title: Added cancer yield of breast magnetic resonance imaging screening in women with a prior history of chest radiation therapy.
abstract: BACKGROUND
  Recommendation for breast magnetic resonance imaging (MRI) screening for women with a prior history of chest radiation is currently based on expert opinion, because existing data are very scant. The objective of this study was to evaluate added cancer yield of screening breast MRI in this population.
  
  
  METHODS
  A retrospective review identified 98 women with a prior history of chest radiation therapy who had screening mammography and screening MRI performed at the authors' institution between January 2004 and July 2010. Medical records of these patients and results of 558 screening studies (296 mammograms and 262 MRI) were reviewed. Sensitivity, specificity, positive predictive value, negative predictive value, and added cancer yield were calculated.
  
  
  RESULTS
  Malignancy was diagnosed in 13 patients, invasive cancer was diagnosed in 10 patients, and ductal carcinomas in situ was diagnosed in 3 patients. The median latency from completion of radiation to detection of the breast cancer was 18 years (range, 8-37 years). Of the 13 cancers, 12 (92%) were detected by MRI, and 9 (69%) by mammography. For mammography, the sensitivity, specificity, positive predictive value, and negative predictive value were 69%, 98%, 82%, and 95%, respectively; and, for MRI, these values were 92%, 94%, 71%, and 99%, respectively. In 4 of 98 patients, cancer was diagnosed on MRI only, resulting in an incremental cancer detection rate of 4.1% (95% confidence interval, 1.6%-10%).
  
  
  CONCLUSIONS
  The current results indicated that MRI is a useful adjunct modality for screening high-risk women who have a prior history of chest radiation therapy, resulting in a 4.1% (4 of 98 women) added cancer detection rate. The authors concluded that both MRI and mammography should be used to screen women in this high-risk group.
authors.affiliation: Breast Imaging Department, Brazilian National Cancer Institute, Rio De Janeiro, Brazil.
authors.forename: Vivianne
authors.initials: V
authors.lastname: Freitas
authors.forename: Anabel
authors.initials: A
authors.lastname: Scaranelo
authors.forename: Ravi
authors.initials: R
authors.lastname: Menezes
authors.forename: Supriya
authors.initials: S
authors.lastname: Kulkarni
authors.forename: David
authors.initials: D
authors.lastname: Hodgson
authors.forename: Pavel
authors.initials: P
authors.lastname: Crystal
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D002277:Carcinoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data*; D004526:Efficiency; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000706:statistics & numerical data; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000453:epidemiology; D011237:Predictive Value of Tests; D011859:Radiography; D011878:Radiotherapy / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D013909:Thorax / Q000528:radiation effects*