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Studies have shown that the combination of MRI and mammography is the most effective screening method for women at high risk of carcinoma, resulting in a recommendation from the National Institute for Health and Clinical Excellence (NICE) for annual surveillance MRI. The purpose of this study is to determine the effectiveness of screening MRI in this group.
A retrospective review was performed of all the patients from our family history clinic who were referred for breast MRI screening in accordance with the NICE guidelines. The study period was from July 2008 to July 2010. The recall rate, biopsy rate and outcome were recorded and analysed.
A total of 233 scans were performed in 173 patients over the 2-year period. Of these, 38 (16.3%) were recalled for a second-look ultrasound scan (US). Fourteen of these underwent biopsy (6%). US-guided core biopsy in 12 patients confirmed six cases of invasive ductal carcinoma and six cases of benign pathology. Two cases were referred for MR-guided biopsy, where one case was shown to be DCIS and the other was shown to be fibrocystic change. Overall, there were seven cases (3% of scans or 4% of patients) of malignancy that were all mammographically occult. Nine of the cases (3.9%) had early repeat MRI scans that were unremarkable. Recall for assessment and cancer detection rates were comparable with published data.
This study has shown that MRI is an effective screening tool in the surveillance of women at high risk of breast carcinoma.