Christopher Riedl, Presenter: Nothing to Disclose

Nikolaus Luft, Abstract Co-Author: Nothing to Disclose

Clemens Bernhart Bernhart, Abstract Co-Author: Nothing to Disclose

Gertraud Heinz-Peer, Abstract Co-Author: Nothing to Disclose

Katja Pinker MD, Abstract Co-Author: Nothing to Disclose

Thomas Hans Helbich MD, Abstract Co-Author: Research Consultant, Siemens AG Research Consultant, Hologic, Inc Research Grant, Siemens AG

To assess the value of mammography, ultrasound, and magnetic resonance imaging (MRI) of the breast in the surveillance of women at high risk for breast cancer.

In a prospective multicter screening trial, women at high risk for breast cancer were offered annual surveillance examinations, consisting of mammography, ultrasound, and MRI. The sensitivity and specificity of each modality was based on the histopathologic evaluation of suspicious findings from all modalities plus the detected interval cancers.

Six hundred and nine patients underwent 1346 complete imaging rounds. A total number of 39 cancers were detected. Ninteen of theses were detected in the 782 first screening rounds (2.4% prevanence cancers), and 20 in 564 follow-up screening rounds (3.5% incidence cancers). Of the total 39 cancers, 19 were detected by mammography, 16 by ultrasound, and 34 by MRI, with sensitivitis of 48.7%, 41%, and 87.1%, respectively (P < 0.01). In the 20 incidence cancers the sensitivities of mammography, ultrasound and MRI were 40.0%, 30%, 85.0%. Of 39 cancers, 18 (46%) were ductal carcinoma in situ. Of these 8 were detected by mammography, 6 by ultrasound, and 16 by MRI, with sensitivities of 44.4% 33.3% 88.9% (P < 0.01). Mammography, ultrasound, and MRI led to 40, 34, and 147 false-positive findings, which resulted in specificities of 96.6%, 97.0%, and 88.0%, respectively (P < 0.05). Fourty-nine of these false-positive findings were atypical ductal hyperplasias, lesions considered to be of premalignant character. Eleven (22.4%) of those were detected by mammography, six (12,2%) with ultrasound, and fourty-six (93.9%) by MRI (P < 0.05). If ADH lesions were to be considered true positive findings, the specificities would amount to 97.8%, 97.8% and 91.4% (P < 0,05).

The use of MRI improves the detection of invasive and preinvasive cancers. Additionally, MRI seems to increase the detection of high risk lesions.

MRI in conjunct with MG should be used in screening for familial breast cancer. The increased number of detected premalignant lesions might decrease cancer incidence and improve risk stratification.

Riedl, C, Luft, N, Bernhart, C, Heinz-Peer, G, Pinker, K, Helbich, T, Final Results of the Austrian National Screening Trial for Familial Breast Cancer.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11016385.html