Breast MRI screening for high-risk family history: the Sheffield experience

Introduction

Around 5% of breast cancers can be attributed to gene mutations. NICE guidelines have recently advocated the use of MRI screening in high-risk young women. We have retrospectively audited our unit’s experience in this field.

Methods

All eligible women were identified from the family history database. Notes, imaging and pathology were reviewed.

Results

One hundred and thirty-three breast MRI scans were performed on 91 women with a high-risk family history between 2007 and 2010. Sixteen women were recalled for assessment (one woman was recalled twice). The total recall rate was 12.7%. Of the recalled patients, four had normal ultrasound (US) and follow-up imaging has remained unchanged. Thirteen patients had corresponding US-detected abnormalities. Twelve were biopsied, the other was a normal intramammary lymph node. Eight of the biopsies were benign (benign core biopsy rate 6%). Four biopsies were malignant (age range of women 35 to 45), giving a cancer detection rate of 3%. Three of these were solitary lesions (8 mm, 11 mm and 16 mm). One patient had multifocal malignancy, the largest single lesion being 16 mm. All were node-negative ductal carcinoma. Two patients were oestrogen receptor-positive, all were herceptin receptor-negative. Only the extensive malignant change could be seen on conventional mammography.

Conclusions

We suggest that MRI screening is beneficial in these patients, and although our recall rate lies a little above what is to be recommended by the NHSBSP (7 to 10%) we feel this can be attributed to the steep learning curve that introducing a new screening technique to a service invariably brings.