© 2001 by Oxford University Press
Journal of the National Cancer Institute, Vol. 93, No. 14, 1095-1102,
July 18, 2001
© 2001 Oxford University Press
REPORT |
Magnetic Resonance Imaging and Mammography in Women With a Hereditary Risk of Breast Cancer
Affiliations of authors: M. J. Stoutjesdijk, C. Boetes, G. J. Jager, J. H. C. L. Hendriks, L. E. van Die, J. O. Barentsz (Department of Radiology), L. Beex (Department of Oncology), P. Bult (Department of Pathology), R. J. F. Laheij (Department of Medical Technology Assessment), L. Massuger (Department of Gynecology), T. Wobbes (Department of Surgery), University Medical Center St Radboud, Nijmegen, The Netherlands.
Correspondence to: Mark J. Stoutjesdijk, M.D., M.Sc., Department of Radiology, University Medical Center St Radboud, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands (e-mail: m.stoutjesdijk{at}rdiag.azn.nl).
Background: Although breast cancer screening is recommended to start at a younger age for women with a hereditary risk of breast cancer, the sensitivity of mammography for these women is reduced. We compared magnetic resonance imaging (MRI) with mammography to determine which is more sensitive and whether MRI could play a role in the early detection of breast cancer for these women. Methods: We constructed a retrospective cohort of all breast MRI and mammography surveillance reports made in our department from November 1994 to February 2001. All of the 179 women in the cohort had received biannual palpation in addition to annual imaging by MRI, mammography, or both. The 258 MRI images and the 262 mammograms were classified with the use of the BI-RADSTM (i.e., Breast Imaging Reporting and Data System) scoring system, which has five categories to indicate the level of suspicion of a lesion. Receiver operator characteristic curves were generated for MRI and mammography, and the area under each curve (AUC) was assessed for the entire cohort of 179 women and for a subset of 75 women who had received both an MRI and a mammographic examination within a 4-month period. All statistical tests were two-sided. Results: In the cohort of 179 women, we detected 13 breast cancers. Seven cancers were not revealed by mammography, but all were detected by MRI. For the entire cohort, the AUC for mammography was 0.74 (95% confidence interval [CI] = 0.68 to 0.79), and the AUC for MRI was 0.99 (95% CI = 0.98 to 1.0). For the subset of women who had both examinations, the AUC for mammography was 0.70 (95% CI = 0.60 to 0.80), and the AUC for MRI was 0.98 (95% CI = 0.95 to 1.0). Conclusion: MRI was more accurate than mammography in annual breast cancer surveillance of women with a hereditary risk of breast cancer. Larger prospective studies to examine the role of MRI in screening programs are justified.
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