PURPOSE
Breast cancer screening in women at elevated risk is performed with yearly MRI and mammography. This includes women with BRCA mutations and women at elevated risk for other causes (mainly family history). The purpose of this study was to assess differences between BRCA mutation carriers and non-BRCA patients in a longitudinal MRI screening program in terms of recall rate, positive predictive value, and detection.
METHOD AND MATERIALS
An IRB approved, retrospective review of patient files from women screened with breast MRI between 2003 and 2013 was performed at our academic center. We analysed 9.504 screening MR examinations in 2843 women (age: 45 A-A?A 1/2 12.09 years), including 761 BRCA patients, and 2082 non-BRCA patients. Recall rate (RR), positive predictive value (PPV), and cancer detection rate (CDR) were evaluated for first round examinations and follow-up examinations separately. BRCA patients were compared with non-BRCA patients. Chi-square tests were used to determine statistical significance.
RESULTS
The RR for BRCA patients in the first round of screening was 86.07 per 1000 examinations and 52.58 per 1000 examinations in non-BRCA patients (p<0.001). The PPV for BRCA patients in the first round of screening was found to be 0.44, compared to 0.50 in non-BRCA patients (p=0.013). The CDR was 38.25 per 1000 examinations for BRCA patients and 26.53 per 1000 examinations for non-BRCA patients (p<0.001). In follow up, the RR was found to be 24.92 per 1000 examinations for BRCA patients and 22.81 per 1000 examinations for non-BRCA patients (p<0.001). The PPV was 0.46 for BRCA patients and 0.21 for non-BRCA patients (p<0.001). CDR was 11.42 per 1000 examinations for BRCA patients and 4.86 per 1000 examinations for non-BRCA patients (p<0.001).
CONCLUSION
RR and CDR are high for all patients in the first round. RR and CDR significantly decreased in follow-up rounds (p<0.001). PPV remained at an acceptable level for both patient groups, and remains particularly high in BRCA carriers. RR, PPV, and CDR differed significantly between BRCA and non-BRCA patients in both first and follow up rounds.
CLINICAL RELEVANCE/APPLICATION
These results underline that MRI is an excellent tool for screening high risk patients. Cancer detection is very high in the first round in all patients, but remains high only in BRCA carriers in follow up rounds.