cancer. Overall sensitivity for the entire study was 92.6% (25/27) with two MRI occult cancers detected through the tumor registry (both in the PH group). Cancer yield and specificity were significantly greater in the PH group compared to the GFH group (3.1% versus 1.5%, p<0.0001 and 93.6% versus 86.3%, p=0.0003, respectively). Biopsy was recommended in fewer individuals with PH compared to GFH (9.3% versus 15.0%) and the positive predictive value of biopsy was greater in the PH group (20/56 (35.7%) versus 5/41 (12.2%), p=0.009).

Cancer yield was higher by screening MRI in women with PH compared to women with GFH despite fewer recommendations for biopsy. Sensitivity and specificity of screening MRI were also higher in women with PH compared to those with a GFH of breast cancer. Therefore, screening MRI may be an important adjunct to mammographic surveillance in women with a PH of breast cancer.

The diagnostic performance of screening MRI in patients with a personal history of treated breast cancer supports consideration of this tool as an adjunct to screening mammography.

Kalish, G, Demartini, W, Peacock, S, Eby, P, Gutierrez, R, Lehman, C, Screening MRI for High Risk Women: Should Patients with a Treated Personal History of Breast Cancer Be Screened?.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9006996.html