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MRI shows greater screening sensitivity for familial breast cancer
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MRI is an effective early detection tool for women with an inherited predisposition for breast cancer regardless of breast density, patient age or risk status, according to study results.
MRI also demonstrated greater sensitivity than mammography and ultrasound, results showed.
Christopher C. Riedl, MD, of the department of biomedical imaging and image-guided therapy at the Medical University Vienna and General Hospital Vienna, and colleagues evaluated data from 559 women (median age, 44 years) who were offered screening with mammography, ultrasound and MRI every 12 months. All women either were BRCA1/2 mutation carriers (n = 156; 28%) or had a greater than 20% lifetime risk for breast cancer based on family history.
The population underwent 1,365 complete image rounds, or 2.45 rounds per woman. There were 204 (15%) suspicious findings, of which 38 (19%) were malignant. Two additional cancers were detected during follow-up.
MRI sensitivity (90%) was significantly higher than the sensitivity of mammography (37.5%), ultrasound (37.5%), and mammography combined with ultrasound (50%; P < .001 for all).
Of the 40 cancers detected, 45% (n = 18) were identified by MRI alone. Mammography alone detected two cancers (5%) — one ductal carcinoma in situ (DCIS) with microinvasion and one DCIS with less than 10-mm invasive areas. No cancers were found by ultrasound alone. Thus, sensitivity of MRI did not significantly increase with the addition of ultrasound or mammography.
“The ultrasound did not lead to the detection of any additional cancers but increased false-positive findings,” Riedl and colleagues wrote.
MRI identified all 14 cases of DCIS, whereas mammography and ultrasound each detected five (35.7%). Mammography and ultrasound combined detected seven (50%).
The false-positive rate was greater with MRI (88.6%) than with mammography (22.9%) or ultrasound (34.7%; P ˂ .001); however, researchers noted the majority of false-positive lesions detected by MRI were cases of atypical ductal hyperplasia.
Analyses stratified for screening round, mutation status, age and breast density indicated MRI still had significantly greater sensitivity compared with ultrasound or mammography (largest P = .017), as well as significantly lower specificity (P ˂ .001 for all subgroups).
“The use of MRI to screen women at an increased risk for breast cancer improved detection of invasive cancers and DCIS, regardless of mutation status, age or breast density,” Riedl and colleagues concluded. “The high sensitivity of MRI comes with a low specificity, which seems to be most pronounced in the first screening round, in young patients and in patients without a BRCA mutation. Mammography may not be indicated for all high-risk patients, and its use should be considered on a personalized basis. Ultrasound should only be used when MRI is not available or contraindicated.” – by Cameron Kelsall
Disclosure: One researcher reports research funding and travel accommodations from Abbott Medical Optics, Carl Zeiss Meditec, Croma-Pharma GmbH, HOYA, NIDEK, Oculentis and Omeros.
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