title: Assessment of false-negative cases of breast MR imaging  in women with a familial or genetic predisposition.
abstract: In order to assess the characteristics of malignant breast lesions those were not detected during screening by MR imaging. In the Dutch MRI screening study(MRISC), a non-randomized prospective multicenter study,women with high familial risk or a genetic predisposition for breast cancer were screened once a year by mammography and MRI and every 6 months with a clinical breast examination (CBE). The false-negative MR examinations were subject of this study and were retrospectively reviewed by two experienced radiologists. From November 1999 until March 2006, 2,157 women were eligible for study analyses. Ninety-seven malignant breast tumors were detected, including 19 DCIS (20%). In 22 patients with a malignant lesion, the MRI was assessed as BI-RADS 1 or 2. One patient was excluded because the examinations were not available for review. Forty-three percent (9/21) of the false-negative MR cases concerned pure ductal carcinoma in situ (DCIS) or DCIS with invasive foci, in eight of them no enhancement was seen at the review. In six patients the features of malignancy were missed or misinterpreted.Small lesion size (n = 3), extensive diffuse contrast enhancement of the breast parenchyma (n = 2),and a technically inadequate examination (n = 1) were other causes of the missed diagnosis. A major part of the false-negative MR diagnoses concerned non-enhancing DCIS, underlining the necessity of screening not only with MRI but also with mammography. Improvement of MRI scanning protocols may increase the detection rate of DCIS. The missed and misinterpreted cases are reflecting the learning curve of a multicenter study.
authors.affiliation: Department of Radiology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
authors.forename: Inge-Marie A
authors.initials: IM
authors.lastname: Obdeijn
authors.forename: Claudette E
authors.initials: CE
authors.lastname: Loo
authors.forename: Adriana J
authors.initials: AJ
authors.lastname: Rijnsburger
authors.forename: Martin N J M
authors.initials: MN
authors.lastname: Wasser
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Bergers
authors.forename: Theo
authors.initials: T
authors.lastname: Kok
authors.forename: Jan G M
authors.initials: JG
authors.lastname: Klijn
authors.forename: Carla
authors.initials: C
authors.lastname: Boetes
mesh_terms: D000328:Adult; D051017:Apoptosis Regulatory Proteins; D019313:BRCA1 Protein / Q000235:genetics; D024682:BRCA2 Protein / Q000235:genetics; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000235:genetics* / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging / Q000235:genetics* / Q000473:pathology*; D005188:False Negative Reactions; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D020022:Genetic Predisposition to Disease; D006801:Humans; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009154:Mutation; D009426:Netherlands; D010375:Pedigree; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D051017:Apoptosis Regulatory Proteins; C118024:BLID protein, human; D019313:BRCA1 Protein; C492913:BRCA1 protein, human; D024682:BRCA2 Protein; C551750:BRCA2 protein, human