Use of breast MRI surveillance in women at high risk for breast cancer: a single-institutional experience.
BACKGROUND
The study aim is to investigate indications for breast magnetic resonance imaging (MRI) screening for high-risk women and to determine outcomes, correlation with routine imaging, and adherence to current guidelines for use.


METHODS
We identified 200 patients undergoing 275 breast MRIs for high-risk surveillance from 2005 to 2008. Data collected included patient characteristics, need for additional imaging and/or biopsy, correlation with routine imaging, and outcomes. Gail scores were calculated for patients without hereditary breast cancer syndromes or previous chest radiation. Descriptive statistics were utilized for data summary.


RESULTS
Two hundred patients underwent 275 breast MRIs for high-risk surveillance (mean age 45 years, range 18-76 years). Indications included BRCA mutation (n =21), history of chest radiation (n = 10), and perceived high risk (n =169). The mean Gail score for the latter group was 25% (range 10-46%); 32 (16%) patients had Gail score <20%. Of 275 MRIs, 49 (18%) required additional imaging and 21 (8%) prompted biopsy. Of 21 biopsies, 4 were malignant; 2 were also visible on routine imaging performed concurrently with breast MRI. The false-positive rate for breast MRI screening in our cohort of high-risk patients was 23%.


CONCLUSIONS
The rate of cancer detection in high-risk patients undergoing breast MRI at our institution is similar to that of large, multicenter trials. Sixteen percent of patients undergoing breast MRI did not meet high-risk criteria. Because the need for additional imaging and biopsy remains high, further investigation is necessary to determine if this strategy is cost effective.
Elmore
Leisha
L
Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Margenthaler
Julie A
JA
D000293:Adolescent; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D055088:Early Detection of Cancer; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D006801:Humans; D008279:Magnetic Resonance Imaging; D008403:Mass Screening; D008875:Middle Aged; D009154:Mutation; D009367:Neoplasm Staging; D011159:Population Surveillance; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult