Study Finds No Benefit to MRI Screening in Women with High-Risk Breast Lesions

In a study involving nearly 700 patients with atypical ductal or lobular hyperplasia, or lobular carcinoma in situ, researchers found no difference in four-year breast cancer detection rates between women who had screening mammography and breast magnetic resonance imaging (MRI), and women who only had mammography screening.

Is magnetic resonance imaging (MRI) a worthwhile screening tool for breast cancer?

In a recently published study in the Annals of Surgical Oncology, researchers compared the use of screening mammography versus a combination of screening mammography and MRI in women with high-risk breast lesions.1 Out of 699 patients included in the study, 542 patients had atypical ductal or lobular hyperplasia, and 157 patients had lobular carcinoma in situ, according to the study.

After a median follow-up period of 25 months (including a median of two MRI exams in the combination screening group), the study authors found an identical breast cancer detection rate of 3.6 percent for patients who had mammography alone and those who had mammography and MRI.1

The researchers also pointed out that the combination screening group had a significantly higher biopsy rate (30.5 percent) than the mammography-only group (12.6 percent). Out of the five cancers detected in the combination screening group, the study authors noted that only two were detected on MRI.1

“Collectively, these early findings question the benefit of screening MRI for this population, with a cost of nearly a threefold increased rate of breast biopsies during surveillance of patients receiving MRI,” wrote study co-author Tari A. King, M.D., chief of the Division of Breast Surgery and vice-chair for Multidisciplinary Oncology within the Department of Surgery at Brigham and Women’s Hospital in Boston, and colleagues.

The researchers noted that breast MRI was more often reserved for younger patients; those with a family history of breast cancer and/or a history of lobular carcinoma in situ; and/or extremely dense breasts.

King and colleagues said the three mammographically occult cancers in the study were detected in women with heterogeneously dense or extremely dense breasts. Citing the findings from a recently published trial by Bakker and colleagues, the study authors suggested that MRI screening is still warranted for women with dense breasts.2

“Selective MRI use for patients with extremely dense breasts is likely appropriate due to reduced sensitivity of (mammography) in this setting and lower interval cancer rates observed with supplemental MRI than with (mammography) alone in the recent DENSE randomized controlled trial,” maintained King and colleagues.2

The study authors acknowledged that the small sample size in the combined mammography/MRI group (159 patients), a low event rate (five detected cancers in 699 patients) and short follow-up period (a median of 25.2 months) were limitations of the study. King and colleagues also pointed out that a lack of information on prior breast screening in the group with mammography and MRI prohibited comparison of baseline and follow-up screens.1

References

1. Laws A, Katlin F, Hans M, et al. Screening MRI does not increase cancer detection or result in an earlier stage at diagnosis for patients with high-risk breast lesions: a propensity score analysis. Ann Surg Oncol. 2022 Sep 28. doi: 10.1245/s10434-022-12568-z. Online ahead of print.

2. Bakker MF, de Lange SV, Pijnappel RM, et al. Supplemental MRI screening for women with extremely dense breast tissue. N Engl J Med. 2019;381(??):2091-2102.