Constance D Lehman1, Janie M Lee2, Wendy B DeMartini2, Daniel S Hippe2, Mara H Rendi2, Grace Kalish2, Peggy Porter2, Julie Gralow2, Savannah C Partridge2. 1. Department of Radiology, Massachusetts General Hospital, Boston, MA (CDL); Department of Radiology, University of Washington Medical Center, Seattle, WA (JML, DSH, GK, SCP); Seattle Cancer Care Alliance, Seattle, WA (JML, SCP); Department of Radiology, University of Wisconsin-Madison, Madison, WI (WBD); Department of Pathology, University of Washington Medical Center, Seattle, WA (MHR); Fred Hutchinson Cancer Research Center, Seattle, WA, (PP, JG); Department of Medical Oncology, University of Washington Medical Center, Seattle, WA (JG). clehman@mgh.harvard.edu. 2. Department of Radiology, Massachusetts General Hospital, Boston, MA (CDL); Department of Radiology, University of Washington Medical Center, Seattle, WA (JML, DSH, GK, SCP); Seattle Cancer Care Alliance, Seattle, WA (JML, SCP); Department of Radiology, University of Wisconsin-Madison, Madison, WI (WBD); Department of Pathology, University of Washington Medical Center, Seattle, WA (MHR); Fred Hutchinson Cancer Research Center, Seattle, WA, (PP, JG); Department of Medical Oncology, University of Washington Medical Center, Seattle, WA (JG).
Abstract
BACKGROUND: Screening MRI is recommended for individuals at high risk for breast cancer, based on genetic risk or family history (GFH); however, there is insufficient evidence to support screening MRI for women with a personal history (PH) of breast cancer. We compared screening MRI performance in women with PH vs GFH of breast cancer. METHODS: We analyzed case-series registry data, collected at time of MRI and at 12-month follow-up, from our regional Clinical Oncology Data Integration project. MRI performance was compared in women with PH with those with GFH. Chi-square testing was used to identify associations between age, prior history of MRI, and clinical indication with MRI performance; logistic regression was used to determine the combined contribution of these variables in predicting risk of a false-positive exam. All statistical tests were two-sided. RESULTS: Of 1521 women who underwent screening MRI from July 2004 to November 2011, 915 had PH and 606 had GFH of breast cancer. Overall, MRI sensitivity was 79.4% for all cancers and 88.5% for invasive cancers. False-positive exams were lower in the PH vs GFH groups (12.3% vs 21.6%, P < .001), specificity was higher (94.0% vs 86.0%, P < .001), and sensitivity and cancer detection rate were not statistically different (P > .99). Age (P < .001), prior MRI (P < .001), and clinical indication (P < .001) were individually associated with initial false-positive rate; age and prior MRI remained statistically significant in multivariable modeling (P = .001 and P < .001, respectively). CONCLUSION: MRI performance is superior in women with PH compared with women with GFH. Screening MRI warrants consideration as an adjunct to mammography in women with a PH of breast cancer.
BACKGROUND: Screening MRI is recommended for individuals at high risk for breast cancer, based on genetic risk or family history (GFH); however, there is insufficient evidence to support screening MRI for women with a personal history (PH) of breast cancer. We compared screening MRI performance in women with PH vs GFH of breast cancer. METHODS: We analyzed case-series registry data, collected at time of MRI and at 12-month follow-up, from our regional Clinical Oncology Data Integration project. MRI performance was compared in women with PH with those with GFH. Chi-square testing was used to identify associations between age, prior history of MRI, and clinical indication with MRI performance; logistic regression was used to determine the combined contribution of these variables in predicting risk of a false-positive exam. All statistical tests were two-sided. RESULTS: Of 1521 women who underwent screening MRI from July 2004 to November 2011, 915 had PH and 606 had GFH of breast cancer. Overall, MRI sensitivity was 79.4% for all cancers and 88.5% for invasive cancers. False-positive exams were lower in the PH vs GFH groups (12.3% vs 21.6%, P < .001), specificity was higher (94.0% vs 86.0%, P < .001), and sensitivity and cancer detection rate were not statistically different (P > .99). Age (P < .001), prior MRI (P < .001), and clinical indication (P < .001) were individually associated with initial false-positive rate; age and prior MRI remained statistically significant in multivariable modeling (P = .001 and P < .001, respectively). CONCLUSION: MRI performance is superior in women with PH compared with women with GFH. Screening MRI warrants consideration as an adjunct to mammography in women with a PH of breast cancer.
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Authors: Min Sun Bae; Janice S Sung; Blanca Bernard-Davila; Elizabeth J Sutton; Christopher E Comstock; Elizabeth A Morris Journal: J Breast Imaging Date: 2020-01-15