title: MRI of the breast as part of the assessment in population-based mammography screening.
abstract: OBJECTIVE
  To evaluate the indications and impact of MRI of the breast as an assessment modality in population-based mammography screening.
  
  
  METHODS
  135 consecutive contrast-enhanced MRI exams of the breast, which were performed between April 2007 and October 2012 as part of the assessment at one mammography screening unit before issuance of a final management recommendation (e. g. definitely benign or malignant), were retrospectively reviewed. Overall, the cases with an MRI exam of the breast during assessment represent less than 2 % of all assessment cases at this screening unit. All MRI exams were performed as part of the routine clinical care on a 1.5 T or 3 T whole-body magnet using a standard dynamic breast MRI protocol.
  
  
  RESULTS
  In the 135 study patients, a total of 30 malignancies in 28 patients were found, including two bilateral cancers. One patient was diagnosed with a non-Hodgkin lymphoma, and of the remaining 29 malignant lesions, 3 (10 %) were in-situ cancers (DCIS) and 26 (90 %) were invasive breast cancers including 3 multifocal or multicentric cancers. All 26 detected invasive cancers were lymph-node negative and 25/29 (86 %) of the detected breast cancer were early stage cancers (stage 0 or 1). 53 of the 135 MRI exams (39.3 %) were suspicious for malignancy (BIRADS 4 or 5) with no cancer missed by MRI. The sensitivity, specificity, positive predictive value, and negative predictive value of the MRI on a per patient basis were 100 %, 77 %, 0.53, and 1, respectively.
  
  
  CONCLUSIONS
  MRI is a useful problem-solving tool in mammography screening assessment with a high sensitivity and an acceptable positive predictive value.
authors.affiliation: Institut für Radiologie, Charité - Universitätsmedizin Berlin. Ulrich.Bick@charite.de
authors.forename: U
authors.initials: U
authors.lastname: Bick
authors.forename: F
authors.initials: F
authors.lastname: Engelken
authors.forename: G
authors.initials: G
authors.lastname: Diederichs
authors.forename: R
authors.initials: R
authors.lastname: Dzyuballa
authors.forename: M
authors.initials: M
authors.lastname: Ortmann
authors.forename: E M
authors.initials: EM
authors.lastname: Fallenberg
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis*; D002277:Carcinoma / Q000175:diagnosis / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis* / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis* / Q000473:pathology; D018275:Carcinoma, Lobular / Q000175:diagnosis* / Q000473:pathology; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008327:Mammography / Q000379:methods*; D008403:Mass Screening / Q000379:methods*; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis; D011159:Population Surveillance; D012680:Sensitivity and Specificity; D047368:Tumor Burden
chemical_list: D003287:Contrast Media