title: MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer.
abstract: BACKGROUND
  Even after careful clinical and mammographic evaluation, cancer is found in the contralateral breast in up to 10% of women who have received treatment for unilateral breast cancer. We conducted a study to determine whether magnetic resonance imaging (MRI) could improve on clinical breast examination and mammography in detecting contralateral breast cancer soon after the initial diagnosis of unilateral breast cancer.
  
  
  METHODS
  A total of 969 women with a recent diagnosis of unilateral breast cancer and no abnormalities on mammographic and clinical examination of the contralateral breast underwent breast MRI. The diagnosis of MRI-detected cancer was confirmed by means of biopsy within 12 months after study entry. The absence of breast cancer was determined by means of biopsy, the absence of positive findings on repeat imaging and clinical examination, or both at 1 year of follow-up.
  
  
  RESULTS
  MRI detected clinically and mammographically occult breast cancer in the contralateral breast in 30 of 969 women who were enrolled in the study (3.1%). The sensitivity of MRI in the contralateral breast was 91%, and the specificity was 88%. The negative predictive value of MRI was 99%. A biopsy was performed on the basis of a positive MRI finding in 121 of the 969 women (12.5%), 30 of whom had specimens that were positive for cancer (24.8%); 18 of the 30 specimens were positive for invasive cancer. The mean diameter of the invasive tumors detected was 10.9 mm. The additional number of cancers detected was not influenced by breast density, menopausal status, or the histologic features of the primary tumor.
  
  
  CONCLUSIONS
  MRI can detect cancer in the contralateral breast that is missed by mammography and clinical examination at the time of the initial breast-cancer diagnosis. (ClinicalTrials.gov number, NCT00058058 [ClinicalTrials.gov].).
authors: University of Washington Medical Center, Seattle, WA 98109, USA. lehman@u.washington.edu
authors: Constance D
authors: CD
authors: Lehman
authors: Constantine
authors: C
authors: Gatsonis
authors: Christiane K
authors: CK
authors: Kuhl
authors: R Edward
authors: RE
authors: Hendrick
authors: Etta D
authors: ED
authors: Pisano
authors: Lucy
authors: L
authors: Hanna
authors: Sue
authors: S
authors: Peacock
authors: Stanley F
authors: SF
authors: Smazal
authors: Daniel D
authors: DD
authors: Maki
authors: Thomas B
authors: TB
authors: Julian
authors: Elizabeth R
authors: ER
authors: DePeri
authors: David A
authors: DA
authors: Bluemke
authors: Mitchell D
authors: MD
authors: Schnall
mesh_terms: D001706:Biopsy; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D002278:Carcinoma in Situ / Q000175:diagnosis; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity