MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer

Constance D. Lehman, Constantine Gatsonis, Christiane K. Kuhl, R. Edward Hendrick, Etta D. Pisano, Lucy Hanna, Sue Peacock, Stanley F. Smazal, Daniel D. Maki, Thomas B. Julian, Elizabeth R. DePeri, David A. Bluemke, Mitchell D. Schnall

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Abstract

BACKGROUND: Even after careful clinical and mammographic evaluation, cancer is found in the contralateral breast in up to 10% of women who have received treatment for unilateral breast cancer. We conducted a study to determine whether magnetic resonance imaging (MRI) could improve on clinical breast examination and mammography in detecting contralateral breast cancer soon after the initial diagnosis of unilateral breast cancer. METHODS: A total of 969 women with a recent diagnosis of unilateral breast cancer and no abnormalities on mammographic and clinical examination of the contralateral breast underwent breast MRI. The diagnosis of MRI-detected cancer was confirmed by means of biopsy within 12 months after study entry. The absence of breast cancer was determined by means of biopsy, the absence of positive findings on repeat imaging and clinical examination, or both at 1 year of follow-up. RESULTS: MRI detected clinically and mammographically occult breast cancer in the contralateral breast in 30 of 969 women who were enrolled in the study (3.1%). The sensitivity of MRI in the contralateral breast was 91%, and the specificity was 88%. The negative predictive value of MRI was 99%. A biopsy was performed on the basis of a positive MRI finding in 121 of the 969 women (12.5%), 30 of whom had specimens that were positive for cancer (24.8%); 18 of the 30 specimens were positive for invasive cancer. The mean diameter of the invasive tumors detected was 10.9 mm. The additional number of cancers detected was not influenced by breast density, menopausal status, or the histologic features of the primary tumor. CONCLUSIONS: MRI can detect cancer in the contralateral breast that is missed by mammography and clinical examination at the time of the initial breast-cancer diagnosis.

Original languageEnglish (US)
Pages (from-to)1295-1303
Number of pages9
JournalNew England Journal of Medicine
Volume356
Issue number13
DOIs
StatePublished - Mar 29 2007

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Breast
Magnetic Resonance Imaging
Breast Neoplasms
Neoplasms
Mammography
Biopsy
Unilateral Breast Neoplasms

ASJC Scopus subject areas

  • Medicine(all)

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Lehman, C. D., Gatsonis, C., Kuhl, C. K., Hendrick, R. E., Pisano, E. D., Hanna, L., ... Schnall, M. D. (2007). MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. New England Journal of Medicine, 356(13), 1295-1303. https://doi.org/10.1056/NEJMoa065447

MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. / Lehman, Constance D.; Gatsonis, Constantine; Kuhl, Christiane K.; Hendrick, R. Edward; Pisano, Etta D.; Hanna, Lucy; Peacock, Sue; Smazal, Stanley F.; Maki, Daniel D.; Julian, Thomas B.; DePeri, Elizabeth R.; Bluemke, David A.; Schnall, Mitchell D.

In: New England Journal of Medicine, Vol. 356, No. 13, 29.03.2007, p. 1295-1303.

Research output: Contribution to journalArticle

Lehman, CD, Gatsonis, C, Kuhl, CK, Hendrick, RE, Pisano, ED, Hanna, L, Peacock, S, Smazal, SF, Maki, DD, Julian, TB, DePeri, ER, Bluemke, DA & Schnall, MD 2007, 'MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer', New England Journal of Medicine, vol. 356, no. 13, pp. 1295-1303. https://doi.org/10.1056/NEJMoa065447
Lehman CD, Gatsonis C, Kuhl CK, Hendrick RE, Pisano ED, Hanna L et al. MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. New England Journal of Medicine. 2007 Mar 29;356(13):1295-1303. https://doi.org/10.1056/NEJMoa065447
Lehman, Constance D. ; Gatsonis, Constantine ; Kuhl, Christiane K. ; Hendrick, R. Edward ; Pisano, Etta D. ; Hanna, Lucy ; Peacock, Sue ; Smazal, Stanley F. ; Maki, Daniel D. ; Julian, Thomas B. ; DePeri, Elizabeth R. ; Bluemke, David A. ; Schnall, Mitchell D. / MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. In: New England Journal of Medicine. 2007 ; Vol. 356, No. 13. pp. 1295-1303.
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title = "MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer",
abstract = "BACKGROUND: Even after careful clinical and mammographic evaluation, cancer is found in the contralateral breast in up to 10{\%} of women who have received treatment for unilateral breast cancer. We conducted a study to determine whether magnetic resonance imaging (MRI) could improve on clinical breast examination and mammography in detecting contralateral breast cancer soon after the initial diagnosis of unilateral breast cancer. METHODS: A total of 969 women with a recent diagnosis of unilateral breast cancer and no abnormalities on mammographic and clinical examination of the contralateral breast underwent breast MRI. The diagnosis of MRI-detected cancer was confirmed by means of biopsy within 12 months after study entry. The absence of breast cancer was determined by means of biopsy, the absence of positive findings on repeat imaging and clinical examination, or both at 1 year of follow-up. RESULTS: MRI detected clinically and mammographically occult breast cancer in the contralateral breast in 30 of 969 women who were enrolled in the study (3.1{\%}). The sensitivity of MRI in the contralateral breast was 91{\%}, and the specificity was 88{\%}. The negative predictive value of MRI was 99{\%}. A biopsy was performed on the basis of a positive MRI finding in 121 of the 969 women (12.5{\%}), 30 of whom had specimens that were positive for cancer (24.8{\%}); 18 of the 30 specimens were positive for invasive cancer. The mean diameter of the invasive tumors detected was 10.9 mm. The additional number of cancers detected was not influenced by breast density, menopausal status, or the histologic features of the primary tumor. CONCLUSIONS: MRI can detect cancer in the contralateral breast that is missed by mammography and clinical examination at the time of the initial breast-cancer diagnosis.",
author = "Lehman, {Constance D.} and Constantine Gatsonis and Kuhl, {Christiane K.} and Hendrick, {R. Edward} and Pisano, {Etta D.} and Lucy Hanna and Sue Peacock and Smazal, {Stanley F.} and Maki, {Daniel D.} and Julian, {Thomas B.} and DePeri, {Elizabeth R.} and Bluemke, {David A.} and Schnall, {Mitchell D.}",
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T1 - MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer

AU - Lehman, Constance D.

AU - Gatsonis, Constantine

AU - Kuhl, Christiane K.

AU - Hendrick, R. Edward

AU - Pisano, Etta D.

AU - Hanna, Lucy

AU - Peacock, Sue

AU - Smazal, Stanley F.

AU - Maki, Daniel D.

AU - Julian, Thomas B.

AU - DePeri, Elizabeth R.

AU - Bluemke, David A.

AU - Schnall, Mitchell D.

PY - 2007/3/29

Y1 - 2007/3/29

N2 - BACKGROUND: Even after careful clinical and mammographic evaluation, cancer is found in the contralateral breast in up to 10% of women who have received treatment for unilateral breast cancer. We conducted a study to determine whether magnetic resonance imaging (MRI) could improve on clinical breast examination and mammography in detecting contralateral breast cancer soon after the initial diagnosis of unilateral breast cancer. METHODS: A total of 969 women with a recent diagnosis of unilateral breast cancer and no abnormalities on mammographic and clinical examination of the contralateral breast underwent breast MRI. The diagnosis of MRI-detected cancer was confirmed by means of biopsy within 12 months after study entry. The absence of breast cancer was determined by means of biopsy, the absence of positive findings on repeat imaging and clinical examination, or both at 1 year of follow-up. RESULTS: MRI detected clinically and mammographically occult breast cancer in the contralateral breast in 30 of 969 women who were enrolled in the study (3.1%). The sensitivity of MRI in the contralateral breast was 91%, and the specificity was 88%. The negative predictive value of MRI was 99%. A biopsy was performed on the basis of a positive MRI finding in 121 of the 969 women (12.5%), 30 of whom had specimens that were positive for cancer (24.8%); 18 of the 30 specimens were positive for invasive cancer. The mean diameter of the invasive tumors detected was 10.9 mm. The additional number of cancers detected was not influenced by breast density, menopausal status, or the histologic features of the primary tumor. CONCLUSIONS: MRI can detect cancer in the contralateral breast that is missed by mammography and clinical examination at the time of the initial breast-cancer diagnosis.

AB - BACKGROUND: Even after careful clinical and mammographic evaluation, cancer is found in the contralateral breast in up to 10% of women who have received treatment for unilateral breast cancer. We conducted a study to determine whether magnetic resonance imaging (MRI) could improve on clinical breast examination and mammography in detecting contralateral breast cancer soon after the initial diagnosis of unilateral breast cancer. METHODS: A total of 969 women with a recent diagnosis of unilateral breast cancer and no abnormalities on mammographic and clinical examination of the contralateral breast underwent breast MRI. The diagnosis of MRI-detected cancer was confirmed by means of biopsy within 12 months after study entry. The absence of breast cancer was determined by means of biopsy, the absence of positive findings on repeat imaging and clinical examination, or both at 1 year of follow-up. RESULTS: MRI detected clinically and mammographically occult breast cancer in the contralateral breast in 30 of 969 women who were enrolled in the study (3.1%). The sensitivity of MRI in the contralateral breast was 91%, and the specificity was 88%. The negative predictive value of MRI was 99%. A biopsy was performed on the basis of a positive MRI finding in 121 of the 969 women (12.5%), 30 of whom had specimens that were positive for cancer (24.8%); 18 of the 30 specimens were positive for invasive cancer. The mean diameter of the invasive tumors detected was 10.9 mm. The additional number of cancers detected was not influenced by breast density, menopausal status, or the histologic features of the primary tumor. CONCLUSIONS: MRI can detect cancer in the contralateral breast that is missed by mammography and clinical examination at the time of the initial breast-cancer diagnosis.

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