New evidence on breast Magnetic Resonance Imaging (MRI) screening has become available since the American Cancer Society (ACS) last issued guidelines for the early detection of breast cancer in 2003. A guideline panel has reviewed this evidence and developed new recommendations for women at different defined levels of risk. Screening MRI is recommended for women with an approximately 20-25% or greater lifetime risk of breast cancer, including women with a strong family history of breast or ovarian cancer and women who were treated for Hodgkin disease. There are several risk subgroups for which the available data are insufficient to recommend for or against screening, including women with a personal history of breast cancer, carcinoma in situ, atypical hyperplasia, and extremely dense breasts on mammography. Diagnostic uses of MRI were not considered to be within the scope of this review.

https://onlinelibrary.wiley.com/doi/pdf/10.3322/canjclin.57.2.75

American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography

Breast imaging reporting and data system (BI-RADS).

PURPOSE: To (a) determine the performance of screening mammography, ultrasonography (US), and physical examination (PE); (b) analyze the influence of age, hormonal status, and breast density; (c) compare the size and stage of tumors detected with each modality; and (d) determine which modality or combination of modalities optimize cancer detection. MATERIALS AND METHODS: A total of 11,130 asymptomatic women underwent 27,825 screening sessions, (mammography and subsequent PE). Women with dense breasts subsequently underwent screening US. Abnormalities were deemed positive if biopsy findings revealed malignancy and negative if findings from biopsy or all screening examinations were negative. RESULTS: In 221 women, 246 cancers were found. Sensitivity, specificity, negative and positive predictive values, and accuracy of mammography were 77.6%, 98.8%, 99.8%, 35.8%, and 98.6%, respectively; those of PE, 27.6%, 99.4%, 99.4%, 28.9%, and 98.8%, respectively; and those of US, 75.3%, 96.8%, 99.7%, 20.5%, and 96.6%,...

Comparison of the Performance of Screening Mammography, Physical Examination, and Breast US and Evaluation of Factors that Influence Them: An Analysis of 27,825 Patient Evaluations

background The value of regular surveillance for breast cancer in women with a genetic or familial predisposition to breast cancer is currently unproven. We compared the efficacy of magnetic resonance imaging (MRI) with that of mammography for screening in this group of high-risk women. methods Women who had a cumulative lifetime risk of breast cancer of 15 percent or more were screened every six months with a clinical breast examination and once a year by mammography and MRI, with independent readings. The characteristics of the cancers that were detected were compared with the characteristics of those in two different agematched control groups. results We screened 1909 eligible women, including 358 carriers of germ-line mutations. Within a median follow-up period of 2.9 years, 51 tumors (44 invasive cancers, 6 ductal carcinomas in situ, and 1 lymphoma) and 1 lobular carcinoma in situ were detected. The sensitivity of clinical breast examination, mammography, and MRI for detecting invasive breast cancer was 17.9 percent, 33.3 percent, and 79.5 percent, respectively, and the specificity was 98.1 percent, 95.0 percent, and 89.8 percent, respectively. The overall discriminating capacity of MRI was significantly better than that of mammography (P<0.05). The proportion of invasive tumors that were 10 mm or less in diameter was significantly greater in our surveillance group (43.2 percent) than in either control group (14.0 percent [P<0.001] and 12.5 percent [P = 0.04], respectively). The combined incidence of positive axillary nodes and micrometastases in invasive cancers in our study was 21.4 percent, as compared with 52.4 percent (P<0.001) and 56.4 percent (P=0.001) in the two control groups. conclusions MRI appears to be more sensitive than mammography in detecting tumors in women with an inherited susceptibility to breast cancer.

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Efficacy of MRI and Mammography for Breast-Cancer Screening in Women with a Familial or Genetic Predisposition

Question: In women with a familial or genetic predisposition for breast cancer is screening with MRI more effective than mammography or usual care? Design: Prospective cohort study Setting: Six familial cancer centers in the Netherlands Patients: One thousand and nine women aged 25 to 75 years with a cumulative lifetime risk of breast cancer of 15% or more owing to a familial or genetic predisposition based on a modified Clasus model were included. Description of Test and Diagnostic Standard: Two view mammography (oblique and craniocaudal views and if necessary, compression views or magnification) and dynamic breast MRI with gadolinium containing contrast medium using a standard protocol were performed yearly. Clinical breast examination was performed every 6 months. When possible, both imaging investigations were performed on the same day or same time period between day 5 & day 15 of the menstrual cycle. The results of both investigations, which were blinded were scored in a standardized way, according the Breast Imaging Reporting and Data Systems (BI-RADS) Classification. Main Outcomes Measure: Sensitivity and specificity of clinical examination, mammography and MRI. Main Results: The sensitivity of clinical breast examination, mammography and MRI for detecting invasive breast cancer was 17.9%, 33.3% and 79.5% respectively and the specificity was 98.1%, 95.0% and 89.8% respectively. Conclusion: MRI appears to be more sensitive than mammography in detecting tumors in females with a genetic or familial predisposition to breast cancer Commentary: Although Kriege et al, 1 address two questions in this study, the focus of this review is the comparison of mammography to MRI in detecting breast cancers in women with a familial or genetic predisposition to breast cancer.

Efficacy of MRI and mammography for breast-cancer screening in women with familial or genetic predisposition

The purpose of the study was to assess the positive predictive value of mammographic features and final assessment categories described in the Breast Imaging Reporting and Data System (BI-RADS) for lesions on which biopsies have been performed.We prospectively evaluated 492 impalpable mammographically detected lesions on which surgical biopsy (as opposed to percutaneous biopsy) was performed. Each lesion was classified according to BI-RADS descriptors for masses (margins and shape) and calcifications (morphology and distribution) and was categorized by the BI-RADS final assessment categories as category 3 ("probably benign"), category 4 ("suspicious abnormality"), or category 5 ("highly suggestive of malignancy"). Mammographic and pathologic findings were reviewed.Carcinoma was present in 225 (46%) of 492 lesions. For the 492 lesions subject to biopsy, BI-RADS final assessment categories were category 3 in eight lesions (2%), category 4 in 355 (72%), and category 5 in 129 (26%). The features with highest ...

The breast imaging reporting and data system: positive predictive value of mammographic features and final assessment categories.

OBJECTIVE. The purpose of this study was to review MR imaging findings in the ipsilateral breast in women with percutaneously proven breast cancer. MATERIALS AND METHODS. Retrospective review was performed of records of 70 consecutive women with percutaneously proven unilateral breast cancer who were considered candidates for breast conservation surgery and who had preoperative MR imaging of the ipsilateral breast. MR images and medical records were reviewed. RESULTS. MR imaging identified mammographically and clinically occult cancer other than the index lesion in the ipsilateral breast in 19 women (27%), including infiltrating cancer in 11 women (16%) and ductal carcinoma in situ in eight women (11%). These additional sites of cancer were in the same quadrant as the index cancer in 14 women (20%), in a different quadrant in three women (4%), and in both the same and different quadrants in two women (3%). Additional sites of cancer were more likely in women with, rather than in those without, a family history of breast cancer (42% vs 14%, p < 0.02) and in women whose index cancer was infiltrating lobular rather than other histologies (55% vs 22%, p < 0.06). In 17 women (24%), MR imaging detected ipsilateral lesions that were benign. Changes due to prior percutaneous biopsy were infrequently observed on MR images and included a clip in 12 women (17%) and a small hematoma in two women (3%). CONCLUSION. MR imaging identified additional sites of ipsilateral cancer in 27% of women with percutaneously proven breast cancer. The yield was highest in women with a family history of breast cancer or infiltrating lobular histology in the index cancer. Change after biopsy was infrequent and did not interfere with the MR imaging interpretation.

MR Imaging of the Ipsilateral Breast in Women with Percutaneously Proven Breast Cancer

OBJECTIVE. The purpose of this study was to determine the frequency of cancer and the positive predictive value of biopsy in the first screening round of breast MRI in women at high risk of developing breast cancer.MATERIALS AND METHODS. Retrospective review was performed of the records of 367 consecutive women at high risk of developing breast cancer who had normal findings on mammography and their first breast MRI screening examination during a 2-year period. The frequency of recommending biopsy at the first screening MRI study and the biopsy results were reviewed.RESULTS. Biopsy was recommended in 64 women (17%). Biopsy revealed cancer that was occult on mammography and physical examination in 14 (24%) of 59 women who had biopsy and in 14 (4%) of 367 women who underwent breast MRI screening. Histologic findings in 14 women with cancer were ductal carcinoma in situ in eight (57%) and infiltrating carcinoma in six (43%). The median size of infiltrating carcinoma was 0.4 cm (range, 0.1-1.2 cm). Two patien...

MRI of occult breast carcinoma in a high-risk population.

PURPOSE: To determine the frequency with which ultrasonographically (US) guided core biopsy obviated diagnostic surgical biopsy of nonpalpable breast masses, to calculate the cost savings of diagnosis attributable to US-guided core biopsy, and to compare the costs of US-guided versus stereotactically guided core biopsy. MATERIALS AND METHODS: US-guided core biopsy was performed in 151 consecutive solitary, nonpalpable breast masses in 151 women (age range, 23-80 years) by using a 14-gauge automated gun and needle. Clinical follow-up data were obtained. Cost savings were assessed by using national Medicare reimbursement costs of +385 for US-guided core biopsy, +610 for stereotactic core biopsy, and +1,332 for needle localization and surgical biopsy. RESULTS: US-guided core biopsy obviated a surgical procedure in 128 (85%) of 151 women. The mean adjusted direct cost saving per US-guided core biopsy was +744 per case. Use of US-guided biopsy decreased the cost of diagnosis by 56% (+744/+1,332) over the cost ...

US-guided core breast biopsy: use and cost-effectiveness.

OBJECTIVE. The purpose of this study was to determine the frequency and positive predictive value of biopsy performed on the basis of MR imaging findings in the contralateral breast in women with recently diagnosed breast cancer.MATERIALS AND METHODS. We performed a retrospective review of records of 1336 consecutive breast MR imaging examinations over a 2-year period. Of these examinations, 223 imaged the asymptomatic, mammographically normal contralateral breast in women whose breast cancer was diagnosed within 6 months preceding MR imaging. Records of these 223 examinations were reviewed to determine the frequency of recommending contralateral breast biopsy and the biopsy results.RESULTS. Contralateral breast biopsy was recommended in 72 (32%) of 223 women and performed in 61 women. Cancer occult to mammography and physical examination was detected by MR imaging in 12 women, constituting 20% (12/61) of women who underwent contralateral biopsy and 5% (12/223) of women who underwent contralateral breast ...

Andrea F. Abramson

Papers

The breast imaging reporting and data system: positive predictive value of mammographic features and final assessment categories.

MR Imaging of the Ipsilateral Breast in Women with Percutaneously Proven Breast Cancer

MRI of occult breast carcinoma in a high-risk population.

US-guided core breast biopsy: use and cost-effectiveness.

MR Imaging Findings in the Contralateral Breast of Women with Recently Diagnosed Breast Cancer