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In certain patient populations, magnetic resonance imaging is more sensitive than mammography for detecting breast cancer. In this multicenter study, researchers examined the yield of MRI of the other breast in 969 women with recently diagnosed breast cancer and no clinically or mammographically detected abnormalities in the other breast. The following outcomes were noted:
-- MRI detected contralateral breast cancer in 30 patients; during the ensuing year, 3 additional patients developed contralateral breast cancer after a negative MRI (sensitivity, 91%, with 3 false-negatives).
-- MRI was negative in 822 of the 936 women who did not develop contralateral breast cancer during the ensuing year (specificity, 88%, with 114 false-positives).
-- Positive predictive value was 21% (30 true-positives, divided by 144 total positives).
-- Negative predictive value was greater than 99% (822 true-negatives, divided by 825 total negatives).
Lehman CD et al. MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med 2007 Mar 29; 356:1295-303.
Comment
MRI detected contralateral breast cancer in about 3% of women with recently diagnosed breast cancer but no clinical or mammographic findings in the other breast. The findings are potentially important for at least two reasons: First, when contralateral breast cancer is discovered concurrently, the woman can undergo simultaneous treatment and avoid a second course of treatment later. Second, for women who are considering prophylactic contralateral mastectomy, the high negative predictive value of a negative MRI might argue against that procedure. However, some authorities have expressed concern about the high rate of false-positive MRI results (leading to many biopsies of benign lesions) and the lack of expertise in breast MRI at many clinical centers.