MRI surveillance for women with a personal history of breast cancer: comparison between abbreviated and full diagnostic protocol

Abstract

Objective: To compare the diagnostic performance of breast MRI with abbreviated protocol (AB-MRI) and full ddiagnostic protocol (FDP-MRI) for surveillance of females with a personal history of breast cancer.

Methods: In this retrospective study, we analyzed the outcomes of total 1312 post-operative screening breast MRI matched from 1045 AB-MRI and 677 FDP-MRI, which had histologic confirmation for suspicious MRI findings or 1 year negative follow-up images. This study was approved by the institutional review board and informed patient consent was waved. AB-MRI consists of T₂ weighted scanning and dynamic contrast-enhanced imaging including one pre-contrast and two post-contrast scans. We compared the diagnostic performance for recurrent breast cancer in terms of sensitivity, specificity, positive-predictive value, negative-predictive value, and accuracy and area under the curve between the screening AB-MRI and FDP-MRI.

Results: Overall, 13 recurrent tumors among 1312 post-operative cases screened with breast MRI (1.0%) were detected including 8 invasive cancer, 2 cases of in situ cancer, and 3 cases of metastatic lymph nodes. The sensitivity and negative predictive value were 70 vs 100 and 99.5% vs 100% in AB-MRI and FDP-MRI. Specificity, positive predictive value, accuracy, and area under the curve of AB-MRI and FDP-MRI were 98.0% vs 96.9%, 35.0% vs 23.1%, 97.6% vs 97.0%, and 0.840 vs 0.985, respectively.

Conclusion: The performance of AB-MRI was comparable to that of FDP-MRI in detecting recurrent breast cancer and decreased false positive cases.

Advances in knowledge: AB-MRI provides a reliable alternative with similar diagnostic performance and shorter MRI acquisition time.

Figure 1.

A case of recurrent breast cancer using post-operative screening MRI with AB-MRI. A 50-year-old female, who had right breast conserving surgery for ductal carcinoma in situ 3 years ago, underwent post-operative screening MRI. Dynamic contrast-enhanced images (a) consisted of pre-, and two post-contrast sequences and axial T₂ weighted images without fat suppression (b) demonstrated 1.4 cm irregular mass (arrow) adjacent to the post-operative scar (opened arrow). Mammography (c) revealed asymmetry corresponding to the lesions on screening MRI only in the right MLO view (arrow). The targeted breast ultrasound (d) showed an area of parenchymal heterogeneity (arrows) in the right breast, and the lateral side-of scar (thin arrows). Ultrasound-guided core needle biopsy of this lesion showed recurrent ductal carcinoma in situ. AB-MRI, abbreviated protocol of breast MRI; MLO, mediolateral oblique.

Figure 2.

A case of contralateral recurrent breast cancer which was not apparent on AB-MRI. A 53-year-old female, who had left total mastectomy with flap reconstruction for IDC 1.5 years ago, underwent post-operative screening MRI. Dynamic contrast-enhanced images (a) consisted of pre-, and two post-contrast sequences showed no abnormal enhancement in right breast. Screening mammography 6 months after the AB-MRI (b) showed grouped coarse heterogeneous microcalcifications (arrow) in right upper outer breast. Stereotactic vacuum-assisted biopsy was performed and the lesion was confirmed as ductal carcinoma in situ. Following surgery revealed intermediate grade invasive ductal carcinoma. AB-MRI, abbreviated protocol of breast MRI; IDC, invasive ductal carcinoma.

Figure 3.

A case of benign mass using FDP-MRI but not apparent under AB-MRI. A 55-year-old female underwent bilateral breast-conserving surgery for IDC. Post-operative screening MRI using FDP-MRI 2 years after left breast conserving surgery showed a 1 cm-size benign mass in the left mid-outer breast (arrow), especially well demarcated in the delayed image (pre-, first- and sixth post-contrast images) (a). Follow-up MRI using AB-MRI was performed after a year, and benign mass on previous MRI was not seen on AB-MRI (b). AB-MRI, abbreviated protocol of breast MRI; FDP-MRI, full diagnostic protocol-MRI; IDC, invasive ductal carcinoma.