In Newly Diagnosed Breast Cancer, Screening MRI of the Contralateral Breast Detects Mammographically Occult Cancer, Even in Elderly Women: The Mayo Clinic in Florida Experience

Abstract

The role of magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer is somewhat controversial. The purpose of this study was to evaluate the prevalence of synchronous, occult contralateral breast cancer detected by MRI but not by mammography or clinical breast examination in women with newly diagnosed breast cancer, including those aged 70 years or older at our institution. MRI results for women with newly diagnosed breast cancer who underwent bilateral breast MRI after negative mammography and clinical examination between February 2003 and November 2007 at Mayo Clinic in Florida were reviewed. The prevalence of pathologically confirmed contralateral carcinoma diagnosed solely by MRI was determined and analyzed in the context of age, family history, menopausal status, breast density, and primary-tumor characteristics. Logistic regression was used to explore the association between contralateral carcinoma and potential patient risk factors. A total of 425 women were evaluated, of whom 129 (30%) were aged 70 years or older. A contralateral biopsy was recommended and performed solely on the basis of MRI in 72 of the 425 women (17%). Sixteen of these 72 women (22%) had pathologically confirmed carcinoma, including seven in the older subgroup. The prevalence of clinically and mammographically occult contralateral carcinoma detected by MRI was 3.8% (16/425) overall and 5.4% (7/129) in the group of older women. When potential risk factors for contralateral breast cancer were evaluated, postmenopausal status was the only significant predictor of contralateral cancer detected by MRI (p = 0.016). We concluded that contralateral breast screening with MRI should be considered in postmenopausal women with newly diagnosed breast cancer, even those aged 70 years or older at diagnosis.

Impact of Presurgical Breast Magnetic Resonance Imaging (MRI) on Surgical Planning - A Retrospective Analysis from a Private Radiology Group

“…The Mayo Clinic in Florida reported that an older age was a risk factor associated with bilateral synchronous malignancy . They found that older patients (>70 years) had a higher rate of contralateral cancer (5.4% versus 3.8%).…”

Evaluation of expert criteria for preoperative magnetic resonance imaging of newly diagnosed breast cancer

“…Two of those criteria (ILC and high genetic-familial risk) were similarly unconfirmed in a previous study [13], while a third criterion, mammographic density, was not confirmed in multiple previous studies [13,18–22]. The 2 other criteria (multifocal/multicentric disease, candidacy for PBI) have not been previously tested as predictors of MMA.…”

Is contralateral breast ultrasound worthwhile in preoperative staging of breast cancer?

“…[3][4][5][6][7] It is well-known that mammography/tomosynthesis can miss breast cancers, especially in dense breasts. 23 Preoperative bilateral breast MRI finds 2.2%-5.5% additional contralateral breast cancers when compared to mammography alone, [17][18][19] but its limited access and high cost may create undesirable delays in the preoperative investigation and increases the health care costs. Weinstock et al 24 showed that mammography had a poor sensitivity for the surveillance of the contralateral breast, reiterating the importance of using other imaging methods during the preoperative evaluation.…”

“…Despite the fact that bilateral synchronous neoplasms are often of the same histological subtype, the contralateral cancer frequently exhibits a different and benign‐looking appearance at imaging when compared to the index lesion . The incidence of synchronous contralateral cancer in the setting of prophylactic contralateral mastectomy is 2.1%‐15.4%, while it is 0.4%‐2% for mammography or physical examination, and 2.2%‐5.5% on magnetic resonance imaging (MRI) . The use of preoperative MRI to detect synchronous contralateral invasive is controversial, given that MRI is expensive in terms of money, examination and staff time, and that it is not readily available in many regions of the world.…”