Use Of Breast Magnetic Resonance Imaging Research Articles

Current Trends in the Utilization of Preoperative Breast Magnetic Resonance Imaging Among Women With Newly Diagnosed Breast Cancer.

The clinical benefit of preoperative breast magnetic resonance imaging (MRI) for early-stage breast cancer (BC) remains controversial. We examined trends and the associated factors of preoperative breast MRI use. This study cohort, constructed from Optum Clinformatics database, included women with early-stage BC who had a cancer surgery between March 1, 2008, and December 31, 2020. Preoperative breast MRI was performed between the date of BC diagnosis and index surgery. Multivariable logistic regressions, one for elderly (65 years and older) and the other for non-elderly patients (younger than 65 years), were performed to examine factors associated with the use of preoperative MRI. Among 92,077 women with early-stage BC, the crude rate of preoperative breast MRI increased from 48% in 2008 to 60% in 2020 for nonelderly and from 27% to 34% for elderly women. For both age groups, non-Hispanic Blacks were less likely (odds ratio [OR]; 95% CI, younger than 65 years: 0.75, 0.70 to 0.81; 65 years and older: 0.77, 0.72 to 0.83) to receive preoperative MRI than non-Hispanic White patients. Across Census divisions, the highest adjusted rate was observed in Mountain division (OR compared with New England; 95% CI, younger than 65 years: 1.45, 1.27 to 1.65; 65 years and older: 2.42, 2.16 to 2.72). Other factors included younger age, fewer comorbidities, family history of BC, axillary node involvement, and neoadjuvant chemotherapy for both age groups. The use of preoperative breast MRI has steadily increased. Aside from clinical factors, age, race/ethnicity, and geographic location were associated with preoperative MRI use. This information is important for future implementation or deimplementation strategies of preoperative MRI.

Abstract PD16-01: Racial Disparities in the Use of Preoperative Breast MRI after Breast Cancer Diagnosis

Abstract Introduction: The use of magnetic resonance imaging (MRI) prior to surgical treatment for breast cancer has greatly increased over the past decade. As MRI more accurately defines disease extent vs mammography and sonography, it is frequently utilized for staging women at elevated risk of occult disease due to young age, dense breast tissue, and/or lobular histology. However, it is not known whether women from different racial backgrounds and socioeconomic statuses have equal access to preoperative breast MRI. The goal of this study was to assess whether the use of preoperative breast MRI varies by race and insurance type. Methods: We identified adult women who were diagnosed with Stage 0-III breast cancer within our mixed academic/community health system between 2016-2019 and were subsequently treated with surgical resection. We limited our analysis to non-Hispanic Black and non-Hispanic White women, as they comprised 93% of the eligible cohort. Patients who underwent breast MRI between their date of diagnosis and date of surgery were considered to have had a “preoperative MRI.” We used multivariable logistic regression to quantify the association between patient factors and receipt of preoperative MRI. Covariates included patient race, insurance type, age, year of diagnosis, clinical stage, histology, breast density, receptor subtype, and receipt of neoadjuvant systemic therapy. Results: 1,268 women met inclusion criteria and had complete clinical information available for analysis. 362 (29%) were Black, and 906 (71%) were White. 718 (57%) had private insurance, 460 (36%) had Medicare, and 72 (6%) had Medicaid. Compared to White patients, a larger proportion of Black patients had Medicaid (15% vs. 2.0%), fatty or scattered density (i.e., level 1 or 2) breasts (69% vs 48%), and regional disease (26% vs 19%) (Table). Patients with Medicare had the highest proportion of fatty or scattered density breasts (67% vs private=46% vs Medicaid=56%), while patients with Medicaid had the highest proportion of regional disease (35% vs private=23% vs Medicare=15%). The proportion of patients who received preoperative MRI was higher for White (49%) vs Black women (37%, p< 0.001). After adjustment, Black patients were 52% less likely to undergo preoperative MRI compared to White patients (OR 0.48, 95% CI 0.35-0.66, p< 0.001). Compared to privately-insured patients, patients with Medicare had a similar likelihood of undergoing preoperative MRI (OR 0.81, 95% CI 0.54-1.22, p=0.309), while patients with Medicaid may have had a lower likelihood of undergoing preoperative MRI (OR 0.55, 95% CI 0.30-1.00, p=0.053). Conclusions: Black patients with newly diagnosed breast cancer were less likely than White patients to undergo preoperative breast MRI, a disparity that persisted after controlling for insurance and clinical factors. Algorithmic use of preoperative MRI may mitigate provider- and system-level biases and promote more equitable resource utilization. Table 1: Characteristics of patients with non-metastatic breast cancer, diagnosed and treated at our institution (2016-2019) *Biomarker data for 2019 cohort is pending Citation Format: Sara P. Ginzberg, Connor B. Grady, Oluwadamilola (Lola) Fayanju, Christine E. Edmonds. Racial Disparities in the Use of Preoperative Breast MRI after Breast Cancer Diagnosis [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD16-01.

Abstract P6-02-04: Use of breast surveillance between women with pathogenic variants and variants of uncertain significance in breast cancer susceptibility genes

Abstract Background: Surveillance is a fundamental tool in the early detection and secondary prevention of many cancers. For women at increased genetic risk of breast cancer, mammography and breast magnetic resonance imaging (MRI) serve as the standard screening modalities. Use of surveillance mammography and MRI has been understudied among women with variant of uncertain significance (VUS) compared to pathogenic and likely pathogenic variants (P/LP). To address this gap, we examined the use of breast cancer surveillance and breast surgery in women who underwent multiple gene sequencing in a multicenter cohort of patients. We also expanded the surveillance literature by assessing correlates of breast MRI and mammography among women with VUS and investigating how rates of imaging changed over time after genetic testing. Methods: Using data from two cancer settings, we calculated use of risk reducing mastectomy (RRM) and surveillance for all women at genetically elevated risk of breast cancer, regardless of their personal history of breast cancer, with VUS or P/LP variants in a breast cancer susceptibility gene of high penetrance (BRCA1, BRCA2, PALB2, PTEN, TP53) and moderate penetrance (ATM, CDH1, CHEK2, NBN, NF1, STK11). The primary outcome was longitudinal use of surveillance mammography and breast MRI for women during the 13-month span after genetic testing, and each subsequent 13-month period up to 6 years afterwards. Results: Of 889 women, those with and without personal history of breast cancer were similar with regards to race/ethnicity, marital status, and high- or average-risk status. However, women with a personal history of breast cancer were on average older (54.1 vs 48.2 years), had longer follow-up time since genetic testing (3.4 vs 3.0 years), and were more likely to have VUS (62.5% vs 37.7%) compared to those without personal history of breast cancer. VUS carriers were less likely to undergo RRM compared to those with P/LP (HR=0.17, p=< 0.001) and high-risk women were more likely to undergo RRM than average-risk women (HR=3.91, p=0.005). Longitudinally, surveillance use among unaffected women decreased from 49.8% in the first year to 31.2% in the sixth year after genetic testing. In comparison, a greater proportion of women with a personal history of breast cancer underwent surveillance, which increased from 59.3% in the first year to 63.6% in the sixth year after genetic testing. Mammography rates did not differ between women with P/LP and VUS within the first 13 months after genetic testing and up to 4 years afterwards. Over the first four years after genetic testing, women with VUS were less likely to undergo annual MRIs compared to P/LP. This observation was true for women without a personal history of breast cancer (OR=0.34, p=0.003; OR=0.37, p=0.03; OR=0.19, p=0.004 for years 1, 2, and 3 respectively) as well as for women with a personal history of breast cancer (OR=0.31, p<=0.001; OR=0.33, p=0.002; OR=0.37, p=0.012; OR=0.3, p=0.14 for years 1, 2, 3, and 4 respectively). Conclusion: In this study of surveillance mammography and breast MRI use among women at elevated risk of breast cancer, we found that women with P/LP variants in breast cancer susceptibility genes are more likely to undergo annual breast MRI compared to those with VUS, whereas there was no difference between the groups in their use of annual surveillance mammography. This study is one of the first to examine maintenance of breast surveillance in a sample of women at elevated risk of breast cancer with non-negative genetic test results in BRCA1/2 as well as non-BRCA1/2 genes, while adjusting for personal and family history of cancer. In addition, we found that VUS, whether in high or moderate penetrance breast cancer susceptibility genes, was associated with lower use of annual breast MRI compared to P/LP variants, and equivalent use of annual mammography. These results add important evidence to dispel the myth of VUS-associated mismanagement of care. Citation Format: Sukh Makhnoon, Minxing Chen, Brooke Levin, Megan Ensinger, Kristin Mattie, Generosa Grana, Sanjay Shete, Banu K. Arun, Susan K. Peterson. Use of breast surveillance between women with pathogenic variants and variants of uncertain significance in breast cancer susceptibility genes [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-02-04.

Resonance imaging on the surgical management of newly diagnosed breast cancer

Introduction: Breast cancer is the most commonly diagnosed malignancy in women and the leading cause of cancer death in women. Tumor size is a critical factor in determining the type and extent of surgical and oncologic treatment. It is accurately determined by imaging modalities such as mammography, ultrasound, and magnetic resonance imaging (MRI), which provide a more reliable determination of tumor size. The aim of our study was to investigate the impact of preoperative breast magnetic resonance imaging on surgical treatment of newly diagnosed breast cancer. Material and Methods: The study retrospectively reviewed the records of 241 participants with newly diagnosed breast cancer who underwent preoperative mammography, breast ultrasound, and MRI between 2016 and 2020 at University Hospital Centre Rijeka. Patients were diagnosed with invasive ductal carcinoma, invasive lobular carcinoma, ductal carcinoma in situ, or a combination of the types. Surgical treatment included one of the following procedures: simple quadrantectomy, quadrantectomy and sentinel lymph node biopsy, quadrantectomy and axillary lymph node dissection, mastectomy and sentinel biopsy, or mastectomy and axillary dissection. Results: Compared with histopathologic tumor size, breast MRI overestimated size in 10% of patients. T stage was underestimated in 5% of patients (p>0.050). In comparison, breast ultrasound overestimated tumor size in 12% and underestimated it in 48% (p<0.001). Similarly, mammography overestimated tumor size in 14% and underestimated it in 62% (p<0.001). Conclusion: In patients with newly diagnosed breast cancer, the use of preoperative breast MRI as an adjunct to mammography and ultrasound for locoregional staging significantly alters subsequent surgical treatment.

Use of breast surveillance between women with pathogenic variants and variants of uncertain significance in breast cancer susceptibility genes.

Use of surveillance mammography and magnetic resonance imaging (MRI) has been understudied among women with variant of uncertain significance (VUS) compared to pathogenic and likely pathogenic variants (P/LP). Using data from two cancer settings, we calculated use of risk-reducing mastectomy (RRM) and surveillance during each 13-month span after genetic testing up to 6 years afterwards for a cohort of genetically elevated risk women. Of 889 women, VUS carriers were less likely to undergo RRM compared to those with P/LP (hazard ratio [HR], 0.17; p=<.001) and high-risk women were more likely to undergo RRM than average-risk women (HR, 3.91; p=.005). Longitudinally, surveillance use among unaffected women decreased from 49.8% in the first year to 31.2% in the sixth year after genetic testing. In comparison, a greater proportion of women with a personal history of breast cancer underwent surveillance, which increased from 59.3% in the first year to 63.6% in the sixth year after genetic testing. Mammography rates did not differ between women with P/LP and VUS within the first 13 months after genetic testing and up to 4 years afterward. Over the first 4 years after genetic testing, women with VUS were less likely to undergo annual MRIs compared to P/LP. The authors found that VUS, whether in high or moderate penetrance breast cancer susceptibility genes, was associated with lower use of annual breast MRI compared to P/LP variants and equivalent use of annual mammography. These results add important evidence regarding VUS-related breast surveillance.

Breast cancer and background parenchymal enhancement at breast magnetic resonance imaging: a meta-analysis

BackgroundThe background parenchymal enhancement at breast magnetic resonance imaging use to predict breast cancer attracts many searchers to draw a possible relationship. However, the results of their relationships were conflicting. This meta-analysis was performed to assess breast cancer frequency associations with background parenchymal enhancement.MethodsA systematic literature search up to January 2020 was performed to detect studies recording associations between breast cancer frequency and background parenchymal enhancement. We found thirteen studies including 13,788 women at the start with 4046 breast cancer. We calculated the odds ratio (OR) and the 95% confidence intervals (CIs) between breast cancer frequency and background parenchymal enhancement by the dichotomous technique with a random or fixed-effect model.ResultsWomen with minimal or mild background parenchymal enhancement at breast magnetic resonance imaging did not have any risk of breast cancer compared to control women (OR, 1.20; 95% CI 0.54–2.67). However, high background parenchymal enhancement at breast magnetic resonance imaging (OR, 2.66; 95% CI 1.36–5.19) and moderate (OR, 2.51; 95% CI 1.49–4.21) was associated with a significantly higher rate of breast cancer frequency compared to control women.ConclusionsOur meta-analysis showed that the women with high and moderate background parenchymal enhancement at breast magnetic resonance imaging have higher risks, up to 2.66 fold, of breast cancer. We suggest that women with high or moderate background parenchymal enhancement at breast magnetic resonance imaging to be scheduled for more frequent follow-up and screening for breast cancer to avoid any complications.

Effect of Personalized Breast Cancer Risk Tool on Chemoprevention and Breast Imaging: ENGAGED-2 Trial.

BackgroundLimited evidence exists about how to communicate breast density-informed breast cancer risk to women at elevated risk to motivate cancer prevention.MethodsWe conducted a randomized controlled trial evaluating a web-based intervention incorporating personalized breast cancer risk, information on chemoprevention, and values clarification on chemoprevention uptake vs active control. Eligible women aged 40-69 years with normal mammograms and elevated 5-year breast cancer risk were recruited from Kaiser Permanente Washington from February 2017 to May 2018. Chemoprevention uptake was measured as any prescription for raloxifene or tamoxifen within 12 months from baseline in electronic health record pharmacy data. Secondary outcomes included breast magnetic resonance imaging (MRI), mammography use, self-reported distress, and communication with providers. We calculated unadjusted odds ratios (ORs) using logistic regression models and mean differences using analysis of covariance models with 95% confidence intervals (CIs) with generalized estimating equations.ResultsWe randomly assigned 995 women to the intervention arm (n = 492) or control arm (n = 503). The intervention (vs control) had no effect on chemoprevention uptake (OR = 1.04, 95% CI = 0.07 to 16.62). The intervention increased breast MRI use (OR = 5.65, 95% CI = 1.61 to 19.74) while maintaining annual mammography (OR = 0.98, 95% CI = 0.75 to 1.28). Women in the intervention (vs control) arm had 5.67-times higher odds of having discussed chemoprevention or breast MRI with provider by 6 weeks (OR = 5.67, 95% CI = 2.47 to 13.03) and 2.36-times higher odds by 12 months (OR = 2.36, 95% CI = 1.65 to 3.37). No measurable differences in distress were detected.ConclusionsA web-based, patient-level intervention activated women at elevated 5-year breast cancer risk to engage in clinical discussions about chemoprevention, but uptake remained low.

Indications for breast magnetic resonance imaging at a referral center for the diagnosis and treatment of breast cancer in Brazil.

ObjectiveTo describe the indications for breast magnetic resonance imaging (MRI) at a referral center for breast cancer in Brazil.Materials and MethodsThis was a retrospective study in which we reviewed the clinical records, including physician requests and patient questionnaires, of women who underwent breast MRI between 2014 and 2018 at a referral center for the diagnosis and treatment of breast cancer in the city of Belo Horizonte, Brazil.ResultsThe most common indication for breast MRI was as a complement to mammography/ultrasonography (in 43.6% of cases), followed by breast cancer staging (in 25.1%), the screening of patients at high risk (in 17.4%), the evaluation of breast implants (in 10.1%), and the evaluation of the response to neoadjuvant chemotherapy (in 3.8%).ConclusionAlthough there is strong evidence supporting the use of breast MRI, mainly for the screening of high-risk patients, the imaging method is underutilized in Brazil.

Trends in screening breast magnetic resonance imaging use among US women, 2006 to 2016.

Supplemental breast cancer screening with breast magnetic resonance imaging (MRI) is recommended for women at high risk of breast cancer. To the authors' knowledge, recent national trends in breast MRI use are unknown. The authors used claims data from a large national insurer to calculate screening breast MRI rates from 2006 to 2016 in a US cohort of 10 million women aged 20 to 64 years. Use was stratified by subgroups of women with a BRCA mutation, family history of breast cancer, and prior breast cancer history and stratified by age. Joinpoint regression evaluated annual changes in trends. The total sample included 37,447 screening breast MRI examinations in 25,617 women. Overall screening breast MRI rates were low and increased from 2.9 to 12.1 examinations per 10,000 women from 2006 to 2016. MRI use in women with a BRCA mutation increased by 21% on average annually from 210.8 per 10,000 women to 1562.0 per 10,000 women from 2006 to 2016. By 2016, women aged 50 to 64 years who had a BRCA mutation had the highest use of breast MRI (1669.6 MRI examinations per 10,000 women) compared with younger women (1198.4 MRI examinations per 10,000 women, 1519.1 MRI examinations per 10,000 women, and 1567.2 MRI examinations per 10,000 women, respectively, among women aged 20-29 years, 30-39 years, and 40-49 years). Women with a BRCA mutation comprised <1% of the current study population but received approximately 9% of screening breast MRI examinations. Breast MRI rates among women with a family history of breast cancer or prior breast cancer history initially increased from 2006 to 2008, but then stabilized or decreased. The increases in breast MRI use observed in the current study have indicated improvements in concordance with breast imaging guidelines. However, women with BRCA mutations remain underscreened, particularly younger women, thereby identifying a clear gap with which to enhance access.

Association Between Degrees of Separation in Physician Networks and Surgeons' Use of Perioperative Breast Magnetic Resonance Imaging.

Perioperative magnetic resonance imaging (MRI) is frequently used in breast cancer despite unproven benefits. It is unclear whether surgeons' use of breast MRI is associated with the practices of other surgeons to whom they are connected through shared patients. We conducted a retrospective study using Medicare data to identify physicians providing breast cancer care during 2007-2009 and grouped them into patient-sharing networks. Physician pairs were classified according to their "degree of separation" based on patient-sharing (eg, physician pairs that care for the same patients were separated by 1 degree; pairs that both share patients with another physician but not with each other were separated by 2 degrees). We assessed the association between the MRI use of a surgeon and the practice patterns of surgical colleagues by comparing MRI use in the observed networks with networks with randomly shuffled rates of MRI utilization. Of the 15,273 patients who underwent surgery during the study period, 28.8% received perioperative MRI. These patients received care from 1806 surgeons in 60 patient-sharing networks; 55.1% of surgeons used MRI. A surgeon was 24.5% more likely to use MRI if they were directly connected to a surgeon who used MRI. This effect decreased to 16.3% for pairs of surgeons separated by 2 degrees, and 0.8% at the third degree of separation. Surgeons' use of perioperative breast MRI is associated with the practice of surgeons connected to them through patient-sharing; the strength of this association attenuates as the degree of separation increases.

Breast MRI ordering practices in a large health care network.

The purpose of this study was to evaluate providers' ordering practices and perceptions of breast magnetic resonance imaging (MRI) in an academic network in order to better understand and educate a referral base. An online survey was distributed to primary care providers (PCPs) and specialists in our hospital and community practices. Questions included provider demographics, current ordering practices, challenges to ordering, and perceptions about breast MRI. Of 525 ordering providers, 134 responded (26% response rate). Of 134 providers, 57 (42%) order breast MRI in practice. Of those who do not, the most consistent reason was a lack of familiarity with the use of breast MRI (32/77 [42%] of cases). Of 57 cases, 45 (79%) order less than 10 exams annually. The most frequent indication is for high-risk screening (40/47 [84%]). PCPs order fewer breast MRI compared with specialists (P=0.01). Both PCPs and specialists have mixed perceptions of the clinical utility of breast MRI. However, 30% of all providers are ordering more breast MRI since the enactment of breast density legislation in Massachusetts. Furthermore, 29% report they would order breast MRI more often to screen women with dense breasts if there was a low cost option. Referring provider surveys are useful tools for assessing a radiology practice. Our study suggests a growing clinical interest in breast MRI for screening; however, there is a need for provider education on the clinical utility of breast MRI. Increasing the radiologist's role in targeted educational interventions may help improve awareness and lead to more appropriate utilization of resources.

Factors associated with breast MRI use among women with a family history of breast cancer.

Although annual breast magnetic resonance imaging (MRI) is recommended for women at high risk for breast cancer as an adjunct to screening mammography, breast MRI use remains low. We examined factors associated with breast MRI use in a cohort of women with a family history of breast cancer but no personal cancer history. Study participants came from the Sister Study cohort, a nationwide, prospective study of women with at least 1 sister who had been diagnosed with breast cancer but who themselves had not ever had breast cancer (n=17894). Participants were surveyed on breast cancer beliefs, cancer worry, breast MRI use, provider communication, and genetic counseling and testing. Logistic regression was used to assess factors associated with having a breast MRI overall and for those at high risk. Breast MRI was reported by 16.1% and was more common among younger women and those with higher incomes. After adjustment for demographics, ever use of breast MRI was associated with actual and perceived risk. Odds ratios (OR) were 12.29 (95% CI, 8.85-17.06), 2.48 (95% CI, 2.27-2.71), and 2.50 (95% CI, 2.09-2.99) for positive BRCA1/2 test, lifetime breast cancer risk ≥ 20%, and being told by a health care provider of higher risk, respectively. Women who believed they had much higher risk than others or had higher level of worry were twice as likely to have had breast MRI; OR=2.23 (95% CI, 1.82-2.75) and OR=1.76 (95% CI, 1.52-2.04). Patterns were similar among women at high risk. Breast cancer risk, provider communication, and personal beliefs were determinants of breast MRI use. To support shared decisions about the use of breast MRI, women could benefit from improved understanding of the chances of getting breast cancer and increased quality of provider communications.

Preoperative Breast Magnetic Resonance Imaging Use by Breast Density and Family History of Breast Cancer.

Use of preoperative breast magnetic resonance imaging (MRI) among women with a new breast cancer has increased over the past decade. MRI use is more frequent in younger women and those with lobular carcinoma, but associations with breast density and family history of breast cancer are unknown. Data for 3075 women ages >65 years with stage 0-III breast cancer who underwent breast conserving surgery or mastectomy from 2005 to 2010 in the Breast Cancer Surveillance Consortium were linked to administrative claims data to assess associations of preoperative MRI use with mammographic breast density and first-degree family history of breast cancer. Multivariable logistic regression estimated adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for the association of MRI use with breast density and family history, adjusting for woman and tumor characteristics. Overall, preoperative MRI use was 16.4%. The proportion of women receiving breast MRI was similar by breast density (17.6% dense, 16.9% nondense) and family history (17.1% with family history, 16.5% without family history). After adjusting for potential confounders, we found no difference in preoperative MRI use by breast density (OR = 0.95 for dense vs. nondense, 95% CI: 0.73-1.22) or family history (OR = 0.99 for family history vs. none, 95% CI: 0.73-1.32). Among women aged >65 years with breast cancer, having dense breasts or a first-degree relative with breast cancer was not associated with greater preoperative MRI use. This utilization is in keeping with lack of evidence that MRI has higher yield of malignancy in these subgroups.

The Value of Quality-Assured Magnetic Resonance Imaging of the Breast for the Early Detection of Breast Cancer in Asymptomatic Women.

The aim of this study was to evaluate the exclusive performance of quality-assured high-resolution breast magnetic resonance imaging (MRI) for early detection of breast cancer in a population of asymptomatic women. A total of 1189 MRI examinations performed in 789 asymptomatic women (mean age, 51.1 years) were evaluated. All examinations were performed using open bilateral surface coil, dedicated compression device, and high spatial resolution (matrix, 512 × 512). Digital mammography was available for all participants. Assessment included density types, artifact level, and Breast Imaging Reporting and Data System classification. Evaluation was performed by 2 readers. In addition, a computer-assisted diagnosis (CAD) system was used for image assessment. Breast MRI showed density types I and II in 87.6% and artifacts categories III and IV in 3.1%. Study included 32 carcinomas (8 ductal carcinoma in situ, 24 invasive tumors). Both readers detected 29 of 32 correctly (sensitivity 90.6%). The variation between the readers was low (reader 1: specificity, 94.4% and positive predictive value (PPV), 25.7%; reader 2: specificity, 97.6% and PPV, 34.1%). Sensitivity of CAD was 62.5% (specificity, 84.4%; PPV, 5.2%). Digital mammography detected 13 of 32 carcinomas (sensitivity, 56.3%; specificity, 98.4%; PPV, 32.1%). The exclusive use of quality-assured breast MRI allows the early detection of breast cancer with a high sensitivity and specificity. The CAD analysis of MRI does not give additional information but shows results comparable with digital mammography.

The Influence of Breast Density on Preoperative MRI Findings and Outcome in Patients with a Known Diagnosis of Breast Cancer.

The role of breast density as an indication for preoperative breast magnetic resonance imaging (MRI) for surgical planning in women with breast cancer is unknown. We retrospectively reviewed breast cancer patients diagnosed from 2007 to 2011 who underwent preoperative MRI. We obtained clinical and pathological data and grouped patients by mammographic breast density, with Breast Imaging Reporting and Data System (BI-RADS) density A and B considered low density, and C and D considered high density. We analyzed local recurrence rates by breast density. Among 683 patients, 66.6% had high breast density. We noted MRI abnormalities in the ipsilateral breast in 41.8% high-density and 30.7% low-density breasts, while contralateral abnormalities were noted in 24.9% high-density and 13.8% low-density breasts. Biopsy was recommended for MRI findings in a similar number of patients regardless of density cohort. While more abnormalities were found in high-density breasts, the rate of additional cancer found was not significantly different (ipsilateral: 32 vs. 23%; contralateral: 6.2 vs. 3.2%) for high-and low-density patients, respectively (both p>0.15). With a median follow-up of 89 months, and similar rates of adjuvant systemic and radiation therapy, no difference in local recurrence rates existed when stratified according to density classification (p>0.53). While more abnormalities were identified on MRI in dense breasts, there was no statistically significant difference in the number of cancers identified or in recurrence rates. These findings question the routine use of preoperative breast MRI in women with newly diagnosed breast cancer based solely on breast density.

Predicting the level of tumor-infiltrating lymphocytes in patients with triple-negative breast cancer: Usefulness of breast MRI computer-aided detection and diagnosis.

To evaluate the usefulness of magnetic resonance imaging (MRI) computer-aided detection and diagnosis (CAD) for the detection of tumor-infiltrating lymphocytes (TILs) in triple-negative breast cancer (TNBC) patients. TNBC is a heterogeneous malignancy with a varying prognosis. Recently, the importance of TILs in TNBC has been determined. We retrospectively enrolled 60 lesions of TNBC. Either at 1.5T or 3T MRI, including T1 , T2 -weighted, and dynamic contrast-enhanced, images were obtained. The CAD results for all lesions were obtained, and we analyzed quantitative kinetic features including the initial peak enhancement and enhancement profiles. We divided the tumors into two groups: those with a TIL level of less than 50%, and those with a TIL level of 50% or more. Kinetic parameters were compared using Student's t-tests and chi-square tests. There were 48 low-TIL lesions and 12 high-TIL lesions. The portion of persistent enhancement of tumors was negatively associated with the TIL levels (P = 0.003). The persistent minus washout value of the low-TIL group was higher than that of the high-TIL group (P = 0.008). The odds ratios were 0.944 (P = 0.012) for the persistent portion and 0.971 (P = 0.008) for the persistent minus washout value. The prediction model using kinetic enhancement parameters, particularly persistent proportion and plateau minus washout value, could be helpful for identifying TIL levels in TNBC and may be used as an imaging biomarker to guide the treatment plan. 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:760-766.

The role of screening MRI in the era of next generation sequencing and moderate-risk genetic mutations.

With the advent of next-generation sequencing, the ability to rapidly analyze numerous genes simultaneously has led to the creation of large cancer gene panels. Some of these genes, like BRCA1 and BRCA2, have been heavily researched and have well-established management guidelines. Other more newly established genes, like ATM, CHEK2, and PALB2, have previously had less robust research surrounding them which has limited the ability to create accurate risk estimates. With their inclusion on gene panels, there has been more pressure to produce management guidelines for patients discovered to carry pathogenic variants in these genes. For known high-risk genes, it is recommended for breast magnetic resonance imaging (MRI) and mammogram to be offered annually. This combination has been proven to be more effective at detecting breast cancer than mammography alone, with a combined sensitivity of 94% (Leach et al. in Lancet 365(9473):1769-1778, 2005). Women with a lifetime risk of breast cancer of 20% and higher have been recommended to have both breast MRI and mammography performed (Saslow et al. in CA Cancer J Clin 57(2):75-89, 2007). For women with pathogenic variants detected in moderate risk genes with lifetime breast cancer risks of at least 20%, breast MRI should be offered as part of their management. For more newly discovered genes with suspected associated risks at or above 20%, the use of breast MRI should be considered for their management as well.

Practical Considerations for the Use of Breast MRI for Breast Cancer Evaluation in the Preoperative Setting

Preoperative contrast-enhanced (CE) breast magnetic resonance imaging (MRI) remains controversial in the newly diagnosed breast cancer patient. Additional lesions are frequently discovered in these patients with CE breast MRI. As staging and treatment planning evolve to include more information on tumor biology and aggression, so should our consideration of extent of disease. Directing CE breast MRI to those patients most likely to have additional disease may be beneficial. We sought to develop practical guidance for the use of preoperative CE breast MRI in the newly diagnosed breast cancer patient based on recent scientific data. Our review suggests several populations for whom preoperative breast MRI is most likely to find additional disease beyond that seen on conventional imaging. These can be viewed in three categories: (1) tumor biology-patients with invasive lobular carcinoma or aggressive tumors such as triple negative breast cancer (estrogen receptor negative, progesterone receptor negative, and human epidermal growth factor receptor 2 (HER2) negative) and HER2 positive tumors; (2) patient characteristics-dense breast tissue or younger age, especially those age <60; and (3) clinical scenarios-patients with more sonographic disease than expected or those who are node positive at initial diagnosis. Focusing breast MRI on patients with any of the aforementioned characteristics may help utilize preoperative breast MRI where it is likely to have the most impact.

Breast magnetic resonance imaging use in patients undergoing neoadjuvant chemotherapy is associated with less mastectomies in large ductal cancers but not in lobular cancers

BackgroundTo assess the impact of breast magnetic resonance imaging (MRI) use on surgical outcome per histological breast cancer subtype in patients treated with neoadjuvant chemotherapy. Patients and methodsAll patients aged 18–70 years who underwent neoadjuvant chemotherapy for stage I–III invasive breast cancer in the Netherlands in the years 2011–2013 were identified from the Netherlands Cancer Registry. Patients with cT4 tumours were excluded from the analysis. Use of breast MRI and impact on surgical treatment, resection margins and detection of contralateral breast cancer were analysed by multivariable analyses. ResultsBreast MRI was performed in 2879 (83.9%) out of 3433 patients treated with neoadjuvant chemotherapy. Younger age (odds ratio [OR] 1.42; 95% confidence interval [CI] 1.17–1.71 for 18–50 years compared with 50–70 years), larger tumour stage (OR 1.46 [95% CI 1.15–1.86] for cT3, compared to cT1–2 tumours) and multifocality (OR 1.30; 95% CI 1.04–1.61, versus unifocality) were associated with increased breast MRI use. In ductal breast cancer, after stratification for cT-status, breast MRI use is associated with a significant lower OR for mastectomy as final surgery in cT3 tumours (OR 0.45, 95% CI 0.21–0.99). Resection margin involvement and detection of contralateral breast cancer were not associated with breast MRI use. ConclusionIn patients treated with neoadjuvant chemotherapy, the use of breast MRI was associated with a reduced mastectomy rate, particularly in patients with large invasive ductal breast tumours but not in patients with lobular breast cancer.

Usefulness of Breast MRI for Safe Omission of Axillary Lymph Nodes Dissection in Sentinel Node-Positive Breast Cancer Patients

Background: Preoperative identification of patients with extensive lymph node metastasis (LNM) is important for safe omission of axillary lymph node dissection (ALND) in sentinel node (SN)-positive (SN+) breast cancer patients. Methods: We evaluated retrospectively the collected data of 758 breast cancer patients who underwent axillary surgery between 2008 and 2017, excluding those who received neoadjuvant chemotherapy. Results: Of the 758 patients, 607 were not suspicious to have LNM by axillary ultrasound (AUS-), but 38 suspicious cases were found by breast magnetic resonance imaging (MRI). Of 15 patients undergoing axillary fine needle biopsy (AFNA) due to second-look axillary ultrasound (AUS), 9 underwent ALND because of a positive AFNA (AFNA+). Among 81 (10.9%) patients undergoing ALND due to SN+ findings, 6 (7.4%) had extensive LNM (LNM ≥ 4). If MRI was not performed, among the 90 of 673 patients undergoing ALND who had SN+ findings, 12 (13.3%) had LNM ≥ 4. Conclusions: The proportion of cases with LNM ≥ 4 was reduced from 13.3% to 7.4% among patients undergoing SN biopsies combined with breast MRI. ALND might be omitted safely in SN+ cases according to detailed preoperative evaluations using additional breast MRI to ultrasound.