Screening MRI in Women With a Personal History of Breast Cancer

Lehman, Constance D.; Lee, Janie M.; DeMartini, Wendy B.; Hippe, Daniel S.; Rendi, Mara H.; Kalish, Grace; Porter, Peggy L.; Gralow, Julie R.; Partridge, Savannah C.

doi:10.1093/jnci/djv349

Cited by 128 publications

(81 citation statements)

References 35 publications

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“…Finally, we found that screening of women with a personal history of treated breast cancer accounted for a large proportion (42%) of our screening examinations, with breast MRI performance in this population at least comparable to that of other screened patients. These findings corroborate other recent results (19), and suggest that MRI may be an important tool to supplemental screening in patients with a personal history of breast cancer.…”

Section: Discussionsupporting

confidence: 92%

“…In our study, both the cancer detection rate and the PPV3 (biopsy performed) were higher in those patients undergoing breast MRI screening for a personal history of breast cancer versus those with a family history of breast cancer, (42.3% vs 14.3% for PPV3 and 3.0% vs 1.6% cancer yield, respectively). These results are similar to other single-site, retrospective studies (19,35,36). Overall, the performance of breast MRI in women with a personal history of treated breast cancer is promising and in support of consideration of this tool for supplemental screening.…”

Section: Discussionsupporting

confidence: 91%

“…This proportion is similar to that reported by Niell et al, with the largest proportion (46%) of screening breast MRI examinations at their institution performed in patients with a personal history of breast cancer (20). Lehman et al also described a larger proportion of patients screened for a personal history of breast cancer compared to a genetic and family history (19). In our study, both the cancer detection rate and the PPV3 (biopsy performed) were higher in those patients undergoing breast MRI screening for a personal history of breast cancer versus those with a family history of breast cancer, (42.3% vs 14.3% for PPV3 and 3.0% vs 1.6% cancer yield, respectively).…”

Section: Discussionmentioning

confidence: 99%

“…The NCCN states that the utility of MRI in follow-up screening of women with prior breast cancer is undefined (18). However, recent data suggest that particularly those patients with a personal history of treated breast cancer constitute a significant proportion of patients being screened with breast MRI (19,20). …”

Section: Introductionmentioning

confidence: 99%

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Screening Breast MRI Outcomes in Routine Clinical Practice

et al. 2017

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Rationale and Objectives The BI-RADS Atlas 5th Edition includes screening breast magnetic resonance imaging (MRI) outcome benchmarks. However, the metrics are from expert practices and clinical trials of women with hereditary breast cancer predispositions, and it is unknown if they are appropriate for routine practice. We evaluated screening breast MRI audit outcomes in routine practice across a spectrum of elevated risk patients. Materials and Methods This Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study included all consecutive screening breast MRI examinations from July 1, 2010 to June 30, 2013. Examination indications were categorized as gene mutation carrier (GMC), personal history (PH) breast cancer, family history (FH) breast cancer, chest radiation, and atypia/lobular carcinoma in situ (LCIS). Outcomes were determined by pathology and/or ≥12 months clinical and/or imaging follow-up. We calculated abnormal interpretation rate (AIR), cancer detection rate (CDR), positive predictive value of recommendation for tissue diagnosis (PPV2) and biopsy performed (PPV3), and median size and percentage of node-negative invasive cancers. Results Eight hundred and sixty examinations were performed in 566 patients with a mean age of 47 years. Indications were 367 of 860 (42.7%) FH, 365 of 860 (42.4%) PH, 106 of 860 (12.3%) GMC, 14 of 860 (1.6%) chest radiation, and 8 of 22 (0.9%) atypia/LCIS. The AIR was 134 of 860 (15.6%). Nineteen cancers were identified (13 invasive, 4 DCIS, two lymph nodes), resulting in CDR of 19 of 860 (22.1 per 1000), PPV2 of 19 of 88 (21.6%), and PPV3 of 19 of 80 (23.8%). Of 13 invasive breast cancers, median size was 10 mm, and 8 of 13 were node negative (61.5%). Conclusions Performance outcomes of screening breast MRI in routine clinical practice across a spectrum of elevated risk patients met the American College of Radiology Breast Imaging Reporting and Data System benchmarks, supporting broad application of these metrics. The indication of a personal history of treated breast cancer accounted for a large proportion (42%) of our screening examinations, with breast MRI performance in this population at least comparable to that of other screening indications.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Screening Breast MRI Outcomes in Routine Clinical Practice

et al. 2017

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“…The current evidence for breast MRI surveillance of patients with a personal history of sporadic breast cancer is based on relatively small single-institution retrospective studies [48–54] and is summarized in Table 2. The largest of these studies, by Lehman et al [52], showed that breast MRI in patients with a personal history of cancer had sensitivity and cancer detection rate similar to those for patients with a genetic or family history of breast cancer, with a lower false-positive rate. The range of cancer detection rates across these studies of MRI surveillance may be attributed in part to the differential selection and small number of women in these surveillance cohorts.…”

Section: Synopsis and Synthesis Of Evidencementioning

confidence: 99%

Imaging Surveillance After Primary Breast Cancer Treatment

Lam

Houssami

Lee

2017

American Journal of Roentgenology

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OBJECTIVE Current clinical guidelines are consistent in supporting annual mammography for women after treatment of primary breast cancer. Surveillance imaging beyond standard digital mammography, including digital breast tomosynthesis (DBT), breast ultrasound, and MRI, may improve outcomes. This article reviews the evidence on the performance and effectiveness of breast imaging modalities available for surveillance after treatment of sporadic unilateral primary breast cancer and identifies additional factors to be considered when selecting an imaging surveillance regimen. CONCLUSION Evidence review supports the use of mammography for surveillance after primary breast cancer treatment. Variability exists in guideline recommendations for surveillance initiation, interval, and cessation. DBT offers the most promise as a potential modality to replace standard digital mammography as a front-line surveillance test; a single published study to date has shown a significant decrease in recall rates compared with standard digital mammography alone. Most guidelines do not support the use of whole-breast ultrasound in breast cancer surveillance, and further studies are needed to define the characteristics of women who may benefit from MRI surveillance. The emerging evidence about surveillance imaging outcomes suggests that additional factors, including patient and imaging characteristics, tumor biology and gene expression profile, and choice of treatment, warrant consideration in selecting personalized posttreatment imaging surveillance regimens.

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