Most recently, a meta-analysis from 2000-2019 evaluating MRI as a screening modality in 8,338 women with a history of breast cancer (12,335 MRI examinations) found insufficient data to recommend for or against MRI as a surveillance examination in addition to mammographic screening [196]. Cancer detection rates of a second breast cancer by MRI were 8 to 20 per 1,000 examinations, but the sensitivity range was from 61% to 100%, with BI- RADS benchmark for MRI screening of at least 80%. Thus, clinical performance benchmarks have not been met in this population. Still, with the exception of the study on the BCSC cohort, other studies did not account for patient characteristics that could increase risk, such as premenopausal status, breast density, mutation status, or family history, through adjustment, stratification, or descriptive analysis. MRI Breast Without IV Contrast There is no evidence to support the use of noncontrast breast MRI in evaluating extent of disease. US Breast There is limited evidence to support the use of US breast for surveillance in women with history of BCT. A single study in Asian patients with a personal history of breast cancer treated with breast-conserving surgery or mastectomy showed diagnostic performances for the sensitivity, specificity, PPV, and accuracy of US of 95.8%, 97.8%, 27.1%, and 97.9% after BCS and 42.9%, 97.5%, 9.4%, and 97.2% after mastectomy [197]. There is additional evidence that whole breast US, as an adjunct to screening mammography in all women with dense breasts, detects additional 0.3 to 7.7 cancers per 1,000 at the expense of 11.7 to 106.6 biopsies per 1,000 women [198]. Although useful as a general supplemental screening tool, these limited data do not support US breast as supplemental screening after breast cancer conservation, with more data needed to determine how postoperative changes and fat necrosis specific to this population might impact specificity and sensitivity. Variant 7: Surveillance.
Imaging of Invasive Breast Cancer. Most recently, a meta-analysis from 2000-2019 evaluating MRI as a screening modality in 8,338 women with a history of breast cancer (12,335 MRI examinations) found insufficient data to recommend for or against MRI as a surveillance examination in addition to mammographic screening [196]. Cancer detection rates of a second breast cancer by MRI were 8 to 20 per 1,000 examinations, but the sensitivity range was from 61% to 100%, with BI- RADS benchmark for MRI screening of at least 80%. Thus, clinical performance benchmarks have not been met in this population. Still, with the exception of the study on the BCSC cohort, other studies did not account for patient characteristics that could increase risk, such as premenopausal status, breast density, mutation status, or family history, through adjustment, stratification, or descriptive analysis. MRI Breast Without IV Contrast There is no evidence to support the use of noncontrast breast MRI in evaluating extent of disease. US Breast There is limited evidence to support the use of US breast for surveillance in women with history of BCT. A single study in Asian patients with a personal history of breast cancer treated with breast-conserving surgery or mastectomy showed diagnostic performances for the sensitivity, specificity, PPV, and accuracy of US of 95.8%, 97.8%, 27.1%, and 97.9% after BCS and 42.9%, 97.5%, 9.4%, and 97.2% after mastectomy [197]. There is additional evidence that whole breast US, as an adjunct to screening mammography in all women with dense breasts, detects additional 0.3 to 7.7 cancers per 1,000 at the expense of 11.7 to 106.6 biopsies per 1,000 women [198]. Although useful as a general supplemental screening tool, these limited data do not support US breast as supplemental screening after breast cancer conservation, with more data needed to determine how postoperative changes and fat necrosis specific to this population might impact specificity and sensitivity. Variant 7: Surveillance.