MRI screening of survivors may boost detection of successive breast cancer

A study in Clinical Imaging aimed to determine the utility and rate of biopsy in women with a positive history of breast cancer using MRI as the screening method.

The retrospective study, led by Audree Tadros of the Icahn School of Medicine at Mount Sinai in New York, reviewed patients with a personal history of breast cancer who underwent surveillance MRI as part of routine follow-up screening from 2007 to 2015. A total of 186 women with a history of breast cancer were in the research cohort.

Baseline characteristics including age, menopausal status, family history, genetics, primary histology, primary stage and history of radiation therapy, chemotherapy or endocrine therapy.

  • The 186 patients underwent 491 surveillance MRIs over the study period with an average follow up rate of 77 months.
  • The average number of MRIs performed per person was 2.64 and the average number per person years was 0.52.
  • One hundred seven biopsies were performed over the study period on a total of 74 patients—34 of the 107 (32 percent) were due to MRI findings alone. Of the 34 biopsies, eight had malignancy.
  • The positive predictive value for all patients undergoing biopsy prompted by MRI screenings alone was 0.24 (95 percent C.I. 10-0.38).
  • Overall specificity of MRI in the cohort was 94.6 percent. Nine patients developed a new primary or local recurrence.
  • Eight of the nine new breast cancers were detected by screening MRI alone with no concordant findings on screening mammography.

The chief finding in this study was surveillance MRIs in breast cancer survivors may increase detection of subsequent cancers.

“Surveillance MRI as an adjunct to routine mammography in breast cancer survivors may increase detection of local recurrence while also increasing rate of biopsy,” the authors wrote. “Based on the results of this study, surveillance breast MRI in women with a personal history of breast cancer alone cannot yet be recommended, however, a prospective randomized trial is needed to clarify the utility of breast MRI in this population.”