MRI detects recurring breast cancer missed by other modalities

Single-screening MRI can detect recurring breast cancer missed by ultrasound and mammography, suggests a study published in the August issue of Radiology.

Hye Mi Gweon, MD, of the Seoul National University College of Medicine in South Korea, and colleagues wrote that a single MRI screening detected 18.1 recurring breast cancer tumors after negative findings by ultrasound and mammography per 1,000 women with a history of breast cancer.

Gweon and colleagues wrote their study, along with previous studies, suggested that “it may be appropriate to recommend screening MRI imaging in women (younger than 50) with a personal history of breast cancer.”

“[O]ur data suggest that women with a history of [breast conservation therapy] for breast cancer may be appropriate candidates for breast MR imaging screening in view of the high detection yield for T1 invasive cancers,” they wrote. “Women at highest risk were those younger than 50 years of age at the time of index cancer diagnosis.”

However, they noted, mammogram screenings are currently the standard of care. “Meanwhile, guidelines from the American Cancer Society and European Society of Breast Cancer Specialists suggest that there is insufficient evidence to recommend for or against screening breast MRI imaging in women with a personal history of breast cancer.”

The retrospective study looked at 607 women with a median age of 48 who all had received breast conservation therapy and had undergone between one and three postoperative MRI screenings after negative ultrasound and mammography results. Nearly all (91.8 percent) had preoperative MRIs, while about half of the group (332) underwent just one postoperative MRI screening.

The authors said MRI screening detected 11 recurring breast cancers that were mostly node negative and T1 invasive cancers (72.7 percent, or eight of 11). The rest of the cancers found were ductal carcinoma in situ (27.3 percent, or three of 11). The study had a positive predictive value (PPV) for recall of 9.4 percent (11 of 117). The PPV for biopsies was 43.5 percent (10 of 23). The sensitivity was 91.7 percent and specificity was 82.2 percent.

Although MRI screening may detect cancers more effectively in women under 50 with BCT, the authors noted its drawbacks include “the high false-positive rate, cost, and tolerability of MRI examinations.”