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Joo Y, Kim MJ, Yoon JH, Rho M, Park VY. Second breast cancer following negative breast MRI: Analysis by interval from surgery and risk factors. PLoS One 2024; 19:e0306828. [PMID: 39146263 PMCID: PMC11326552 DOI: 10.1371/journal.pone.0306828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/24/2024] [Indexed: 08/17/2024] Open
Abstract
OBJECTIVES This study aims to compare outcomes following a negative surveillance MRI study by surgery-MRI interval and investigate factors associated with second breast cancers in women with a personal history of breast cancer (PHBC). METHODS This retrospective study included 1552 consecutive women (mean age, 53 years) with a PHBC and a negative prevalence surveillance breast MRI result between August 2014 and December 2016. The incidence and characteristics of second breast cancers were reviewed and compared according to surgery-MRI interval (< 3 years vs ≥ 3 years). Logistic regression analysis was used to investigate associations with clinical-pathologic characteristics. RESULTS Twenty-five second breast cancers occurred after negative MRI. The incidence of second breast cancers or local-regional recurrence did not significantly differ by surgery-MRI interval. The median intervals between MRI to second breast cancer detection showed no significant difference between the two groups (surgery-MRI interval <3 years vs. ≥ 3 years). Two node-positive second breast cancers were detected in the group with <3 years interval. BRCA mutation status, receipt of breast-conserving surgery, and adjuvant chemotherapy (all p < .05) were significant factors associated with the development of second breast cancers. CONCLUSION Outcomes following a negative surveillance MRI did not differ by surgery-MRI interval. BRCA mutation status, receipt of breast-conserving surgery and adjuvant chemotherapy were independently associated with the risk of developing second breast cancers after negative surveillance MRI.
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Affiliation(s)
- Yohan Joo
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Jung Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Hyun Yoon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Miribi Rho
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Vivian Youngjean Park
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
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2
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Matheson J, Elder K, Nickson C, Park A, Mann GB, Rose A. Contrast-enhanced mammography for surveillance in women with a personal history of breast cancer. Breast Cancer Res Treat 2024:10.1007/s10549-024-07419-2. [PMID: 38963525 DOI: 10.1007/s10549-024-07419-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 06/27/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE Women with a personal history of breast cancer have an increased risk of subsequent breast malignancy and may benefit from more sensitive surveillance than conventional mammography (MG). We previously reported outcomes for first surveillance episode using contrast-enhanced mammography (CEM), demonstrating higher sensitivity and comparable specificity to MG. We now report CEM performance for subsequent surveillance. METHODS A retrospective study of 1,190 women in an Australian hospital setting undergoing annual surveillance following initial surveillance CEM between June 2016 and December 2022. Outcome measures were recall rate, cancer detection rate, contribution of contrast to recalls, false positive rate, interval cancer rate and characteristics of surveillance detected and interval cancers. RESULTS 2,592 incident surveillance episodes were analysed, of which 93% involved contrast-based imaging. Of 116 (4.5%) recall episodes, 40/116 (34%) recalls were malignant (27 invasive; 13 ductal carcinoma in situ), totalling 15.4 cancers per 1000 surveillance episodes. 55/116 (47%) recalls were contrast-directed including 17/40 (43%) true positive recalls. Tumour features were similar for contrast-directed recalls and other diagnoses. 8/9 (89%) of contrast-directed invasive recalls were Grade 2-3, and 5/9 (56%) were triple negative breast cancers. There were two symptomatic interval cancers (0.8 per 1000 surveillance episodes, program sensitivity 96%). CONCLUSION Routine use of CEM in surveillance of women with PHBC led to an increase in the detection of clinically significant malignant lesions, with a low interval cancer rate compared to previous published series. Compared to mammographic surveillance, contrast-enhanced mammography increases the sensitivity of surveillance programs for women with PHBC.
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Affiliation(s)
- Julia Matheson
- The Royal Melbourne Hospital, Grattan Street, Parkville, Australia
- Department of Surgery, The University of Melbourne, Parkville, Australia
| | - Kenneth Elder
- The Royal Melbourne Hospital, Grattan Street, Parkville, Australia
- The Royal Women's Hospital, Flemington Road, Parkville, Australia
| | - Carolyn Nickson
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Sydney, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Allan Park
- The Royal Melbourne Hospital, Grattan Street, Parkville, Australia
| | - Gregory Bruce Mann
- The Royal Melbourne Hospital, Grattan Street, Parkville, Australia.
- Department of Surgery, The University of Melbourne, Parkville, Australia.
- The Royal Women's Hospital, Flemington Road, Parkville, Australia.
| | - Allison Rose
- The Royal Melbourne Hospital, Grattan Street, Parkville, Australia
- The Royal Women's Hospital, Flemington Road, Parkville, Australia
- Department of Radiology, The University of Melbourne, Parkville, Australia
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3
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Chikarmane SA, Smith S. Background Parenchymal Enhancement: A Comprehensive Update. Radiol Clin North Am 2024; 62:607-617. [PMID: 38777537 DOI: 10.1016/j.rcl.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Breast MR imaging is a complementary screening tool for patients at high risk for breast cancer and has been used in the diagnostic setting. Normal enhancement of breast tissue on MR imaging is called breast parenchymal enhancement (BPE), which occurs after administration of an intravenous contrast agent. BPE varies widely due to menopausal status, use of exogenous hormones, and breast cancer treatment. Degree of BPE has also been shown to influence breast cancer risk and may predict treatment outcomes. The authors provide a comprehensive update on BPE with review of the recent literature.
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Affiliation(s)
- Sona A Chikarmane
- Breast Imaging Division, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Sharon Smith
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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Camps-Herrero J, Pijnappel R, Balleyguier C. MR-contrast enhanced mammography (CEM) for follow-up of breast cancer patients: a "pros and cons" debate. Eur Radiol 2024:10.1007/s00330-024-10684-w. [PMID: 38488968 DOI: 10.1007/s00330-024-10684-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/07/2024] [Accepted: 02/03/2024] [Indexed: 03/17/2024]
Abstract
Women with a personal history of breast cancer (PHBC) are at an increased risk of either a local recurrence or a new primary breast cancer. Thus, surveillance is essential for the detection of recurrent disease at the earliest possible stage, allowing for prompt treatment, and potentially improving overall survival. Nowadays, mammography follow-up is the only surveillance imaging technique recommended by international guidelines. Nevertheless, sensitivity of mammography is lower after breast cancer treatment, particularly during the first 5 years, due to increased density or post-treatment changes. Contrast-enhanced breast imaging techniques, such as MRI or contrast-enhanced mammography (CEM), are very sensitive to detect malignant enhancement, especially in dense breasts. This Special Report will provide arguments in favor of and against breast cancer follow-up with MRI or CEM, in a debate style between experts in Breast Imaging. Finally, the scientific points of pros and cons arguments will be summarized to help objectively decide the best follow-up strategy for women with a personal history of breast cancer. CLINICAL RELEVANCE STATEMENT: A personalized approach to follow-up imaging after conservative breast cancer treatment could optimize patient outcomes, using mammography as a baseline for most patients, and MRI or CEM selectively in patients with higher risks for a recurrence. KEY POINTS: • Women with a personal history of breast cancer are at an increased risk of either a local recurrence or a new primary breast cancer. • Breast cancer survivors may benefit from additional imaging with MRI/CEM, in case of increased risk of a second breast cancer, with dense breasts or a cancer diagnosis before age 50 years. • As survival after local recurrence seems to depend on the initial stage at diagnosis, imaging should be more focused on detecting tumors in the earliest stages.
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Affiliation(s)
| | - Ruud Pijnappel
- Department of Radiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Corinne Balleyguier
- Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France.
- BIOMAPS, UMR 1281, Université Paris-Saclay, 94800, Villejuif, France.
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5
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Yoen H, Chang JM. Artificial Intelligence Improves Detection of Supplemental Screening Ultrasound-detected Breast Cancers in Mammography. J Breast Cancer 2023; 26:504-513. [PMID: 37704383 PMCID: PMC10625864 DOI: 10.4048/jbc.2023.26.e39] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/21/2023] [Accepted: 08/17/2023] [Indexed: 09/15/2023] Open
Abstract
Despite recent advances in artificial intelligence (AI) software with improved performance in mammography screening for breast cancer, insufficient data are available on its performance in detecting cancers that were initially missed on mammography. In this study, we aimed to determine whether AI software-aided mammography could provide additional value in identifying cancers detected through supplemental screening ultrasound. We searched our database from 2017 to 2018 and included 238 asymptomatic patients (median age, 50 years; interquartile range, 45-57 years) diagnosed with breast cancer using supplemental ultrasound. Two unblinded radiologists retrospectively reviewed the mammograms using commercially available AI software and identified the reasons for missed detection. Clinicopathological characteristics of AI-detected and AI-undetected cancers were compared using univariate and multivariate logistic regression analyses. A total of 253 cancers were detected in 238 patients using ultrasound. In an unblinded review, the AI software failed to detect 187 of the 253 (73.9%) mammography cases with negative findings in retrospective observations. The AI software detected 66 cancers (26.1%), of which 42 (63.6%) exhibited indiscernible findings obscured by overlapping dense breast tissues, even with the knowledge of magnetic resonance imaging and post-wire localization mammography. The remaining 24 cases (36.4%) were considered interpretive errors by the radiologists. Invasive tumor size was associated with AI detection after multivariable analysis (odds ratio, 2.2; 95% confidence intervals, 1.5-3.3; p < 0.001). In the control group of 160 women without cancer, the AI software identified 19 false positives (11.9%, 19/160). Although most ultrasound-detected cancers were not detected on mammography with the use of AI, the software proved valuable in identifying breast cancers with indiscernible abnormalities or those that clinicians may have overlooked.
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Affiliation(s)
- Heera Yoen
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jung Min Chang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.
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6
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Monticciolo DL, Newell MS, Moy L, Lee CS, Destounis SV. Breast Cancer Screening for Women at Higher-Than-Average Risk: Updated Recommendations From the ACR. J Am Coll Radiol 2023; 20:902-914. [PMID: 37150275 DOI: 10.1016/j.jacr.2023.04.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/26/2023] [Accepted: 04/06/2023] [Indexed: 05/09/2023]
Abstract
Early detection decreases breast cancer death. The ACR recommends annual screening beginning at age 40 for women of average risk and earlier and/or more intensive screening for women at higher-than-average risk. For most women at higher-than-average risk, the supplemental screening method of choice is breast MRI. Women with genetics-based increased risk, those with a calculated lifetime risk of 20% or more, and those exposed to chest radiation at young ages are recommended to undergo MRI surveillance starting at ages 25 to 30 and annual mammography (with a variable starting age between 25 and 40, depending on the type of risk). Mutation carriers can delay mammographic screening until age 40 if annual screening breast MRI is performed as recommended. Women diagnosed with breast cancer before age 50 or with personal histories of breast cancer and dense breasts should undergo annual supplemental breast MRI. Others with personal histories, and those with atypia at biopsy, should strongly consider MRI screening, especially if other risk factors are present. For women with dense breasts who desire supplemental screening, breast MRI is recommended. For those who qualify for but cannot undergo breast MRI, contrast-enhanced mammography or ultrasound could be considered. All women should undergo risk assessment by age 25, especially Black women and women of Ashkenazi Jewish heritage, so that those at higher-than-average risk can be identified and appropriate screening initiated.
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Affiliation(s)
- Debra L Monticciolo
- Division Chief, Breast Imaging, Massachusetts General Hospital, Boston, Massachusetts.
| | - Mary S Newell
- Interim Division Chief, Breast Imaging, Emory University, Atlanta, Georgia
| | - Linda Moy
- Associate Chair for Faculty Mentoring, New York University Grossman School of Medicine, New York, New York; Editor-in-Chief, Radiology
| | - Cindy S Lee
- New York University Grossman School of Medicine, New York, New York
| | - Stamatia V Destounis
- Elizabeth Wende Breast Care, Rochester, New York; Chair, ACR Commission on Breast Imaging
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7
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Elder K, Matheson J, Nickson C, Box G, Ellis J, Mou A, Shadbolt C, Park A, Tay J, Rose A, Mann GB. Contrast enhanced mammography in breast cancer surveillance. Breast Cancer Res Treat 2023; 199:221-230. [PMID: 36966271 PMCID: PMC10175447 DOI: 10.1007/s10549-023-06916-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/13/2023] [Indexed: 03/27/2023]
Abstract
PURPOSE Mammography (MG) is the standard imaging in surveillance of women with a personal history of breast cancer or DCIS (PHBC), supplemented with ultrasound. Contrast Enhanced Mammography (CEM) has higher sensitivity than MG and US. We report the performance of CEM compared with MG ± US. METHODS A retrospective study of patients undergoing their first surveillance CEM in an Australian hospital setting between June 2006 and October 2020. Cases where a patient was recalled for assessment were identified, recording radiology, pathology and treatment details. Blinded re-reading of recalled cases was performed to determine the contribution of contrast. Use of surveillance US across the board was assessed for the period. RESULTS 73/1191 (6.1%) patients were recalled. 35 (48%) were true positives (TP), with 26 invasive cancers and 9 cases of DCIS, while 38 (52%) were false positive (FP) with a positive predictive value (PPV) 47.9%. 32/73 were recalled due to MG findings, while 41/73 were only recalled due to Contrast. 14/73 had 'minimal signs' with a lesion identifiable on MG with knowledge of the contrast finding, while 27/73 were visible only with contrast. 41% (17/41) recalled due to contrast were TP. Contrast-only TPs were found with low and high mammographic density (MD). Screening breast US reduced by 55% in the year after CEM was implemented. CONCLUSION Compared to MG, CEM as a single surveillance modality for those with PHBC has higher sensitivity and comparable specificity, identifying additional malignant lesions that are clinically significant. Investigation of interval cancer and subsequent round outcomes is warranted.
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Affiliation(s)
- Kenneth Elder
- The Royal Melbourne Hospital, Grattan Street, Parkville, Melbourne, 3101, Australia.
| | - Julia Matheson
- The Royal Melbourne Hospital, Grattan Street, Parkville, Melbourne, 3101, Australia
| | - Carolyn Nickson
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Sydney, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Georgia Box
- The Royal Melbourne Hospital, Grattan Street, Parkville, Melbourne, 3101, Australia
| | - Jennifer Ellis
- The Royal Melbourne Hospital, Grattan Street, Parkville, Melbourne, 3101, Australia
| | - Arlene Mou
- The Royal Women's Hospital, Flemington Road, Parkville, Melbourne, Australia
| | - Clair Shadbolt
- The Royal Women's Hospital, Flemington Road, Parkville, Melbourne, Australia
| | - Allan Park
- The Royal Women's Hospital, Flemington Road, Parkville, Melbourne, Australia
| | - Jia Tay
- The Royal Melbourne Hospital, Grattan Street, Parkville, Melbourne, 3101, Australia
| | - Allison Rose
- The Royal Women's Hospital, Flemington Road, Parkville, Melbourne, Australia
| | - Gregory Bruce Mann
- The Royal Melbourne Hospital, Grattan Street, Parkville, Melbourne, 3101, Australia
- The Royal Women's Hospital, Flemington Road, Parkville, Melbourne, Australia
- Department of Surgery, The University of Melbourne, Parkville, Australia
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8
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Acciavatti RJ, Lee SH, Reig B, Moy L, Conant EF, Kontos D, Moon WK. Beyond Breast Density: Risk Measures for Breast Cancer in Multiple Imaging Modalities. Radiology 2023; 306:e222575. [PMID: 36749212 PMCID: PMC9968778 DOI: 10.1148/radiol.222575] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 02/08/2023]
Abstract
Breast density is an independent risk factor for breast cancer. In digital mammography and digital breast tomosynthesis, breast density is assessed visually using the four-category scale developed by the American College of Radiology Breast Imaging Reporting and Data System (5th edition as of November 2022). Epidemiologically based risk models, such as the Tyrer-Cuzick model (version 8), demonstrate superior modeling performance when mammographic density is incorporated. Beyond just density, a separate mammographic measure of breast cancer risk is parenchymal textural complexity. With advancements in radiomics and deep learning, mammographic textural patterns can be assessed quantitatively and incorporated into risk models. Other supplemental screening modalities, such as breast US and MRI, offer independent risk measures complementary to those derived from mammography. Breast US allows the two components of fibroglandular tissue (stromal and glandular) to be visualized separately in a manner that is not possible with mammography. A higher glandular component at screening breast US is associated with higher risk. With MRI, a higher background parenchymal enhancement of the fibroglandular tissue has also emerged as an imaging marker for risk assessment. Imaging markers observed at mammography, US, and MRI are powerful tools in refining breast cancer risk prediction, beyond mammographic density alone.
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Affiliation(s)
| | | | - Beatriu Reig
- From the Department of Radiology, University of Pennsylvania, 3400
Spruce St, Philadelphia, PA 19104 (R.J.A., E.F.C., D.K.); Department of
Radiology, Seoul National University Hospital, Seoul, South Korea (S.H.L.,
W.K.M.); and Department of Radiology, NYU Langone Health, New York, NY (B.R.,
L.M.)
| | - Linda Moy
- From the Department of Radiology, University of Pennsylvania, 3400
Spruce St, Philadelphia, PA 19104 (R.J.A., E.F.C., D.K.); Department of
Radiology, Seoul National University Hospital, Seoul, South Korea (S.H.L.,
W.K.M.); and Department of Radiology, NYU Langone Health, New York, NY (B.R.,
L.M.)
| | - Emily F. Conant
- From the Department of Radiology, University of Pennsylvania, 3400
Spruce St, Philadelphia, PA 19104 (R.J.A., E.F.C., D.K.); Department of
Radiology, Seoul National University Hospital, Seoul, South Korea (S.H.L.,
W.K.M.); and Department of Radiology, NYU Langone Health, New York, NY (B.R.,
L.M.)
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9
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Cömert D, van Gils CH, Veldhuis WB, Mann RM. Challenges and Changes of the Breast Cancer Screening Paradigm. J Magn Reson Imaging 2023; 57:706-726. [PMID: 36349728 DOI: 10.1002/jmri.28495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/07/2022] [Accepted: 10/07/2022] [Indexed: 11/11/2022] Open
Abstract
Since four decades mammography is used for early breast cancer detection in asymptomatic women and still remains the gold standard imaging modality. However, population screening programs can be personalized and women can be divided into different groups based on risk factors and personal preferences. The availability of new and evolving imaging modalities, for example, digital breast tomosynthesis, dynamic-contrast-enhanced magnetic resonance imaging (MRI), abbreviated MRI protocols, diffusion-weighted MRI, and contrast-enhanced mammography leads to new challenges and perspectives regarding the feasibility and potential harms of breast cancer screening. The aim of this review is to discuss the current guidelines for different risk groups, to analyze the recent published studies about the diagnostic performance of the imaging modalities and to discuss new developments and future perspectives. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 6.
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Affiliation(s)
- Didem Cömert
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Radiology and Nuclear Medicine, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Carla H van Gils
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wouter B Veldhuis
- Department of Radiology and Nuclear Medicine, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Ritse M Mann
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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10
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Lee SH, Jang MJ, Yoen H, Lee Y, Kim YS, Park AR, Ha SM, Kim SY, Chang JM, Cho N, Moon WK. Background Parenchymal Enhancement at Postoperative Surveillance Breast MRI: Association with Future Second Breast Cancer Risk. Radiology 2023; 306:90-99. [PMID: 36040335 DOI: 10.1148/radiol.220440] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background Background parenchymal enhancement (BPE) is a known risk factor for breast cancer. However, studies on the association between BPE and second breast cancer risk are still lacking. Purpose To investigate whether BPE at surveillance breast MRI is associated with subsequent second breast cancer risk in women with a personal history of breast cancer. Materials and Methods A retrospective search of the imaging database of an academic medical center identified consecutive surveillance breast MRI examinations performed between January 2008 and December 2017 in women who underwent surgery for primary breast cancer and had no prior diagnosis of second breast cancer. BPE at surveillance breast MRI was qualitatively assessed using a four-category classification of minimal, mild, moderate, or marked. Future second breast cancer was defined as ipsilateral breast tumor recurrence or contralateral breast cancer diagnosed at least 1 year after each surveillance breast MRI examination. Factors associated with future second breast cancer risk were evaluated using the multivariable Fine-Gray subdistribution hazard model. Results Among the 2668 women (mean age at baseline surveillance breast MRI, 49 years ± 8 [SD]), 109 developed a second breast cancer (49 ipsilateral, 58 contralateral, and two ipsilateral and contralateral) at a median follow-up of 5.8 years. Mild, moderate, or marked BPE at surveillance breast MRI (hazard ratio [HR], 2.1 [95% CI: 1.4, 3.1]; P < .001), young age (<45 years) at initial breast cancer diagnosis (HR, 3.4 [95% CI: 1.7, 6.4]; P < .001), positive results from a BRCA1/2 genetic test (HR, 6.5 [95% CI: 3.5, 12.0]; P < .001), and negative hormone receptor expression in the initial breast cancer (HR, 1.6 [95% CI: 1.1, 2.6]; P = .02) were independently associated with an increased risk of future second breast cancer. Conclusion Background parenchymal enhancement at surveillance breast MRI was associated with future second breast cancer risk in women with a personal history of breast cancer. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Niell in this issue.
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Affiliation(s)
- Su Hyun Lee
- From the Department of Radiology (S.H.L., H.Y., Y.L., Y.S.K., A.R.P., S.M.H., S.Y.K., J.M.C., N.C., W.K.M.) and Medical Research Collaborating Center (M.J.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; and the Department of Radiology (S.H.L., S.M.H., S.Y.K., J.M.C., N.C., W.K.M.), Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myoung-Jin Jang
- From the Department of Radiology (S.H.L., H.Y., Y.L., Y.S.K., A.R.P., S.M.H., S.Y.K., J.M.C., N.C., W.K.M.) and Medical Research Collaborating Center (M.J.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; and the Department of Radiology (S.H.L., S.M.H., S.Y.K., J.M.C., N.C., W.K.M.), Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Heera Yoen
- From the Department of Radiology (S.H.L., H.Y., Y.L., Y.S.K., A.R.P., S.M.H., S.Y.K., J.M.C., N.C., W.K.M.) and Medical Research Collaborating Center (M.J.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; and the Department of Radiology (S.H.L., S.M.H., S.Y.K., J.M.C., N.C., W.K.M.), Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youkyoung Lee
- From the Department of Radiology (S.H.L., H.Y., Y.L., Y.S.K., A.R.P., S.M.H., S.Y.K., J.M.C., N.C., W.K.M.) and Medical Research Collaborating Center (M.J.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; and the Department of Radiology (S.H.L., S.M.H., S.Y.K., J.M.C., N.C., W.K.M.), Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yeon Soo Kim
- From the Department of Radiology (S.H.L., H.Y., Y.L., Y.S.K., A.R.P., S.M.H., S.Y.K., J.M.C., N.C., W.K.M.) and Medical Research Collaborating Center (M.J.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; and the Department of Radiology (S.H.L., S.M.H., S.Y.K., J.M.C., N.C., W.K.M.), Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ah Reum Park
- From the Department of Radiology (S.H.L., H.Y., Y.L., Y.S.K., A.R.P., S.M.H., S.Y.K., J.M.C., N.C., W.K.M.) and Medical Research Collaborating Center (M.J.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; and the Department of Radiology (S.H.L., S.M.H., S.Y.K., J.M.C., N.C., W.K.M.), Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Su Min Ha
- From the Department of Radiology (S.H.L., H.Y., Y.L., Y.S.K., A.R.P., S.M.H., S.Y.K., J.M.C., N.C., W.K.M.) and Medical Research Collaborating Center (M.J.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; and the Department of Radiology (S.H.L., S.M.H., S.Y.K., J.M.C., N.C., W.K.M.), Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soo-Yeon Kim
- From the Department of Radiology (S.H.L., H.Y., Y.L., Y.S.K., A.R.P., S.M.H., S.Y.K., J.M.C., N.C., W.K.M.) and Medical Research Collaborating Center (M.J.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; and the Department of Radiology (S.H.L., S.M.H., S.Y.K., J.M.C., N.C., W.K.M.), Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung Min Chang
- From the Department of Radiology (S.H.L., H.Y., Y.L., Y.S.K., A.R.P., S.M.H., S.Y.K., J.M.C., N.C., W.K.M.) and Medical Research Collaborating Center (M.J.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; and the Department of Radiology (S.H.L., S.M.H., S.Y.K., J.M.C., N.C., W.K.M.), Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nariya Cho
- From the Department of Radiology (S.H.L., H.Y., Y.L., Y.S.K., A.R.P., S.M.H., S.Y.K., J.M.C., N.C., W.K.M.) and Medical Research Collaborating Center (M.J.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; and the Department of Radiology (S.H.L., S.M.H., S.Y.K., J.M.C., N.C., W.K.M.), Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Woo Kyung Moon
- From the Department of Radiology (S.H.L., H.Y., Y.L., Y.S.K., A.R.P., S.M.H., S.Y.K., J.M.C., N.C., W.K.M.) and Medical Research Collaborating Center (M.J.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; and the Department of Radiology (S.H.L., S.M.H., S.Y.K., J.M.C., N.C., W.K.M.), Seoul National University College of Medicine, Seoul, Republic of Korea
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11
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Kim SY, Cho N, Hong H, Lee Y, Yoen H, Kim YS, Park AR, Ha SM, Lee SH, Chang JM, Moon WK. Abbreviated Screening MRI for Women with a History of Breast Cancer: Comparison with Full-Protocol Breast MRI. Radiology 2022; 305:36-45. [PMID: 35699580 DOI: 10.1148/radiol.213310] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Few studies have compared abbreviated breast MRI with full-protocol MRI in women with a personal history of breast cancer (PHBC), and they have not adjusted for confounding variables. Purpose To compare abbreviated breast MRI with full-protocol MRI in women with PHBC by using propensity score matching to adjust for confounding variables. Materials and Methods In this single-center retrospective study, women with PHBC who underwent full-protocol MRI (January 2008-August 2017) or abbreviated MRI (September 2017-April 2019) were identified. With use of a propensity score-matched cohort, screening performances were compared between the two MRI groups with the McNemar test or a propensity score-adjusted generalized estimating equation. The coprimary analyses were sensitivity and specificity. The secondary analyses were the cancer detection rate, interval cancer rate, positive predictive value for biopsies performed (PPV3), and Breast Imaging Reporting and Data System (BI-RADS) category 3 short-term follow-up rate. Results There were 726 women allocated to each MRI group (mean age ± SD, 50 years ± 8 for both groups). Abbreviated MRI and full-protocol MRI showed comparable sensitivity (15 of 15 cancers [100%; 95% CI: 78, 100] vs nine of 13 cancers [69%; 95% CI: 39, 91], respectively; P = .17). Abbreviated MRI showed higher specificity than full-protocol MRI (660 of 711 examinations [93%; 95% CI: 91, 95] vs 612 of 713 examinations [86%; 95% CI: 83, 88], respectively; P < .001). The cancer detection rate (21 vs 12 per 1000 examinations), interval cancer rate (0 vs five per 1000 examinations), and PPV3 (61% [14 of 23 examinations] vs 41% [nine of 22 examinations]) were comparable (all P < .05). The BI-RADS category 3 short-term follow-up rate of abbreviated MRI was less than half that of full-protocol MRI (5% [36 of 726 examinations] vs 12% [84 of 726 examinations], respectively; P < .001). Ninety-three percent (14 of 15) of cancers detected at abbreviated MRI were node-negative T1-invasive cancers (n = 6) or ductal carcinoma in situ (n = 8). Conclusion Abbreviated breast MRI showed comparable sensitivity and superior specificity to full-protocol MRI in breast cancer detection in women with a personal history of breast cancer. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Soo-Yeon Kim
- From the Department of Radiology (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.), Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Nariya Cho
- From the Department of Radiology (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.), Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Hyunsook Hong
- From the Department of Radiology (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.), Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Youkyoung Lee
- From the Department of Radiology (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.), Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Heera Yoen
- From the Department of Radiology (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.), Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Yeon Soo Kim
- From the Department of Radiology (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.), Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Ah Reum Park
- From the Department of Radiology (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.), Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Su Min Ha
- From the Department of Radiology (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.), Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Su Hyun Lee
- From the Department of Radiology (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.), Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Jung Min Chang
- From the Department of Radiology (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.), Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.)
| | - Woo Kyung Moon
- From the Department of Radiology (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.), Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.)
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12
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Bahl M. Screening MRI in Women at Intermediate Breast Cancer Risk: An Update of the Recent Literature. JOURNAL OF BREAST IMAGING 2022; 4:231-240. [PMID: 35783682 PMCID: PMC9233194 DOI: 10.1093/jbi/wbac021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Indexed: 11/13/2022]
Abstract
Guidelines issued by the American Cancer Society (ACS) in 2007 recommend neither for nor against screening MRI in women at intermediate breast cancer risk (15%-20%), including those with dense breast tissue, a history of lobular neoplasia or atypical ductal hyperplasia (ADH), or a prior breast cancer, because of scarce supporting evidence about the utility of MRI in these specific patient populations. However, since the issuance of the ACS guidelines in 2007, multiple investigations have found that women at intermediate risk may be suitable candidates for screening MRI, given the high detection rates of early-stage cancers and acceptable false-positive rates. For women with dense breast tissue, the Dense Tissue and Early Breast Neoplasm Screening trial reported that the incremental cancer detection rate (CDR) by MRI exceeded 16 cancers per 1000 examinations but decreased in the second round of screening; this decrease in CDR, however, occurred alongside a marked decrease in the false-positive rate. For women with lobular neoplasia or ADH, single-institution retrospective analyses have shown CDRs mostly ranging from 11 to 16 cancers per 1000 MRI examinations, with women with lobular carcinoma in situ benefitting more than women with atypical lobular hyperplasia or ADH. For patients with a prior breast cancer, the cancer yield by MRI varies widely but mostly ranges from 8 to 20 cancers per 1000 examinations, with certain subpopulations more likely to benefit, such as those with dense breasts. This article reviews and summarizes more recent studies on MRI screening of intermediate-risk women.
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Affiliation(s)
- Manisha Bahl
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
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13
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Chalfant JS, Mortazavi S, Lee-Felker SA. Background Parenchymal Enhancement on Breast MRI: Assessment and Clinical Implications. CURRENT RADIOLOGY REPORTS 2021. [DOI: 10.1007/s40134-021-00386-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Purpose of Review
To present recent literature regarding the assessment and clinical implications of background parenchymal enhancement on breast MRI.
Recent Findings
The qualitative assessment of BPE remains variable within the literature, as well as in clinical practice. Several different quantitative approaches have been investigated in recent years, most commonly region of interest-based and segmentation-based assessments. However, quantitative assessment has not become standard in clinical practice to date. Numerous studies have demonstrated a clear association between higher BPE and future breast cancer risk. While higher BPE does not appear to significantly impact cancer detection, it may result in a higher abnormal interpretation rate. BPE is also likely a marker of pathologic complete response after neoadjuvant chemotherapy, with decreases in BPE during and after neoadjuvant chemotherapy correlated with pCR. In contrast, pre-treatment BPE does not appear to be predictive of pCR. The association between BPE and prognosis is less clear, with heterogeneous results in the literature.
Summary
Assessment of BPE continues to evolve, with heterogeneity in approaches to both qualitative and quantitative assessment. The level of BPE has important clinical implications, with associations with future breast cancer risk and treatment response. BPE may also be an imaging marker of prognosis, but future research is needed on this topic.
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14
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Slanetz PJ. MRI Screening of Women with a Personal History of Breast Cancer. Radiology 2021; 300:324-325. [PMID: 34100686 DOI: 10.1148/radiol.2021211080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Priscilla J Slanetz
- From the Department of Radiology, Boston University Medical Center, 820 Harrison Ave, Boston MA 02118; and Department of Radiology, Boston University School of Medicine, Boston, Mass
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