Performance of Screening Breast MRI across Women with Different Elevated Breast Cancer Risk Indications
Dorothy A. Sippo* , Kristine S. Burk*, Sarah F. Mercaldo, Geoffrey M. Rutledge, Christine Edmonds, Zoe Guan, Kevin S. Hughes, Constance D. Lehman
* D.A.S. and K.S.B. contributed equally to this work.

Author Affiliations
From the Department of Radiology, Massachusetts General Hospital, Avon Comprehensive Breast Evaluation Center, Wang Ambulatory Care Building, Suite 240, 15 Parkman St, Boston, MA 02114.
Address correspondence to D.A.S. (e-mail: dsippo@mgh.harvard.edu).
Published Online:May 7 2019https://doi.org/10.1148/radiol.2019181136
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Abstract
This study found no evidence of a difference in screening breast MRI performance between women with BRCA mutation or history of chest radiation, personal history of breast cancer, and personal history of high-risk lesion.

Background
Screening breast MRI is recommended for women with BRCA mutation or a history of chest radiation, but guidelines are equivocal for MRI screening of women with a personal history of breast cancer or high-risk lesion.

Purpose
To evaluate screening breast MRI performance across women with different elevated breast cancer risk indications.

Materials and Methods
All screening breast MRI examinations performed between 2011 and 2014 underwent retrospective medical record review. Indications for screening were as follows: BRCA mutation carrier or history of chest radiation (BRCA/RT group), family history of breast cancer (FH group), personal history of breast cancer (PH group), and history of high-risk lesion (HRL group). Screening performance metrics were calculated and compared among indications by using logistic regression adjusted for age, available prior MRI, mammographic density, examination year, and multiple risk factors.

Results
There were 5170 screening examinations in 2637 women (mean age, 52 years; range, 23–86 years); 67 breast cancers were detected. The cancer detection rate (CDR) was highest in the BRCA/RT group (26 per 1000 examinations; 95% confidence interval [CI]: 16, 43 per 1000 examinations), intermediate for those in the PH and HRL groups (12 per 1000 examinations [95% CI: 9, 17 per 1000 examinations] and 15 per 1000 examinations [95% CI: 7, 32 per 1000 examinations], respectively), and lowest for those in the FH group (8 per 1000 examinations; 95% CI: 4, 14 per 1000 examinations). No difference in CDR was evident for the PH or HRL group compared with the BRCA/RT group (P = .14 and .18, respectively). The CDR was lower for the FH group compared with the BRCA/RT group (P = .02). No difference was evident in positive predictive value for biopsies performed (PPV3) for the BRCA/RT group (41%; 95% CI: 26%, 56%) compared with the PH (41%; 95% CI: 31%, 52%; P = .63) or HRL (36%, 95% CI: 17%, 60%; P = .37) groups. PPV3 was lower for the FH group (14%; 95% CI: 8%, 25%; P = .048).

Conclusion
Screening breast MRI should be considered for women with a personal history of breast cancer or high-risk lesion. Worse screening MRI performance in patients with a family history of breast cancer suggests that better risk assessment strategies may benefit these women.

© RSNA, 2019