MR features of breast cancer missed in the screening MRI

MR features of breast cancer missed in the screening MRI Poster No.: C-1326 Congress: ECR 2013 Type: Scientific Exhibit Authors: H. Abe 1, K. Yamaguchi 2, D. Schacht 1, A. Shimauchi 1, K. M. Keywords: DOI: Kulkarni 1, C. Sennett 1, G. M. Newstead 1 ; 1 Chicago, IL/US, 2 Saga/ JP Breast, MR, Screening 10.1594/ecr2013/C-1326 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 13

Purpose BACKGROUND Cancers detected in the second or subsequent round of screening study is called "incident cancers." Because the most breast cancers are detected in the first round of screening (prevalent cancers), incident cancers are relatively rare. PURPOSE We have a breast cancer screening program for high risk patients. In our series of MRI from 2003 to 2010, there are multiple incident cancers. Among them, there are some retrospectively visible lesions in the prior MR studies. The purpose of this study is to evaluate missed breast cancer detected in the screening MRI in order to learn early MR features and identify relevant factors associated with incident cancer development. This could increase the likelihood of identifying incident cancer at an early stage. Methods and Materials Between March 2003 and February 2012, 2540 screening breast MRI studies were performed on 982 women at our institution. Of these 982 women, 221 women were registered in the high risk screening program at our institution and had biannual MR exams. Another 761 women were not in that program but received screening MR exams annually due to their high risk status. Indications for high risk screening MRI were strong family history of breast cancer in 48% (470/982), personal history of breast cancer (PHBC) with or without a strong family history in 45% (444/982), personal history of a high risk lesion (atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, flat epithelial atypia) with or without a strong family history in 6% (54/982), and other reasons (history of Mantle radiation for lymphoma at young age, history of axillary lymph node metastasis of adenocarcinoma, dense breast on mammography, history of benign biopsy) in 1% (14/982). Page 2 of 13

Images for this section: Fig. 1: MRI techniques Page 3 of 13

Results There were 6 invasive and 3 in situ cancers. Five foci, 2 masses and 2 non mass-like enhancement (NMLE) were identified on the prior exams, and all of them showed interval increase in size (mean 80% increase in diameter). Among them, 4 lesions showed rapid uptake kinetics on the retrospective review of prior MR exams and 5 lesions showed an interval change in kinetic pattern from slow to rapid uptake. Four of the 9 lesions appeared as ill-defined foci or masses with irregular margins on prior exams. Among 5 foci, 1 focus was isolated and 4 foci were in a background with other foci, of which 2 foci could be distinguished from other foci because of their higher signal intensity. Images for this section: Fig. 2: Summary of "missed cancers" Page 4 of 13

Fig. 3: Background parenchymal enhancement and size of "missed cancers" Page 5 of 13

Fig. 4: Imaging features of "missed cancers" Page 6 of 13

Fig. 5: Patient 1: 59 year old with personal and family history of Breast cancer. MRI 7 months prior to the detection. Ill-defined focus (5 x 4 x 4 mm) with kinetics of slowpersistent pattern. Page 7 of 13

Fig. 6: Patient 1: 59 year old with personal and family history of breast cancer. MRI at the time of detection. Irregular-shaped mass (6 x 5 x 5 mm) with homogeneous enhancement with kinetics of predominantly rapid-plateau (yellow) and small focus of rapid-washout (red)pathology: IDC grade 2 with DCIS. Page 8 of 13

Fig. 9: Patient 3: 69 year old with personal history of breast cancer, no family history or gene mutation. MRI 12 months prior to the detection. Ill-defined mass (6 x 6 x 6 mm) within minimal parenchymal enhancement. Focus is more evident on the coronal view. The focus is clearly demonstrated on the DWI. Kinetic pattern is slow-persistent pattern. Page 9 of 13

Fig. 7: Patient 2: 27 year old with personal history of breast cancer, no family history or gene mutation. MRI 7 months prior to the detection. Ill-defined focus (3 x 4 x 4 mm) within moderate parenchymal enhancement. Focus is more evident on the coronal view. Although there are multiple spots showing rapid-washout kinetics (red), the enhancing focus stands out from the surrounding area. Page 10 of 13

Fig. 10: Patient 3: 69 year old with personal history of breast cancer, no family history or gene mutation. MRI at the time of detection. Ill-defined mass has increased in size (11 x 6 x 8 mm), now with spiculations. Kinetic pattern has changes to rapid-washout pattern. The mass can be clearly seen on the MIP image. Pathology: IDC grade 2 with DCIS. Page 11 of 13

Fig. 8: Patient 2: 27 year old with personal history of breast cancer, no family history or gene mutation. MRI at the time of detection. The focus is now a rim enhancing mass (12 x 11 x 12 mm) in 7 months with kinetics of rapid-washout. Pathology: Miscroscopic IDC within high grade DCIS. Page 12 of 13

Conclusion Early cancer tends to be ill-defined when it is focus or mass. Small cancer can be missed regardless of the degree of background parenchymal enhancement. Any lesion with increased size, rapid uptake kinetics, or a change in kinetic pattern on screening MRI deserves a high level of scrutiny. References None Personal Information Page 13 of 13