Feasibility of abbreviated magnetic resonance imaging (AB-MRI) screening in women with a personal history (PH) of breast cancer.

Yeong Yi An,Sung Hun Kim,Young Jin Suh,Bong Joo Kang,Ye Won Jeon,Niels Bergsland

doi:10.1371/journal.pone.0230347

Abstract

PurposeTo investigate the feasibility of abbreviated magnetic resonance imaging (AB-MRI) in women with a personal history (PH) of breast cancer as a screening tool.Materials and methodsWe retrospectively reviewed 1880 screening AB-MRIs in 763 women with a PH of breast cancer (median age, 55 years; range, 23–89 years) between October 2015 and October 2016. The total acquisition times of AB-MRI were 8.3 min and 2.8 min with and without T2-weighted imaging, respectively. The tissue diagnosis or one-year follow-up status was used as the reference standard. The characteristics of tumor recurrences detected on AB-MRI screenings were analyzed. The cancer detection rates (CDRs) and additional CDRs for the 1st round and overall rounds of AB-MRI screening were calculated. The recall rate, sensitivity, specificity, positive predictive values for recall (PPV1) and biopsy (PPV3) for the 1st round of AB-MRI screening were calculated. The diagnostic performance of the combination of mammography and ultrasonography was compared with that of AB-MRI by receiver operating characteristic (ROC) curve analysis.ResultsFifteen of a total of 21 recurrences were detected on the 1st round of AB-MRI screening: 93.3% were node-negative T1 tumors (median tumor size, 1.02 cm; range, 0.1–2 cm) or Tis; 66.7% were high-grade tumors; 8 of these 15 were mammographically and ultrasonographically occult. The CDR and additional CDR for the 1st round of AB-MRI screening were 0.019 and 0.010 per woman, respectively. The sensitivity, specificity, recall rate, PPV1 and PPV3 for the 1st round of AB-MRI screening were 100%, 96.0%, 14.3%, 13.8% and 58.3%, respectively. For detecting secondary cancer, AB-MRI showed a higher sensitivity and PPV than the combination of mammography and ultrasonography (95.2%, 57.1% vs 47.6%, 38.5%). The area under the ROC curve was higher for AB-MRI (0.966; 95% CI: 0.951–0.978) than the combination of mammography and ultrasonography (0.727; 95% CI: 0.694–0.759) (P<0.0001).ConclusionAB-MRI improved cancer detection with a high specificity, sensitivity and PPV in women with a PH of breast cancer. AB-MRI could be a useful screening tool for detecting secondary cancer considering its high diagnostic performance and short examination time.

Highlights

Women with a personal history (PH) of breast cancer are known to be at an increased risk of developing a second breast cancer, which can be local breast cancer recurrence or contralateral breast cancer [1,2,3,4,5]
Fifteen of a total of 21 recurrences were detected on the 1st round of abbreviated magnetic resonance imaging (AB-magnetic resonance imaging (MRI)) screening: 93.3% were node-negative T1 tumors or Tis; 66.7% were high-grade tumors; 8 of these 15 were mammographically and ultrasonographically occult
The area under the receiver operating characteristic (ROC) curve was higher for AB-MRI

Summary

Introduction

Women with a personal history (PH) of breast cancer are known to be at an increased risk of developing a second breast cancer, which can be local breast cancer recurrence or contralateral breast cancer [1,2,3,4,5]. The purpose of surveillance after primary breast cancer treatment (BCT) is to detect second breast cancer in the early and asymptomatic phase, which is associated with improved patient survival and quality of life [6]. To overcome the limited sensitivity and higher interval cancer rate of MG in patients after BCT, supplemental imaging examinations, such as ultrasonography (US) or magnetic resonance imaging (MRI), have been increasingly used [11,12,13,14]. At this point, there remains much controversy regarding the optimal imaging modality for surveillance in these patient populations

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