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European Radiology

31-10-2024 | Breast MRI | Breast

Performance of breast MRI for high-risk screening during lactation

Authors: Noam Nissan, Jill Gluskin, Rosa Elena Ochoa-Albiztegui, Hila Fruchtman-Brot, Janice S. Sung, Maxine S. Jochelson

Published in: European Radiology

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Abstract

Objectives

To assess the diagnostic performance of breast MRI during lactation in the setting of high-risk breast cancer screening.

Materials and methods

Screening breast MRIs performed between April 2008 and March 2024 were retrospectively reviewed. Background parenchymal enhancement (BPE) grade was compared between lactating patients and patients who recently stopped lactating using the Mann–Whitney test. Breast Imaging Reporting and Data System (BI-RADS) scores prevalence rates were compared between lactating patients and controls encompassing young non-lactating patients using the Chi-square test. Diagnostic performance was calculated for patients with a biopsy reference or a 1-year radiologic follow-up.

Results

One-hundred forty-two screening breast MRIs were performed in lactating patients (n = 104, median age, 36.0 ± 6.0 years). Marked BPE appeared in 82% of cases (116/142), with a higher BPE grade in exams performed during lactation as compared with those performed in patients who had recently ceased lactating (p < 0.001). Screening MRIs performed during lactation had a higher rate of BI-RADS 3 scores (40/142, 28% vs. 683/8922, 7%, p < 0.001) and a lower rate of BI-RADS 1/2 scores (88/142, 62% vs. 7549/8922, 84.6%, p = 0.002) compared with those performed in controls (n = 8922). One pregnancy-associated breast cancer was detected, and one interval-cancer occurred. All MRI-guided biopsies were negative (n = 13). Screening breast MRI during lactation had 50% sensitivity (1/2), 60% specificity (72/120), 2.0% positive predictive value (1/49), and 98.6% negative predictive value (71/82).

Conclusion

The efficacy of breast MRI for high-risk screening during lactation is limited by prominent BPE, leading to an increased rate of BI-RADS 3 categorization and diminished overall specificity.

Key Points

Question Studies on breast MRI during lactation were solely focused on studies conducted in patients with known cancer but not in the screening setting.
Findings Screening breast MRI during lactation usually results in marked background parenchymal enhancement, negatively impacting its diagnostic performance.
Clinical relevance Despite the lower performance, and amidst the significant risk of pregnancy-associated breast cancer, this screening approach remains relevant for lactating patients with high-risk profiles, such as BReast Cancer (BRCA) carriers. Radiologists should be familiar with the normal appearance of breast MRI during lactation.
Literature
1.
Chung SH, Woldenberg N, Roth AR et al (2020) BRCA and beyond: comprehensive image-rich review of hereditary breast and gynecologic cancer syndromes. Radiographics 40:306–325PubMedCrossRef
2.
Kuchenbaecker KB, Hopper JL, Barnes DR et al (2017) Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers. JAMA 317:2402–2416PubMedCrossRef
3.
4.
Rahman WT, Gerard S, Grundlehner P et al (2024) Outcomes of high-risk breast MRI screening in women without prior history of breast cancer: effectiveness data from a tertiary care center. J Breast Imaging 6:53–63PubMedCrossRef
5.
6.
Warner E, Plewes DB, Hill KA et al (2004) Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination. JAMA 292:1317–1325PubMedCrossRef
7.
Kuhl CK, Schrading S, Leutner CC et al (2005) Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer. J Clin Oncol 23:8469–8476PubMedCrossRef
8.
9.
Lehman CD (2006) Role of MRI in screening women at high risk for breast cancer. J Magn Reson Imaging 24:964–970PubMedCrossRef
10.
Mainiero MB, Moy L, Baron P et al (2017) ACR Appropriateness Criteria® Breast Cancer Screening. J Am Coll Radiol 14:S383–S390PubMedCrossRef
11.
Monticciolo DL, Newell MS, Moy L et al (2023) Breast cancer screening for women at higher-than-average risk: updated recommendations from the ACR. J Am Coll Radiol 20:902–914
12.
Portnow LH, Snider LC, Bolivar KE et al (2023) Breast cancer screening in high-risk women during pregnancy and lactation. J Breast Imaging 5:508–519PubMedCrossRef
13.
Vashi R, Hooley R, Butler R et al (2013) Breast imaging of the pregnant and lactating patient: physiologic changes and common benign entities. AJR Am J Roentgenol 200:329–336CrossRef
14.
15.
Peterson MS, Gegios AR, Elezaby MA et al (2023) Breast imaging and intervention during pregnancy and lactation. Radiographics 43:e230014PubMedCrossRef
16.
Kieturakis AJ, Wahab RA, Vijapura C, Mahoney MC (2021) Current recommendations for breast imaging of the pregnant and lactating patient. AJR Am J Roentgenol 216:1462–1475CrossRef
17.
Nissan N, Bauer E, Moss Massasa EE, Sklair-Levy M (2022) Breast MRI during pregnancy and lactation: clinical challenges and technical advances. Insights Imaging 13:71PubMedPubMedCentralCrossRef
18.
Ray JG, Vermeulen MJ, Bharatha A et al (2016) Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA 316:952–961PubMedCrossRef
19.
diFlorio-Alexander RM, Slanetz PJ, Moy L et al (2018) ACR Appropriateness Criteria® Breast Imaging of Pregnant and Lactating Women. J Am Coll Radiol 15:S263–S275PubMedCrossRef
20.
Taron J, Fleischer S, Preibsch H et al (2019) Background parenchymal enhancement in pregnancy-associated breast cancer: a hindrance to diagnosis? Eur Radiol 29:1187–1193PubMedCrossRef
21.
Nissan N, Massasa EEM, Bauer E et al (2023) MRI can accurately diagnose breast cancer during lactation. Eur Radiol 33:2935–2944PubMedCrossRef
22.
Espinosa LA, Daniel BL, Vidarsson L et al (2005) The lactating breast: contrast-enhanced MR imaging of normal tissue and cancer. Radiology 237:429–436PubMedCrossRef
23.
Oh SW, Lim HS, Moon SM et al (2017) MR imaging characteristics of breast cancer diagnosed during lactation. Br J Radiol 90:20170203
24.
Myers KS, Green LA, Lebron L, Morris EA (2017) Imaging appearance and clinical impact of preoperative breast MRI in pregnancy-associated breast cancer. AJR Am J Roentgenol 209:W177–W183CrossRef
25.
Daimiel Naranjo I, Lo Gullo R, Saccarelli C et al (2021) Diagnostic value of diffusion-weighted imaging with synthetic b-values in breast tumors: comparison with dynamic contrast-enhanced and multiparametric MRI. Eur Radiol 31:356–367PubMedCrossRef
26.
Sung JS, Lebron L, Keating D et al (2019) Performance of dual-energy contrast-enhanced digital mammography for screening women at increased risk of breast cancer. Radiology 293:81–88PubMedCrossRef
27.
Keinan-Boker L, Lerner-Geva L, Kaufman B, Meirow D (2008) Pregnancy-associated breast cancer. Isr Med Assoc J 10:722–727PubMed
28.
Johansson ALV, Stensheim H (2020) Epidemiology of pregnancy-associated breast cancer. Adv Exp Med Biol 1252:75–79PubMedCrossRef
29.
Vashi R, Hooley R, Butler R et al (2013) Breast imaging of the pregnant and lactating patient: Imaging modalities and pregnancy-associated breast cancer. AJR Am J Roentgenol 200:321–328CrossRef
30.
Wang B, Yang Y, Jiang Z et al (2019) Clinicopathological characteristics, diagnosis, and prognosis of pregnancy-associated breast cancer. Thorac Cancer 10:1060–1068PubMedPubMedCentralCrossRef
31.
Amant F, Von Minckwitz G, Han SN et al (2013) Prognosis of women with primary breast cancer diagnosed during pregnancy: results from an international collaborative study. J Clin Oncol 31:2532–2539PubMedCrossRef
32.
McManaman JL, Neville MC (2003) Mammary physiology and milk secretion. Adv Drug Deliv Rev 55:629–641PubMedCrossRef
33.
Nissan N, Sandler I, Eifer M et al (2021) Physiologic and hypermetabolic breast 18-F FDG uptake on PET/CT during lactation. Eur Radiol 31:163–170PubMedCrossRef
34.
Nissan N, Sorin V, Bauer E et al (2022) MRI of the lactating breast: computer-aided diagnosis false positive rates and background parenchymal enhancement kinetic features. Acad Radiol 29:1332–1341PubMedCrossRef
35.
Nissan N, Furman-Haran E, Shapiro-Feinberg M et al (2017) Monitoring in-vivo the mammary gland microstructure during morphogenesis from lactation to post-weaning using diffusion tensor MRI. J Mammary Gland Biol Neoplasia 22:193–202PubMedCrossRef
36.
37.
Nissan N, Anaby D, Mahameed G et al (2023) Ultrafast DCE-MRI for discriminating pregnancy-associated breast cancer lesions from lactation related background parenchymal enhancement. Eur Radiol 33:8122–8131PubMedCrossRef
38.
Nissan N, Allweis T, Menes T et al (2020) Breast MRI during lactation: effects on tumor conspicuity using dynamic contrast-enhanced (DCE) in comparison with diffusion tensor imaging (DTI) parametric maps. Eur Radiol 30:767–777PubMedCrossRef
39.
Bauer E, Levy MS, Domachevsky L et al (2022) Background parenchymal enhancement and uptake as breast cancer imaging biomarkers: a state-of-the-art review. Clin Imaging 83:41–50PubMedCrossRef
40.
Nissan N, Furman-Haran E, Shapiro-Feinberg M et al (2014) Diffusion-tensor MR imaging of the breast: hormonal regulation. Radiology 271:672–680PubMedCrossRef
41.
Nissan N, Furman-Haran E, Feinberg-Shapiro M et al (2014) Tracking the mammary architectural features and detecting breast cancer with magnetic resonance diffusion tensor imaging. J Vis Exp 15:52048
42.
Iima M, Kataoka M, Sakaguchi R et al (2018) Intravoxel incoherent motion (IVIM) and non-Gaussian diffusion MRI of the lactating breast. Eur J Radiol Open 5:24–30PubMedPubMedCentralCrossRef
43.
Sah RG, Agarwal K, Sharma U et al (2015) Characterization of malignant breast tissue of breast cancer patients and the normal breast tissue of healthy lactating women volunteers using diffusion MRI and in vivo 1H MR spectroscopy. J Magn Reson Imaging 41:169–174PubMedCrossRef
44.
Nissan N, Furman-Haran E, Allweis T et al (2019) Noncontrast breast MRI during pregnancy using diffusion tensor imaging: a feasibility study. J Magn Reson Imaging 49:508–517PubMedCrossRef
45.
Gao Y, Reig B, Heacock L et al (2021) Magnetic resonance imaging in screening of breast cancer. Radiol Clin North Am 59:85–98PubMedCrossRef
46.
Bakker MF, de Lange SV, Pijnappel RM et al (2019) Supplemental MRI screening for women with extremely dense breast tissue. N Engl J Med 381:2091–2102PubMedCrossRef
47.
Fruchtman-Brot H, Mango VL (2023) Pregnancy-associated breast cancer in BRCA1/2 carriers: is intensified breast ultrasound surveillance warranted? Acad Radiol 30:255–257PubMedCrossRef
Metadata
Title
Performance of breast MRI for high-risk screening during lactation
Authors
Noam Nissan
Jill Gluskin
Rosa Elena Ochoa-Albiztegui
Hila Fruchtman-Brot
Janice S. Sung
Maxine S. Jochelson
Publication date
31-10-2024
Publisher
Springer Berlin Heidelberg
Published in
European Radiology
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-024-11091-x