Radiology: Breast MRI may be adjunct screening tool for those with LCIS history
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LCIS is associated with an increased risk of breast cancer, and falls into a gray area with respect to MR screening. The specificity of screening MRI ranges from 37 percent to 97 percent, prompting biopsies that yield normal findings and increased patient anxiety and healthcare costs.
Consequently, the American Cancer Society has said there is insufficient evidence to recommend for or against screening MRI in women with a history of LCIS and atypical hyperplasia, Janice S. Sung, MD, from the department of radiology at Memorial Sloan-Kettering Cancer Center in New York City, and colleagues wrote.
Sung and colleagues sought to evaluate the utility of screening MRI among this population and designed a retrospective review of 670 MRI studies acquired between January 2003 and September 2008 in 220 women with a history of LCIS.
Biopsy was recommended for 71 BI-RADS category 4 lesions in 59 patients and was performed in 60 lesions. Among these lesions, pathologic analysis revealed benign results in 45 percent, high-risk lesions in 35 percent and malignancy in 20 percent, wrote Sung and colleagues.
The authors added that mammography showed suspicious calcifications in an additional 25 patients.
During the study period, 17 breast cancers were detected in 14 patients, with 71 percent detected via MRI alone and 29 percent via mammography alone. “The biopsy recommendation rate per patient was higher for MR imaging than for mammography (27 percent vs. 12 percent),” wrote Sung et al.
“The results support existing evidence that MR imaging is more sensitive than mammography in the detection of early invasive breast cancers in women who are high risk of developing breast cancer because of a genetic mutation or strong family history of disease,” the researchers added.
However, given the possibility of a false-positive outcome and benign biopsy result, Sung and colleagues cautioned physicians to “discuss with patients the possibility that they may have to undergo a biopsy that yields benign findings or a series of short-term follow-up examinations in addition to annual MR screening.”
The researchers acknowledged several limitations to the study, including its retrospective design, small sample size and varied intervals of screening exams.
They concluded, “MR imaging is a useful adjunct modality with which to perform screening in women with a history of LCIS who are high risk for breast cancer, resulting in a 4.5 percent incremental cancer detection rate.” They emphasized that MRI should be an adjunct to, rather than a replacement for, mammography, as the combined modalities yielded higher sensitivity than either modality alone.