MRI Evaluation of the Contralateral Breast in Women with Recently Diagnosed Breast Cancer
Constance D. Lehman, M.D., Ph.D., Constantine Gatsonis, Ph.D., Christiane K. Kuhl, M.D., R. Edward Hendrick, Ph.D., Etta D. Pisano, M.D., Lucy Hanna, M.S., Sue Peacock, M.S., Stanley F. Smazal, M.D., Daniel D. Maki, M.D., Thomas B. Julian, M.D., Elizabeth R. DePeri, M.D., David A. Bluemke, M.D., Ph.D., Mitchell D. Schnall, M.D., Ph.D., for the ACRIN Trial 6667 Investigators Group
Background Even after careful clinical and mammographic evaluation,cancer is found in the contralateral breast in up to 10% ofwomen who have received treatment for unilateral breast cancer.We conducted a study to determine whether magnetic resonanceimaging (MRI) could improve on clinical breast examination andmammography in detecting contralateral breast cancer soon afterthe initial diagnosis of unilateral breast cancer.
Methods A total of 969 women with a recent diagnosis of unilateralbreast cancer and no abnormalities on mammographic and clinicalexamination of the contralateral breast underwent breast MRI.The diagnosis of MRI-detected cancer was confirmed by meansof biopsy within 12 months after study entry. The absence ofbreast cancer was determined by means of biopsy, the absenceof positive findings on repeat imaging and clinical examination,or both at 1 year of follow-up.
Results MRI detected clinically and mammographically occultbreast cancer in the contralateral breast in 30 of 969 womenwho were enrolled in the study (3.1%). The sensitivity of MRIin the contralateral breast was 91%, and the specificity was88%. The negative predictive value of MRI was 99%. A biopsywas performed on the basis of a positive MRI finding in 121of the 969 women (12.5%), 30 of whom had specimens that werepositive for cancer (24.8%); 18 of the 30 specimens were positivefor invasive cancer. The mean diameter of the invasive tumorsdetected was 10.9 mm. The additional number of cancers detectedwas not influenced by breast density, menopausal status, orthe histologic features of the primary tumor.
Conclusions MRI can detect cancer in the contralateral breastthat is missed by mammography and clinical examination at thetime of the initial breast-cancer diagnosis. (ClinicalTrials.govnumber, NCT00058058
[ClinicalTrials.gov]
.)
Source Information
From the University of Washington Medical Center, Seattle (C.D.L., S.P.); Brown University, Providence, RI (C.G., L.H.); University of Bonn, Bonn, Germany (C.K.K.); Feinberg School of Medicine, Northwestern University, Chicago (R.E.H.); University of North Carolina, Chapel Hill (E.D.P.); Porter Adventist Hospital, Denver (S.F.S.); Scottsdale Medical Imaging, Scottsdale, AZ (D.D.M.); Allegheny General Hospital, Allegheny, PA (T.B.J.); Mayo Clinic, Jacksonville, FL (E.R.D.); Johns Hopkins University School of Medicine, Bethesda, MD (D.A.B.); and University of Pennsylvania Medical School, Philadelphia (M.D.S.).
Address reprint requests to Dr. Lehman at the University of Washington Medical Center, Seattle Cancer Care Alliance, 825 Eastlake Ave., E, Rm. G3-200, P.O. Box 19023, Seattle, WA 98109, or at lehman{at}u.washington.edu.
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