Kathleen Wooten MD, Presenter: Nothing to Disclose

Chana Weinstock MD, Abstract Co-Author: Nothing to Disclose

Carly Stokum MPH, Abstract Co-Author: Nothing to Disclose

Olga Ioffe MD, Abstract Co-Author: Nothing to Disclose

Susan Kesmodel MD, Abstract Co-Author: Nothing to Disclose

Steven J. Feigenberg MD, Abstract Co-Author: Nothing to Disclose

Katherine Hanna Tkaczuk MD, Abstract Co-Author: Nothing to Disclose

Cristina Irene Caterina Campassi MD, Abstract Co-Author: Nothing to Disclose

The American Cancer Society (ACS) reports insufficient evidence to recommend for or against MRI in surveillance of asymptomatic breast cancer survivors. The study objective was to determine the utility of MRI in detection of malignancy in asymptomatic women with a personal history of breast cancer diagnosed before age 65.

We identified 250 consecutive female breast cancer survivors <65 with non-metastatic breast cancer or DCIS.  Nearly half (49.6%) were African American. Each patient had at least 1 MRI exam >11 months after diagnosis and a MG done within 6 months of the MRI. We retrospectively reviewed 579 breast MRI and MG reports and correlated the suspicious imaging findings with pathology.

Of the 250 patients, 43 (17%) had 52 suspicious imaging findings. MRI detected 81% of the findings (42/52); 31 of 42 were MG occult. MG detected 40% of the findings (21/52); 10 of 21 were MRI occult. The abnormal imaging findings included 47 breast lesions, 4 abnormal axillary lymph nodes and 1 lung mass. Pathology was obtained in all lesions by imaging guided core needle biopsy (30) and/or surgical biopsy (22). Twelve malignant lesions were detected in 11 of 250 patients (4.4%). The 12 cancers included 10 breast lesions, 1 metastatic axillary lymph node and 1 isolated lung metastasis. MRI detected all 12 malignant lesions (92% as Stage 0 or Stage I disease), whereas MG detected only 4. After exclusion of the lung metastasis, MRI combined with MG showed improved sensitivity (85%) than MG alone (31%, p=0.0003). The specificity for combined MRI and MG (93%) was similar to that of MG alone (97%). The positive (22% for combined and 19% for MG alone) and negative predictive values (99% for combined and 98% for MG) were similar. Only 2 patients (0.8%, false negatives) with normal MRI and MG developed breast cancer within 6 months (both Stage I disease).

Breast MRI as adjunct to MG improves detection of malignancy in breast cancer survivors. Cancer detection rate of 4.4% in our study was similar to that reported in BRCA mutation carriers, which is an established ACS indication for screening breast MRI as adjunct to MG. Prospective investigation should be pursued in this population.

Annual screening breast MRI is beneficial as adjunct to MG for detection of malignancy in women with a personal history of breast cancer.

Wooten, K, Weinstock, C, Stokum, C, Ioffe, O, Kesmodel, S, Feigenberg, S, Tkaczuk, K, Campassi, C, Screening Magnetic Resonance Imaging (MRI) as an Adjunct to Mammography (MG) in Asymptomatic Breast Cancer Survivors.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12033819.html