First, Dr. Christopher Riedl from the University of Vienna
shared initial results from the Austrian National Screening Trial. The patients
for this prospective study were recruited from nine imaging centers and 13
genetic counseling centers across the country. Only patients who carried the
BRCA 1 or 2 genetic mutation were included; patients with a family history of
breast cancer, but no known BRCA status, were excluded.
One-hundred and ninety-two women were enrolled. The trial
protocol consisted of a clinical exam, palpation ultrasound every six months
with mammography, and MR at 12 months. The patients were between the eighth and
twelfth day of their menstrual cycles. MR was performed on either a 1-tesla or
a 1.5-tesla MR unit. The imaging protocol consisted of sagittal T2-weighted
images, TSE or STIR.
Riedl presented results from 90 women and 148 MR studies.
The final analysis on breast carcinoma size and stage covered 80 asymptomatic
and 11 symptomatic patients. Open biopsy in the 11 symptomatic patients
revealed four cancers, all of which were larger than 2 cm and node-positive.
In the 80 patients with at least one screening exam, eight
open biopsies revealed five breast carcinomas and three benign results. MR was
able to detect all five of these cancers, Riedl said, while only two of the
five were uncovered by mammography and ultrasound. The majority of the
carcinomas (80%) were less than 1 cm while 60% were node-negative.
"MRI appears to be superior to mammography and ultrasound
for screening of BRCA 1 and 2 mutation carriers. MRI seems to help early
diagnosis in this patient population. We recommend MR for these mutations
carriers," said Riedl.
Riedl added that next phase of the study will focus on the
women who were excluded from the first arm of the trial, those with a familial
history of breast cancer but no documented BRCA mutations. These updated
results will be presented at the 2004 European Congress of Radiology in Vienna,
Picking up where Riedl and colleagues left off was Dr. Francesco
Sardanelli from the Instituto Policlinico San Donato in Milan, Italy.
Sardanelli and co-investigators tested breast MR in high-risk women who were either BRCA 1 or 2 carriers or had
a strong family history.
Including the latter women was important in order to address
two problems associated with genetic testing for BRCA, Sardanelli explained.
BRCA mutations account for only 50% of inherited cancers. Second, many women
refuse to undergo genetic testing because of the psychological stress involved.
This study was done at 13 centers around Italy and was
managed by the Instituto Superiore di Sanita, a division of the national health
ministry, Sardanelli said. Eligible participants were women 25 years or older
who were either BRCA carriers, had a first-degree relative who was a carrier,
had a strong family history, or a personal history of breast cancer. Up to
March 2003, 153 women were included, with 92 BRCA 1 carriers, 20 BRCA 2
carriers, and 41 with either a family history or a first-degree carrier
MR imaging was done during the second week of the menstrual
cycle on either 1-tesla or 1.5-tesla units. The protocol included 3-D,
T1-weighted gradient echo dynamic imaging. Mammography and ultrasound exams
were also performed.
According to the results, 66 of the 153 women underwent both
the first and second round of annual screening with all three modalities. Ten
patients were found to have breast cancer during the first round and two more
were diagnosed during the second round of screening, for a global incidence of
In total, MRI found 11 of 12 cancers with four
false-positives. Of the dozen cancers, 67% were detected only by MRI. The
cancers ranged in size from 5 mm-18 mm. In women with a family history, the
incidence rate of breast cancer was 19.2%; in women with a previous personal
history of breast cancer, the incidence was 11.7%.
The group concluded that women with a strong family history
of breast cancer would benefit from annual MR screening, independent of genetic
Session moderator Dr. Carol Lee asked both Riedl and
Sardanelli how they handled lesions that were deemed probably benign on MRI.
Riedl said his group performed follow-up imaging at three months, although that
policy was initially met with resistance by his hospital’s surgeons and
gynecologists. Sardanelli also said the patient was recalled for a second MR
While the second exam was feasible for the purposes of the
study, it is a costly prospect in the real world. Sardanelli estimated that an
MR scan in Italy costs ten times as much as a mammogram. However, because of
the higher sensitivity of MR for detecting breast lesions in these particular
patients, the cost may be lower than mammography in the long run, he said.
By Shalmali Pal
AuntMinnie.com staff writer
November 30, 2003
MRS tumor measurement cuts out unnecessary breast biopsies, November 25, 2003
detects breast tumors missed by mammography and US, September 17, 2003
digital mammography helps visualize cancer in dense breasts, August 29,
useful in detecting missed breast cancer in high-risk women, June 25,
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