title: MRI detection of distinct incidental cancer in women with primary breast cancer studied in IBMC 6883.
abstract: BACKGROUND
  Prior single institution studies suggest MRI may improve the assessment of the extent of cancer within the breast, and thus reduce the risk of leaving macroscopic disease in the breast following breast conservation therapy. We report on the rate of MRI and mammography detection of foci of distinct incidental cancer in a prospective, multi center trial involving 426 women with confirmed breast cancer at 15 institutions in the US, Canada, and Germany.
  
  
  METHODS
  Women underwent mammography and MRI prior to biopsy of the suspicious index lesion. Additional incidental lesions (IL) greater than 2 cm from the index lesion that were detected by mammography and MRI were noted and characterized. Biopsy recommendations were associated with ILs given an assessment of suspicious or highly suspicous (BiRads 4 and 5). These assessments were considered a positive test.
  
  
  RESULTS
  MRI had a significantly higher yield of confirmed cancer ILs than mammography (0.18 (95%CI: 0.142-0.214) for MRI versus 0.072 (95%CI: 0.050-0.100) for mammography). The cancer ILs detected by MRI alone appeared to be similar to those detected by mammography with respect to size and histology. The percentage of biopsies of ILs that resulted in a cancer diagnosis was similar between the modalities (MRI 0.72(95%CI: 0.6-0.81); Mammography 0.85 (95%CI: 0.62-0.96)).
  
  
  CONCLUSIONS
  These results suggest that consideration needs to be given regarding the integration of breast MRI into the pretreatment evaluation of women seeking breast conservation therapy.
authors.affiliation: Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. schnall@oasis.rad.upenn.edu
authors.forename: Mitchell D
authors.initials: MD
authors.lastname: Schnall
authors.forename: Jeffery
authors.initials: J
authors.lastname: Blume
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
authors.forename: Gia A
authors.initials: GA
authors.lastname: Deangelis
authors.forename: Nanette
authors.initials: N
authors.lastname: Debruhl
authors.forename: Steven
authors.initials: S
authors.lastname: Harms
authors.forename: Sylvia H
authors.initials: SH
authors.lastname: Heywang-Köbrunner
authors.forename: Nola
authors.initials: N
authors.lastname: Hylton
authors.forename: Christiane K
authors.initials: CK
authors.lastname: Kuhl
authors.forename: Etta D
authors.initials: ED
authors.lastname: Pisano
authors.forename: Petrina
authors.initials: P
authors.lastname: Causer
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Schnitt
authors.forename: Stanley F
authors.initials: SF
authors.lastname: Smazal
authors.forename: Carol B
authors.initials: CB
authors.lastname: Stelling
authors.forename: Constance
authors.initials: C
authors.lastname: Lehman
authors.forename: Paul T
authors.initials: PT
authors.lastname: Weatherall
authors.forename: Constantine A
authors.initials: CA
authors.lastname: Gatsonis
mesh_terms: D001706:Biopsy; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008875:Middle Aged; D012680:Sensitivity and Specificity