However, the ACR recommends annual surveillance with breast MRI in women with a personal history of breast cancer and dense breast tissue, or those diagnosed before age 50 [186]. This ACR recommendation is partially due to data showing that women with a personal history of premenopausal breast cancer benefited from MRI screening [187]. Data from the Breast Cancer Surveillance Consortium (BCSC) showed that, compared with mammography, MRI identified more cancers (10.8 versus 8.2 per 1,000 women screened) at the expense of a higher biopsy rate (10.1% versus 4.0%). However, multivariate models showed no difference in interval cancer detection rate or sensitivity (61.4% versus 70.3%, respectively) [188]. Wernli et al [188] also found that surveillance breast MRI leads to higher biopsy rate (OR, 2.2; 95% CI, 1.9-2.7; P < . 001) and cancer detection rate (OR, 1.7; 95% CI, 1.1-2.7; P = . 03) than mammography alone. However, there were no differences in sensitivity (OR, 1.1; 95% CI, 0.4-2.9; P = . 84) or interval cancer rate (OR, 1.1; 95% CI, 0.6-2.2; P = . 70) compared with mammography. Single-institutional studies at academic centers evaluating MRI for surveillance report sensitivities between 75% to 100% [189-193]. The cancer detection rate ranges from 1% to 2.9% for women whose only risk factor is a personal history of breast cancer [190-192]. However, this increases to 5.4% in patients with a personal history of breast cancer and dense breasts [194]. Another study from the BCSC group showed that women with a personal history of breast cancer undergoing MRI had a 2-fold increase in biopsy rate per 1,000 screening episodes (57.1% versus 23.6%) and lower cancer yield (267.6 versus 404.6 per 1,000 episodes with biopsy) than following mammography [195].
Imaging of Invasive Breast Cancer. However, the ACR recommends annual surveillance with breast MRI in women with a personal history of breast cancer and dense breast tissue, or those diagnosed before age 50 [186]. This ACR recommendation is partially due to data showing that women with a personal history of premenopausal breast cancer benefited from MRI screening [187]. Data from the Breast Cancer Surveillance Consortium (BCSC) showed that, compared with mammography, MRI identified more cancers (10.8 versus 8.2 per 1,000 women screened) at the expense of a higher biopsy rate (10.1% versus 4.0%). However, multivariate models showed no difference in interval cancer detection rate or sensitivity (61.4% versus 70.3%, respectively) [188]. Wernli et al [188] also found that surveillance breast MRI leads to higher biopsy rate (OR, 2.2; 95% CI, 1.9-2.7; P < . 001) and cancer detection rate (OR, 1.7; 95% CI, 1.1-2.7; P = . 03) than mammography alone. However, there were no differences in sensitivity (OR, 1.1; 95% CI, 0.4-2.9; P = . 84) or interval cancer rate (OR, 1.1; 95% CI, 0.6-2.2; P = . 70) compared with mammography. Single-institutional studies at academic centers evaluating MRI for surveillance report sensitivities between 75% to 100% [189-193]. The cancer detection rate ranges from 1% to 2.9% for women whose only risk factor is a personal history of breast cancer [190-192]. However, this increases to 5.4% in patients with a personal history of breast cancer and dense breasts [194]. Another study from the BCSC group showed that women with a personal history of breast cancer undergoing MRI had a 2-fold increase in biopsy rate per 1,000 screening episodes (57.1% versus 23.6%) and lower cancer yield (267.6 versus 404.6 per 1,000 episodes with biopsy) than following mammography [195].