Screening Breast MRI Effectively Detects Early-Stage Breast Cancer in High-Risk Patients without Prior History of Breast Cancer

Take-Away Points

• ■ Major Focus: To determine the effectiveness of breast MRI in detecting breast cancer in an asymptomatic, high-risk screening cohort without a prior diagnosis of breast cancer.

• ■ Key Results: Breast MRI showed 93.3% sensitivity and 83.4% specificity for detecting breast cancer in an asymptomatic, high-risk screening cohort. Most detected malignancies, including all detected in the incidence round, were stage 0 or 1 (26 of 28, 92.9%) and node negative (25 of 28, 89.3%).

• ■ Impact: Screening breast MRI demonstrates high sensitivity and specificity for detection of early-stage, node-negative cancers in high-risk screening cohorts without personal history of breast cancer.

Major professional societies, including the American College of Radiology and the National Comprehensive Cancer Network, recommend asymptomatic screening of high-risk patients without personal history of breast cancer by contrast-enhanced breast MRI. Compared with other modalities, breast MRI demonstrates the highest sensitivity for cancer detection.

Rahman et al performed a retrospective cohort study to assess the diagnostic performance of breast screening MRI for early breast cancer detection in high-risk patients without personal history of breast cancer. Over a 4-year period, 1405 consecutive breast MRI screening examinations were evaluated. A false-negative result was defined as development of malignancy during the 12-month screening interval following a negative breast MRI assessment. The authors reported 93.3% sensitivity (28 of 30) for detecting malignancy, with a positive predictive value of 10.9% (28 of 256). Specificity and negative predictive value were reported as 83.4% (1147 of 1375) and 99.8% (1147 of 1149), respectively. Two false-negative cases were reported: One was stage 1 invasive ductal carcinoma discovered at prophylactic mastectomy 11 months following negative screening MRI, and the other was ductal carcinoma in situ discovered at mammography 7 months after negative screening MRI. Twenty-six of the 28 (92.9%) detected malignancies, including all 14 detected at the incidence screening round (breast MRI in the last 18 months) were stage 0 or 1 and node negative. The two malignancies diagnosed at greater than stage 1 were categorized as nonincidence round (ie, no prior MRI examination available or previous MRI examination obtained ≥ 18 months previously). Notably, the authors did report a Breast Imaging Reporting and Data System (BI-RADS) 3 malignancy rate of 5.0% (six of 119), which is greater than the targeted less than 2% cancer detection rate of comparably graded lesions at mammography and warrants further investigation.

Breast MRI screening of high-risk patients without personal history of breast cancer effectively detected early-stage, node-negative cancers and had a high negative predictive value and low false-negative rate in this real-world clinical effectiveness study.

Highlighted Article

• Rahman WT, Gerard S, Grundlehner P, et al. Outcomes of High-Risk Breast MRI Screening in Women Without Prior History of Breast Cancer: Effectiveness Data from a Tertiary Care Center. J Breast Imaging 2024;6(1):53–63. doi: https://doi.org/10.1093/jbi/wbad092