MRI Alone Beneficial for Surveillance After Breast-Conserving Treatment

Following breast cancer treatment, women who have access to breast MRI may safely forgo additional mammographic or digital breast tomosynthesis follow-up.

Study results presented at the Radiological Society of North America (RSNA) 2021 Annual Meeting suggest that magnetic resonance imaging (MRI) alone is a successful method for the follow-up in women who undergo breast-conserving treatment and ensures early detection of recurrent cancer.

“Women in the follow-up after breast cancer who have access to breast MRI may safely forgo additional mammographic or digital breast tomosynthesis follow-up,” the authors wrote.

The results were presented by Vanessa Raaff, Ph.D., of the department of diagnostic and interventional radiology, RWTH Aachen University Hospital in Germany.

For follow-up after breast conserving treatment, serial two-view mammography is recommended, possibly accompanied by targeted ultrasound. As breast MRI has been shown to be useful to improve breast cancer detection of recurrence in patients after breast conserving treatment, the researchers investigated the usefulness of MRI as a standalone imaging method for this purpose.

Between January 2011 and March 2021, a total of 426 women who had undergone MRI alone for routine follow-up after breast conserving surgery were included. The women started MRI screening at a median of two years after treatment and underwent MRI screening annually. Validation of the last negative MRI study was achieved by tomosynthesis plus clinical examination in 137 women and/or by clinical follow-up for at least two years in 289 women.

The women were followed by 1,553 MRI studies, covering a total 1,727 women years. Across the entire follow-up period, MRI was positive in 108/1,553 examinations (6.9%) and in 85/426 women (19.9%). Recurrent breast cancer was confirmed in 64/108 MRI studies and in 55/85 women, for a positive predictive value of 59.3% per positive MRI study and 64.7% per patient. 

The cancer-detection-rate was 37 per 1000 women years. Recurrent cancers were detected on average 8.9 years after breast conserving treatment. Of the 64 recurrent cancers, 17.2% were ductal carcinoma in situ and 82.8% were invasive. The mean size of invasive recurrent cancer was 11.4 mm, most frequently staged as T1b, followed by T1c.

“None of the women received a diagnosis of breast cancer in between MRI screening rounds, or within the two-year follow up after the respective last negative MRI, or upon digital breast tomosynthesis after the last study MRI,” the authors wrote.

For more coverage of RSNA 2021, click here.