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Fat SC, Weed C, Samaha Y, Chung A, Boyle MK, Giuliano A, Ray E, Amersi F. Incidence of Cancer and Role of Sentinel Lymph Node Biopsy in BRCA Mutation Carriers Undergoing Prophylactic Mastectomies. Am Surg 2023; 89:4066-4071. [PMID: 37184070 DOI: 10.1177/00031348231175498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Breast surveillance in patients with BRCA mutations include mammography (MMG) and MRI. Patients may elect to undergo risk-reducing bilateral prophylactic mastectomies (BPM). Sentinel lymph node biopsies (SLNB) are frequently performed and associated with increased morbidity. This study sought to determine the correlation between preoperative imaging and the final pathology and evaluate the role of SLNB in these high-risk patients. METHODS A prospective database identified BRCA patients who underwent BPM between 2006 and 2022. Imaging, pathology, and operative reports were reviewed. RESULTS 170 patients with BRCA 1/2 mutations were identified. 162 (95.3%) had imaging within one year of BPM. Of these, 28 (17.3%) patients had a MMG/ultrasound, 53 (32.7%) had an MRI, and 81 (50%) had both; 21/162 (13.0%) patients had abnormal imaging. Bilateral SLNB were performed in 31 (18.2%) patients, of which 7 had abnormal imaging; unilateral SLNB were performed in 4 (2.4%) patients, of which 3 had abnormal imaging. 11/170 (6.4%) patients had a malignancy and only one (9%) of these patients had imaging abnormalities. 1/170 (0.6%) patient had an invasive carcinoma requiring an axillary lymph node dissection (ALND), and 10/170 (5.9%) patients had ductal carcinoma in situ (DCIS). 25/170 (14.7%) had ADH/ALH. Only 7/170 (4.1%) patients had imaging abnormalities and abnormal pathology. All SLNB and ALND performed demonstrated no metastatic disease. DISCUSSION There is a high rate of discordance between preoperative imaging prior to surgery in BRCA patients undergoing prophylactic mastectomies and final pathology. This study does not support routine SLNB at the time of BPM.
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Affiliation(s)
- Shelby Chun Fat
- Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Christina Weed
- Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yasmina Samaha
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alice Chung
- Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Marissa K Boyle
- Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Armando Giuliano
- Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Edward Ray
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Farin Amersi
- Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Uysal E, Topaloğlu ÖF, Arı A, Özer H, Koplay M. Can magnetic resonance imaging texture analysis change the breast imaging reporting and data system category of breast lesions? Clin Imaging 2023; 97:44-49. [PMID: 36889114 DOI: 10.1016/j.clinimag.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 02/19/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE This study aimed to reveal magnetic resonance imaging (MRI) texture analysis (TA)'s contribution to categorizing breast lesions according to the Breast Imaging-Reporting and Data System (BI-RADS) lexicon. METHOD Two hundred and seventeen women with BI-RADS category 3, 4, and 5 lesions on breast MRI were included in the study. For TA, the region of interest was drawn manually to encompass the entire lesion on the fat-suppressed T2W and the first post-contrast T1W images. To identify the independent predictors of breast cancer, multivariate logistic regression analyses were performed using texture parameters. Estimated benign and malignant groups were formed according to the TA regression model. RESULTS Texture parameters extracted from T2WI, including median, gray-level co-occurrence matrix (GLCM) contrast, GLCM correlation, GLCM joint entropy, GLCM sum entropy, and GLCM sum of squares, and parameters extracted from T1WI, including maximum, GLCM contrast, GLCM joint entropy, GLCM sum entropy, were independent predictors of breast cancer. In the estimated new groups according to the TA regression model, 19 (91%) of the benign 4a lesions were downgraded to BI-RADS category 3. CONCLUSIONS The addition of quantitative parameters obtained by MRI TA to BI-RADS criteria significantly increased the accuracy rate in differentiating benign and malignant breast lesions. When categorizing BI-RADS 4a lesions, the use of MRI TA in addition to conventional imaging findings may reduce unnecessary biopsy rates.
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Affiliation(s)
- Emine Uysal
- Department of Radiology, Faculty of Medicine, Selçuk University, Selçuklu, Konya, Turkey.
| | - Ömer Faruk Topaloğlu
- Department of Radiology, Faculty of Medicine, Selçuk University, Selçuklu, Konya, Turkey
| | - Ayşe Arı
- Department of Radiology, Faculty of Medicine, Selçuk University, Selçuklu, Konya, Turkey
| | - Halil Özer
- Department of Radiology, Faculty of Medicine, Selçuk University, Selçuklu, Konya, Turkey
| | - Mustafa Koplay
- Department of Radiology, Faculty of Medicine, Selçuk University, Selçuklu, Konya, Turkey
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Alikhassi A, Li X, Au F, Kulkarni S, Ghai S, Allison G, Freitas V. False-positive incidental lesions detected on contrast-enhanced breast MRI: clinical and imaging features. Breast Cancer Res Treat 2023; 198:321-334. [PMID: 36740611 DOI: 10.1007/s10549-023-06861-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 01/08/2023] [Indexed: 02/07/2023]
Abstract
PURPOSE To identify demographic and imaging features of MRI-detected enhancing lesions without clinical, ultrasound, and mammographic correlation associated with false-positive outcomes, impacting patient care. MATERIALS AND METHODS A retrospective multi-institutional study of imaging studies and patient's chart review of consecutive women with MRI-detected enhancing lesions without clinical, mammogram, or ultrasound correlation between January and December 2018, who underwent MRI-guided biopsy. According to the BI-RADS lexicon, lesions' frequency and imaging features were recorded. The demographic and imaging characteristics variables were correlated with histopathology as the gold standard and an uneventful follow-up of at least one year. Univariate logistic regression analysis was used to explore the correlation between the baseline variables such as age, genetic mutation, family history of breast cancer, personal history of breast cancer, MRI indication, background parenchymal enhancement, and MRI characteristic of the lesion with the false-positive results in main data and subgroup analysis. RESULTS Two hundred nineteen women (median age 49 years; range 26-85 years) with 219 MRI-detected enhancing lesions that underwent MRI-guided vacuum-assisted biopsy during the study period fulfilled the study criteria and formed the study cohort. Out of 219, 180 lesions (82.2%) yielded benign pathology results, including 137 benign outcomes (76%) and 43 high-risk lesions (24%). Most demographic and imaging characteristics variables did not help to differentiate malignant from benign lesions. The variables that showed statistically significant association with true-positive results in univariate analyses were age (OR 1.05; 95% CI 1.02-1.08; p = 0.0015), irregular mass-lesion shape when compared with oval/round mass lesion (OR 11.2; 95% CI 1.6-78.4; p = 0.015), and clumped and clustered ring of enhancement when compared with homogeneous (OR 3.22, 95% CI 1.40-7.40; p = 0.0058). For participants with mass breast lesion, the hyperintense signal on the T2-weighted sequence (compared to the normal fibroglandular signal) was significantly related to the false-positive result (OR 0.13; 95% CI 0.02-0.76; p = 0.024). CONCLUSION Young patients, oval/round mass-lesion shape, and homogeneous pattern of non-mass enhancement showed the strongest association with false-positive results of enhancing lesions depicted by MRI. For participants with mass breast lesion, T2-bright mass lesion showed significant association with false-positive result. It may impact the patient's management with a suggestion of follow-up rather than interventional procedure when these demographic and imaging parameters are present, consequently decreasing the patient's anxiety and health care costs.
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Affiliation(s)
- Afsaneh Alikhassi
- Division of Breast Imaging, Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Xuan Li
- Department of Biostatistics-Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 10Th Floor, Room 10-509, Toronto, ON, M5G 2M9, Canada
| | - Frederick Au
- Joint Department of Medical Imaging-University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Supriya Kulkarni
- Joint Department of Medical Imaging-University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Sandeep Ghai
- Joint Department of Medical Imaging-University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Grant Allison
- Joint Department of Medical Imaging-University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Vivianne Freitas
- Joint Department of Medical Imaging-University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
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Wang Y, Liao X, Xiao F, Zhang H, Li J, Liao M. Magnetic Resonance Imaging Texture Analysis in Differentiating Benign and Malignant Breast Lesions of Breast Imaging Reporting and Data System 4: A Preliminary Study. J Comput Assist Tomogr 2020; 44:83-89. [PMID: 31939887 DOI: 10.1097/rct.0000000000000969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
RATIONALE AND OBJECTIVES This novel study aims to investigate texture parameters in distinguishing malignant and benign breast lesions classified as Breast Imaging Reporting and Data System 4 in dynamic contrast-enhanced magnetic resonance imaging (MRI). MATERIALS AND METHODS This retrospective study included 203 patients with 136 breast cancer and 67 benign lesions who underwent breast MRI between November 23, 2016, and August 27, 2018. Co-occurrence matrix-based texture features were extracted from each lesion on T1-weighted contrast-enhanced MRI using MatLab software. The association between texture parameters and breast lesions was analyzed, and the diagnostic model for breast cancer was created. Classification performance was evaluated by the area under the receiver operating characteristic curve, sensitivity, and specificity. RESULTS Significant differences were seen between malignant and benign lesions for a number of textural features, including contrast, correlation, autocorrelation, dissimilarity, cluster shade, and cluster performance (P < 0.05). After the analysis of the multicollinearity, 5 texture features (contrast, correlation, dissimilarity, cluster shade, and cluster performance) were included for the next principal component analysis. The differentiation accuracy of breast cancer based on the diagnostic model was 0.948 (95% confidence interval, 0.908-0.974). CONCLUSIONS Texture features that measure randomness, heterogeneity, or homogeneity may reflect underlying growth patterns of breast lesions and show great difference in malignant and benign lesions. Therefore, texture analysis may be a valuable assisted tool for diagnostic analysis on breast.
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Affiliation(s)
| | - Xing Liao
- Thyroid and Breast Surgery, ZhongNan Hospital of WuHan University, Wuchang District, Wuhan City, People's Republic of China
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van Zelst JCM, Mus RDM, Woldringh G, Rutten MJCM, Bult P, Vreemann S, de Jong M, Karssemeijer N, Hoogerbrugge N, Mann RM. Surveillance of Women with the BRCA1 or BRCA2 Mutation by Using Biannual Automated Breast US, MR Imaging, and Mammography. Radiology 2017; 285:376-388. [PMID: 28609204 DOI: 10.1148/radiol.2017161218] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate a multimodal surveillance regimen including yearly full-field digital (FFD) mammography, dynamic contrast agent-enhanced (DCE) magnetic resonance (MR) imaging, and biannual automated breast (AB) ultrasonography (US) in women with BRCA1 and BRCA2 mutations. Materials and Methods This prospective multicenter trial enrolled 296 carriers of the BRCA mutation (153 BRCA1 and 128 BRCA2 carriers, and 15 women with first-degree untested relatives) between September 2010 and November 2012, with follow-up until November 2015. Participants underwent 2 years of intensified surveillance including biannual AB US, and routine yearly DCE MR imaging and FFD mammography. The surveillance performance for each modality and possible combinations were determined. Results Breast cancer was screening-detected in 16 women (age range, 33-58 years). Three interval cancers were detected by self-examination, all in carriers of the BRCA1 mutation under age 43 years. One cancer was detected in a carrier of the BRCA1 mutation with a palpable abnormality in the contralateral breast. One incidental breast cancer was detected in a prophylactic mastectomy specimen. Respectively, sensitivity of DCE MR imaging, FFD mammography, and AB US was 68.1% (14 of 21; 95% confidence interval [CI]: 42.9%, 85.8%), 37.2% (eight of 21; 95% CI: 19.8%, 58.7%), and 32.1% (seven of 21; 95% CI: 16.1%, 53.8%); specificity was 95.0% (643 of 682; 95% CI: 92.7%, 96.5%), 98.1% (638 of 652; 95% CI: 96.7%, 98.9%), and 95.1% (1030 of 1088; 95% CI: 93.5%, 96.3%); cancer detection rate was 2.0% (14 of 702), 1.2% (eight of 671), and 1.0% (seven of 711) per 100 women-years; and positive predictive value was 25.2% (14 of 54), 33.7% (nine of 23), and 9.5% (seven of 68). DCE MR imaging and FFD mammography combined yielded the highest sensitivity of 76.3% (16 of 21; 95% CI: 53.8%, 89.9%) and specificity of 93.6% (643 of 691; 95% CI: 91.3%, 95.3%). AB US did not depict additional cancers. FFD mammography yielded no additional cancers in women younger than 43 years, the mean age at diagnosis. In carriers of the BRCA2 mutation, sensitivity of FFD mammography with DCE MR imaging surveillance was 90.9% (10 of 11; 95% CI: 72.7%, 100%) and 60.0% (six of 10; 95% CI: 30.0%, 90.0%) in carriers of the BRCA1 mutation because of the high interval cancer rate in carriers of the BRCA1 mutation. Conclusion AB US may not be of added value to yearly FFD mammography and DCE MR imaging surveillance of carriers of the BRCA mutation. Study results suggest that carriers of the BRCA mutation younger than 40 years may not benefit from FFD mammography surveillance in addition to DCE MR imaging. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Jan C M van Zelst
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Roel D M Mus
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Gwendolyn Woldringh
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Matthieu J C M Rutten
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Peter Bult
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Suzan Vreemann
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Mathijn de Jong
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Nico Karssemeijer
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Nicoline Hoogerbrugge
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Ritse M Mann
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
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Padamsee TJ, Wills CE, Yee LD, Paskett ED. Decision making for breast cancer prevention among women at elevated risk. Breast Cancer Res 2017; 19:34. [PMID: 28340626 PMCID: PMC5366153 DOI: 10.1186/s13058-017-0826-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Several medical management approaches have been shown to be effective in preventing breast cancer and detecting it early among women at elevated risk: 1) prophylactic mastectomy; 2) prophylactic oophorectomy; 3) chemoprevention; and 4) enhanced screening routines. To varying extents, however, these approaches are substantially underused relative to clinical practice recommendations. This article reviews the existing research on the uptake of these prevention approaches, the characteristics of women who are likely to use various methods, and the decision-making processes that underlie the differing choices of women. It also highlights important areas for future research, detailing the types of studies that are particularly needed in four key areas: documenting women's perspectives on their own perceptions of risk and prevention decisions; explicit comparisons of available prevention pathways and their likely health effects; the psychological, interpersonal, and social processes of prevention decision making; and the dynamics of subgroup variation. Ultimately, this research could support the development of interventions that more fully empower women to make informed and values-consistent decisions, and to move towards favorable health outcomes.
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Affiliation(s)
- Tasleem J. Padamsee
- Division of Health Services Management & Policy, College of Public Health, The Ohio State University, 280F Cunz Hall, 1841 Neil Avenue, Columbus, OH 43220 USA
| | - Celia E. Wills
- College of Nursing, The Ohio State University, Columbus, OH USA
| | - Lisa D. Yee
- College of Medicine, The Ohio State University, Columbus, OH USA
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de Almeida JRM, Gomes AB, Barros TP, Fahel PE, Rocha MDS. Predictive performance of BI-RADS magnetic resonance imaging descriptors in the context of suspicious (category 4) findings. Radiol Bras 2016; 49:137-43. [PMID: 27403012 PMCID: PMC4938442 DOI: 10.1590/0100-3984.2015.0021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective To determine the positive predictive value (PPV) and likelihood ratio for
magnetic resonance imaging (MRI) characteristics of category 4 lesions, as
described in the Breast Imaging Reporting and Data System
(BI-RADS®) lexicon, as well as to test the predictive
performance of the descriptors using multivariate analysis and the area
under the curve derived from a receiver operating characteristic (ROC)
curve. Materials and Methods This was a double-blind review study of 121 suspicious findings from 98 women
examined between 2009 and 2013. The terminology was based on the 2013
edition of the BI-RADS. Results Of the 121 suspicious findings, 53 (43.8%) were proven to be malignant
lesions, with no significant difference between mass and non-mass
enhancement (p = 0.846). The PPVs were highest for masses
with a spiculated margin (71%) and round shape (63%), whereas segmental
distribution achieved a high PPV (80%) for non-mass enhancement. Kinetic
analyses performed poorly, except for type 3 curves applied to masses (PPV
of 73%). Logistic regression models were significant for both patterns,
although the results were better for masses, particularly when kinetic
assessments were included (p = 0.015; pseudo
R2 = 0.48; area under the curve =
90%). Conclusion Some BI-RADS MRI descriptors have high PPV and good predictive performance-as
demonstrated by ROC curve and multivariate analysis-when applied to BI-RADS
category 4 findings. This may allow future stratification of this
category.
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Affiliation(s)
| | - André Boechat Gomes
- Physician, Department of Diagnostic Imaging, Clínica de Assistência à Mulher (CAM), Salvador, BA, Brazil
| | | | - Paulo Eduardo Fahel
- Physician, Department of Pathology, Clínica de Assistência à Mulher (CAM), Salvador, BA, Brazil
| | - Mário de Seixas Rocha
- PhD, Assistant Professor of Medicine, Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil
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Connors LM, Voian N, Shi Y, Lally RM, Edge S. Decision making after BRCA genetic testing. Down the road of transition. Clin J Oncol Nurs 2015; 18:E58-63. [PMID: 24867125 DOI: 10.1188/14.cjon.e58-e63] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to evaluate women who have completed hereditary cancer risk assessment and BRCA genetic testing to determine if they considered themselves prepared to proceed with decision making regarding cancer screening and prevention options. Levels of decisional conflict were explored, as was their preference for information delivery. The prospective, descriptive survey was conducted at a breast and clinical genetics clinic at a comprehensive cancer center in the northeastern United States. Twenty-seven female participants completed the Preparation for Decision Making scale, Decisional Conflict Scale, and a demographic questionnaire. Scores were consistent with high levels of preparation for decision making and low decisional conflict. The face-to-face approach was the preferred method for information delivery. Subgroup analysis demonstrated a difference in the measured objectives based on cancer status but not based on BRCA status. The current information delivery approach is meeting the decision-making needs of women considered to be at increased risk for hereditary breast and ovarian cancer.
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Affiliation(s)
| | - Nicoleta Voian
- Department of Medicine, Roswell Park Cancer Institute in Buffalo
| | - Yi Shi
- Department of Biostatistics, State University of New York
| | | | - Stephen Edge
- Department of Surgical Oncology, Roswell Park Cancer Institute
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Hofstatter EW, Andrejeva L, Chagpar AB. State of the Art in Imaging and Chemoprevention for High-Risk Patients. CURRENT BREAST CANCER REPORTS 2013. [DOI: 10.1007/s12609-013-0104-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mann RM, Bult P, van Laarhoven HWM, Span PN, Schlooz M, Veltman J, Hoogerbrugge N. Breast cancer size estimation with MRI in BRCA mutation carriers and other high risk patients. Eur J Radiol 2013; 82:1416-22. [PMID: 23567481 DOI: 10.1016/j.ejrad.2013.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 03/02/2013] [Accepted: 03/10/2013] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To assess the value of breast MRI in size assessment of breast cancers in high risk patients, including those with a BRCA 1 or 2 mutation. Guidelines recommend invariably breast MRI screening for these patients and therapy is thus based on these findings. However, the accuracy of breast MRI for staging purposes is only tested in sporadic cancers. METHODS We assessed concordance of radiologic staging using MRI with histopathology in 49 tumors in 46 high risk patients (23 BRCA1, 12 BRCA2 and 11 Non-BRCA patients). The size of the total tumor area (TTA) was compared to pathology. In invasive carcinomas (n=45) the size of the largest focus (LF) was also addressed. RESULTS Correlation of MRI measurements with pathology was 0.862 for TTA and 0.793 for LF. TTA was underestimated in 8(16%), overestimated in 5(10%), and correctly measured in 36(73%) cases. LF was underestimated in 4(9%), overestimated in 5(11%), and correctly measured in 36(80%) cases. Impact of BRCA 1 or 2 mutations on the quality of size estimation was not observed. CONCLUSIONS Tumor size estimation using breast MRI in high risk patients is comparable to its performance in sporadic cancers. Therefore, breast MRI can safely be used for treatment planning.
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Affiliation(s)
- R M Mann
- Radboud University Nijmegen Medical Centre, Department of Radiology, Nijmegen, The Netherlands.
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Oliveira C, Seruca R, Hoogerbrugge N, Ligtenberg M, Carneiro F. Clinical utility gene card for: Hereditary diffuse gastric cancer (HDGC). Eur J Hum Genet 2013; 21:ejhg2012247. [PMID: 23443028 DOI: 10.1038/ejhg.2012.247] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Carla Oliveira
- Expression Regulation in Cancer Group, Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal.
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Crump M. Toward risk-based breast cancer screening and prevention strategies for survivors of Hodgkin's lymphoma: one step closer? J Clin Oncol 2012; 30:2712-4. [PMID: 22734035 DOI: 10.1200/jco.2012.42.9423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kluijt I, Siemerink EJM, Ausems MGEM, van Os TAM, de Jong D, Simões-Correia J, van Krieken JH, Ligtenberg MJ, Figueiredo J, van Riel E, Sijmons RH, Plukker JTM, van Hillegersberg R, Dekker E, Oliveira C, Cats A, Hoogerbrugge N. CDH1-related hereditary diffuse gastric cancer syndrome: clinical variations and implications for counseling. Int J Cancer 2011; 131:367-76. [PMID: 22020549 DOI: 10.1002/ijc.26398] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Accepted: 05/31/2011] [Indexed: 01/26/2023]
Abstract
CDH1 mutation carriers have a strongly increased risk of developing gastric cancer (GC) and lobular breast cancer (LBC). Clinical data of GC cases and surgical and histological data of prophylactic gastrectomies and mastectomies of all 10 Dutch CDH1 mutation families were collected. In vitro functional assays were performed to analyze the nature of the newly found missense mutation c.1748T>G (p.Leu583Arg). Ten different CDH1 mutations were found. Functional assays gave strong arguments for the pathogenic nature of the p.Leu583Arg mutation. The pedigrees comprised 36 GC cases (mean age 40 years, range 20-72 years) and one LBC case. Twenty-nine/37 carriers alive, aged 18-61 years, underwent prophylactic gastrectomy. Invasive GC-foci and premalignant abnormalities were detected in 2 and 25 patients, respectively. In four patients GC/signetring cell (SRC) foci were diagnosed at preoperative gastroscopy. Long-standing presence of SRCs without progression to invasive carcinoma was shown in two others. Multifocal LBC/LCIS was found in the two prophylactic mastectomy specimens. Clefts of lip and/or palate (CL/P) were reported in seven individuals from three families. The age at onset and aggressiveness of GC is highly variable, which has to be included in counseling on planning prophylactic gastrectomies. The incidence of LBC is expected to increase and prophylactic mastectomy needs to be considered. The relationship between CL/P and CDH1 needs further study to inform future parents from hereditary diffuse gastric cancer (HDGC) families adequately.
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Affiliation(s)
- Irma Kluijt
- Family Cancer Clinic, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Jansen SA. Ductal Carcinoma In Situ: Detection, Diagnosis, and Characterization with Magnetic Resonance Imaging. Semin Ultrasound CT MR 2011; 32:306-18. [DOI: 10.1053/j.sult.2011.02.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bilateral prophylactic mastectomy in Swedish women at high risk of breast cancer: a national survey. Ann Surg 2011; 253:1147-54. [PMID: 21587115 DOI: 10.1097/sla.0b013e318214b55a] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND/OBJECTIVE This study attempted a national inventory of all bilateral prophylactic mastectomies performed in Sweden between 1995 and 2005 in high-risk women without a previous breast malignancy. The primary aim was to investigate the breast cancer incidence after surgery. Secondary aims were to describe the preoperative risk assessment, operation techniques, complications, histopathological findings, and regional differences. METHODS Geneticists, oncologists and surgeons performing prophylactic breast surgery were asked to identify all women eligible for inclusion in their region. The medical records were reviewed in each region and the data were analyzed centrally. The BOADICEA risk assessment model was used to calculate the number of expected/prevented breast cancers during the follow-up period. RESULTS A total of 223 women operated on in 8 hospitals were identified. During a mean follow-up of 6.6 years, no primary breast cancer was observed compared with 12 expected cases. However, 1 woman succumbed 9 years post mastectomy to widespread adenocarcinoma of uncertain origin. Median age at operation was 40 years. A total of 58% were BRCA1/2 mutation carriers. All but 3 women underwent breast reconstruction, 208 with implants and 12 with autologous tissue. Four small, unifocal, invasive cancers and 4 ductal carcinoma in situ were found in the mastectomy specimens. The incidence of nonbreast related complications was low (3%). Implant loss due to infection/necrosis occurred in 21 women (10%) but a majority received a new implant later. In total, 64% of the women underwent at least 1unanticipated secondary operation. CONCLUSIONS Bilateral prophylactic mastectomy is safe and efficacious in reducing future breast cancer in asymptomatic women at high risk. Unanticipated reoperations are common. Given the small number of patients centralization seems justified.
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Burness ML, Olopade OI. Is screening with magnetic resonance imaging in BRCA mutation carriers a safe and effective alternative to prophylactic mastectomy? J Clin Oncol 2011; 29:1652-4. [PMID: 21444875 DOI: 10.1200/jco.2010.32.5274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Reasons for risk-reducing mastectomy versus MRI-screening in a cohort of women at high hereditary risk of breast cancer. Breast 2011; 20:254-8. [PMID: 21306899 DOI: 10.1016/j.breast.2011.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 12/24/2010] [Accepted: 01/06/2011] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To determine the reasons that motivate women in a cohort of women under intensive surveillance for breast cancer to undergo risk-reducing mastectomy (RRM). PATIENTS AND METHODS Women with a BRCA1 or BRCA2 mutation who were enrolled in an MRI-based breast screening study were eligible to participate in this survey. A self-administered questionnaire was given to women who did, and who did not terminate annual MRI-based surveillance in order to undergo RRM. The questionnaire included information on family history, risk perception and satisfaction with screening. In addition, women were asked to provide the principal reason for their choice of having preventive surgery or not, and were asked about their satisfaction with this choice. RESULTS 246 women without breast cancer participated in the study. Of these, 39 women (16%) elected to have RRM at some point after initiating screening. Although women who had a mother or sister with breast cancer were more likely to opt for RRM than were women with no affected first-degree relative (21% versus 10%) this did not reach statistical significance. Women who perceived their breast cancer risk to be greater than 50% were more likely to opt for RRM than were women who estimated their risk to be less than 50% (19% versus 6%). Fear of cancer was the most common reason cited for choosing to have RRM (38% of respondents) followed by having had a previous cancer, (25%), then concern over their children (16%). CONCLUSION Among women with a BRCA mutation who are enrolled in an MRI-based screening program, a high perception of personal breast cancer risk and a history of breast cancer in a first-degree relative are predictors of the decision to have RRM.
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Female BRCA mutation carriers with a preference for prophylactic mastectomy are more likely to participate an educational-support group and to proceed with the preferred intervention within 2 years. Fam Cancer 2010; 9:213-20. [PMID: 19967456 DOI: 10.1007/s10689-009-9311-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Women with a BRCA mutation face a complex choice between breast cancer surveillance and prophylactic mastectomy. We determined risk management preferences shortly after genetic test disclosure and mastectomy status after a median observation period of 2 years. The effect of an educational-support group on the realisation of risk management preference was explored. We included 163 newly disclosed BRCA mutation carriers with no history of cancer, whose breast cancer risk management preferences were recorded. All carriers were offered the opportunity to participate an educational-support group. Mastectomy status was checked after a median observation period of 2 years. Of the total sample, 27% had an initial preference for mastectomy and 48% attended an educational-support group. After a median observation period of 2 years, 30% of the total sample had undergone prophylactic mastectomy. Of the women with a preference for surveillance, 90% of educational-support group attendees and 88% of the other mutation carriers, were still under surveillance. The number of women with a preference for mastectomy who actually had a mastectomy performed, was significantly higher in the group that attended an educational-support group as compared to those who did not, 89% and 63% respectively (OR 4.8, P = 0.04). Strong predictors for prophylactic mastectomy within 2 years were younger age and prior preference for mastectomy (R (2) = 0.57). Nearly all BRCA mutation carriers proceed with their initial choice for surveillance or prophylactic mastectomy. The study provides presumptive evidence that educational-support group participants decide to undergo prophylactic mastectomy earlier than non-attendees.
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Suijkerbuijk KPM, van Diest PJ, van der Wall E. Improving early breast cancer detection: focus on methylation. Ann Oncol 2010; 22:24-29. [PMID: 20591821 DOI: 10.1093/annonc/mdq305] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The need for additional breast cancer screening tools is indisputably high, as one may conclude from the high rate of interval malignancies in women undergoing regular screening. DNA promoter methylation frequently occurs during breast carcinogenesis and is an early event in this process. Moreover, a field defect for methylation has been described and methylation values can reliably be assessed in limited amounts of DNA. Simultaneous detection of methylation of a panel of genes in breast fluids and/or blood derivatives could be both sufficiently specific and sensitive to be of additive value to current imaging-based screening methods. This review describes the recent developments in methylation detection in breast fluids, serum and plasma that paved the way for large prospective studies. These studies will provide us with the definite answer as to what will be the additive value of defining the methylation status of specific genes to current imaging-based screening methods.
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Affiliation(s)
| | | | - E van der Wall
- Division of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht, The Netherlands
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Lee JM, Halpern EF, Rafferty EA, Gazelle GS. Evaluating the correlation between film mammography and MRI for screening women with increased breast cancer risk. Acad Radiol 2009; 16:1323-8. [PMID: 19632865 DOI: 10.1016/j.acra.2009.05.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 05/05/2009] [Accepted: 05/06/2009] [Indexed: 01/02/2023]
Abstract
RATIONALE AND OBJECTIVES Breast magnetic resonance imaging (MRI) is increasingly being added to mammography for screening asymptomatic women at increased risk of breast cancer. Because the direction and extent of correlation between mammography and MRI could potentially result in over- or underestimation of the diagnostic gain related to using MRI as an adjunct to mammographic screening, we performed an analysis to evaluate the extent of correlation between mammography and MRI. MATERIALS AND METHODS We reviewed the published literature to identify multimodality breast cancer screening studies reporting the sensitivity of mammography and MRI, alone and in combination, for breast cancer diagnosis. After calculating the expected sensitivity of combined mammography and MRI under conditions of test independence (no correlation), we compared the calculated and observed sensitivities for combined mammography and MRI. We then calculated correlation coefficients for mammography and MRI. RESULTS Seven studies of multimodality screening in women at increased risk of developing breast cancer were included for analysis. Of these studies, the correlation between film mammography and MRI was positive in three studies, negative in two studies, and not identified in two studies. The calculated correlation coefficients ranged from -0.38 to 0.18. In six of seven studies, the 95% confidence interval for the correlation coefficient included 0.0, indicating no significant correlation. CONCLUSIONS Evidence from published trials of multimodality breast cancer screening identified no statistically significant correlation between film mammography and MRI. Using both tests for breast cancer screening is likely to improve the early detection of breast cancer in women at increased risk.
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Affiliation(s)
- Janie M Lee
- Department of Radiology, Massachusetts General Hospital, Institute for Technology Assessment, 101 Merrimac Street, 10(th) Floor, Boston, MA 02114, USA.
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Howard AF, Balneaves LG, Bottorff JL. Women's decision making about risk-reducing strategies in the context of hereditary breast and ovarian cancer: a systematic review. J Genet Couns 2009; 18:578-97. [PMID: 19802692 DOI: 10.1007/s10897-009-9245-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Accepted: 07/09/2009] [Indexed: 12/22/2022]
Abstract
Women who have a mutation in the BRCA1 or BRCA2 genes have up to an 87% lifetime risk of breast cancer and up to a 40% lifetime risk of ovarian cancer. Cancer prevention and early detection strategies are often considered by these women to address this heightened risk. Risk-reducing strategies include risk-reducing mastectomy and oophorectomy, breast and ovarian cancer screening, and chemoprevention. This systematic literature review summarizes the factors and contexts that influence decision making related to cancer risk-reducing strategies among women at high-risk for hereditary breast and ovarian cancer. In the 43 published research articles reviewed, three main types of factors are identified that influence high-risk women's decisions about risk-reducing strategies: a) medical and physical factors, b) psychological factors and c) social context factors. How these factors operate in women's lives over time remains unknown, and would best be elucidated through prospective, longitudinal research, as well as qualitative research.
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Affiliation(s)
- A Fuchsia Howard
- School of Nursing, University of British Columbia, 302-6190 Agronomy Road, Vancouver, BC, V6T 1Z3, Canada.
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Abstract
PURPOSE OF REVIEW The proportion of breast cancers directly attributable to determinant hereditary factors is estimated to be 5-10%. A number of recent findings with regard to hereditary breast cancer should affect the criteria and scope of routine genetic testing and, soon, breast cancer therapy. RECENT FINDINGS The number of genes causing genetic cancer has expanded, mostly with genes that encode proteins that function in the BRCA1/2 pathways. The risk level associated with some genes is still under investigation, but is high for specific mutations. Some mutant alleles occur frequently, some are rare. High-throughput technologies will progressively allow investigating all genes involved in genetic (breast) cancer risks in all individuals for whom this information could be relevant. This and the emerging novel treatment options specific for cancers in mutation carriers will oblige us to progressively drop all currently used selection criteria such as familial phenotype for genomic testing. A major challenge remains the effective penetration of this knowledge in the professional and lay community, the broad application and financing of this high-throughput technology, and the identification of as yet unknown breast cancer predisposition genes. SUMMARY The assessment of breast cancer predisposition genes, previously only an optional predictive genetic test, is growing in importance as it also becomes a therapeutic predictive test.
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Zakhireh J, Gomez R, Esserman L. Converting evidence to practice: a guide for the clinical application of MRI for the screening and management of breast cancer. Eur J Cancer 2008; 44:2742-52. [PMID: 18977653 DOI: 10.1016/j.ejca.2008.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Accepted: 09/23/2008] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) has been increasingly utilized to screen and manage breast care. As the literature demonstrating its benefit expands, so do the potential clinical indications. However, routine review of the literature is merited to re-evaluate the appropriate and cost-effective use of MRI and guide clinicians in the areas of controversy. METHODS A literature review was performed to evaluate the current evidence for the use of MRI. RESULTS Evidence supports MRI screening for genetic mutation carriers and for those with an equivalent lifetime risk (>50%). Regarding staging and management, MRI is indicated for monitoring tumour response to neoadjuvant therapy. MRI should also be considered for patients with invasive lobular carcinoma, mammographically occult breast cancer and Paget's disease. DISCUSSION Though MRI is limited by moderate specificity and high cost, it can be a valuable, sensitive and cost-effective tool with thoughtful and judicious patient selection.
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Affiliation(s)
- Jennifer Zakhireh
- University of California, Department of Surgery, Division of Breast Surgical Oncology, San Francisco, CA 94115, USA
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