Nariya Cho1, Wonshik Han2, Boo-Kyung Han3, Min Sun Bae1, Eun Sook Ko3, Seok Jin Nam4, Eun Young Chae5, Jong Won Lee6, Sung Hun Kim7, Bong Joo Kang7, Byung Joo Song8, Eun-Kyung Kim9, Hee Jung Moon9, Seung Il Kim10, Sun Mi Kim11, Eunyoung Kang12, Yunhee Choi13, Hak Hee Kim5, Woo Kyung Moon1. 1. Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea. 2. Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea. 3. Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 4. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 5. Research Institute of Radiology, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. 6. Division of Breast and Endocrine Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. 7. Department of Radiology, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea. 8. Department of General Surgery, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea. 9. Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. 10. Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. 11. Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang, Republic of Korea. 12. Department of Surgery, Seoul National University Bundang Hospital, Bundang, Republic of Korea. 13. Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea.
Abstract
IMPORTANCE: Younger women (aged ≤50 years) who underwent breast conservation therapy may benefit from breast magnetic resonance imaging (MRI) screening as an adjunct to mammography. OBJECTIVE: To prospectively determine the cancer yield and tumor characteristics of combined mammography with MRI or ultrasonography screening in women who underwent breast conservation therapy for breast cancers and who were 50 years or younger at initial diagnosis. DESIGN, SETTING, AND PARTICIPANTS: This multicenter, prospective, nonrandomized study was conducted from December 1, 2010, to January 31, 2016, at 6 academic institutions. Seven hundred fifty-four women who were 50 years or younger at initial diagnosis and who had undergone breast conservation therapy for breast cancer were recruited to participate in the study. Reference standard was defined as a combination of pathology and 12-month follow-up. INTERVENTIONS: Participants underwent 3 annual MRI screenings of the conserved and contralateral breasts in addition to mammography and ultrasonography, with independent readings. MAIN OUTCOMES AND MEASURES: Cancer detection rate, sensitivity, specificity, interval cancer rate, and characteristics of detected cancers. RESULTS: A total of 754 women underwent 2065 mammograms, ultrasonography, and MRI screenings. Seventeen cancers were diagnosed, and most of the detected cancers (13 of 17 [76%]) were stage 0 or stage 1. Overall cancer detection rate (8.2 vs 4.4 per 1000; P = .003) or sensitivity (100% vs 53%; P = .01) of mammography with MRI was higher than that of mammography alone. After the addition of ultrasonography, the cancer detection rate was higher than that by mammography alone (6.8 vs 4.4 per 1000; P = .03). The specificity of mammography with MRI or ultrasonography was lower than that by mammography alone (87% or 88% vs 96%; P < .001). No interval cancer was found. CONCLUSIONS AND RELEVANCE: After breast conservation therapy in women 50 years or younger, the addition of MRI to annual mammography screening improves detection of early-stage but biologically aggressive breast cancers at acceptable specificity. Results from this study can inform patient decision making on screening methods after breast conservation therapy.
IMPORTANCE: Younger women (aged ≤50 years) who underwent breast conservation therapy may benefit from breast magnetic resonance imaging (MRI) screening as an adjunct to mammography. OBJECTIVE: To prospectively determine the cancer yield and tumor characteristics of combined mammography with MRI or ultrasonography screening in women who underwent breast conservation therapy for breast cancers and who were 50 years or younger at initial diagnosis. DESIGN, SETTING, AND PARTICIPANTS: This multicenter, prospective, nonrandomized study was conducted from December 1, 2010, to January 31, 2016, at 6 academic institutions. Seven hundred fifty-four women who were 50 years or younger at initial diagnosis and who had undergone breast conservation therapy for breast cancer were recruited to participate in the study. Reference standard was defined as a combination of pathology and 12-month follow-up. INTERVENTIONS: Participants underwent 3 annual MRI screenings of the conserved and contralateral breasts in addition to mammography and ultrasonography, with independent readings. MAIN OUTCOMES AND MEASURES: Cancer detection rate, sensitivity, specificity, interval cancer rate, and characteristics of detected cancers. RESULTS: A total of 754 women underwent 2065 mammograms, ultrasonography, and MRI screenings. Seventeen cancers were diagnosed, and most of the detected cancers (13 of 17 [76%]) were stage 0 or stage 1. Overall cancer detection rate (8.2 vs 4.4 per 1000; P = .003) or sensitivity (100% vs 53%; P = .01) of mammography with MRI was higher than that of mammography alone. After the addition of ultrasonography, the cancer detection rate was higher than that by mammography alone (6.8 vs 4.4 per 1000; P = .03). The specificity of mammography with MRI or ultrasonography was lower than that by mammography alone (87% or 88% vs 96%; P < .001). No interval cancer was found. CONCLUSIONS AND RELEVANCE: After breast conservation therapy in women 50 years or younger, the addition of MRI to annual mammography screening improves detection of early-stage but biologically aggressive breast cancers at acceptable specificity. Results from this study can inform patient decision making on screening methods after breast conservation therapy.
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