MRI of the Breast as Part of the Assessment in Population-Based Mammography Screening

Abstract

Purpose: To evaluate the indications and impact of MRI of the breast as an assessment modality in population-based mammography screening.

Materials and 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.

Conclusion: MRI is a useful problem-solving tool in mammography screening assessment with a high sensitivity and an acceptable positive predictive value.

Citation Format:

• Bick U, Engelken F, Diederichs G et al. MRI of the Breast as Part of the Assessment in Population-Based Mammography Screening. Fortschr Röntgenstr 2013; 185: 849 – 856

Zusammenfassung

Ziel: Evaluierung der Indikationen und Bedeutung der MRT der Brust als Abklärungsmodalität im bevölkerungsbezogenen Mammographie-Screening.

Material und Methoden: 135 konsekutive, zwischen April 2007 und Oktober 2012 als Teil der Abklärungsdiagnostik in einer Mammographie-Screening-Einheit vor Festlegung einer definitiven Handlungsempfehlung (z. B. sicher benigne oder maligne) durchgeführte kontrastverstärkte MRT Untersuchungen der Brust wurden retrospektiv ausgewertet. Insgesamt handelt es sich bei den Abklärungsuntersuchungen mit MRT um weniger als 2 % aller Abklärungsuntersuchungen in dieser Screening-Einheit. Alle MRT-Untersuchungen wurde im Rahmen der klinischen Routine an einem 1,5 T oder 3 T MRT-Ganzkörpertomographen mit einem Standard Protokoll für eine dynamische kontrastverstärkte MRT der Brust untersucht.

Ergebnisse: Bei den 135 Studienpatientinnen wurden insgesamt 30 Malignome bei 28 Patientinnen gefunden, einschließlich zwei bilateraler Karzinome. Bei einer Patientin wurde ein Non-Hodgkin-Lymphom diagnostiziert, von den übrigen 29 malignen Läsionen waren 3 (10 %) In-situ Karzinome (DCIS) und 26 (90 %) invasive Karzinome einschließlich drei multifokaler bzw. multizentrischer Karzinome. Bei allen 26 detektierten invasiven Karzinomen waren die Lymphknoten negativ und bei 25/29 (86 %) der detektierten Mammakarzinome handelte es sich um frühe Tumorstadien (Stadium 0 oder I). 53 der 135 MRT Untersuchungen (39,3 %) wurden als malignomverdächtig (BIRADS 4 oder 5) eingestuft. Keines der Karzinome wurde im MRT übersehen. Sensitivität, Spezifität, positiver prädiktiver Wert und negativer prädiktiver Wert der MRT bezogen auf Patienten waren 100 %, 77 %, 0,53, und 1.

Schlussfolgerung: Die MRT ist hilfreich bei der Problemlösung in der Abklärungssituation im Mammographie-Screening und zeichnet sich in dieser Situation durch eine hohe Sensitivität bei akzeptablem positiven prädiktiven Wert aus.

Key words

breast - neoplasms - mammography - screening - MR imaging - assessment

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