AJR October 2017
Johns Hopkins Hospital
“Imaging Appearance and Clinical Impact of Preoperative Breast MRI in Pregnancy-Associated Breast Cancer”
Pregnancy-associated breast cancer, which is rare but often aggressive, was seen on MRI in 98% of cases reviewed in an article published in the September 2017 edition of the American Journal of Roentgenology (AJR).
The study’s authors, led by Kelly S. Myers of the Department of Radiology at Johns Hopkins Hospital, reviewed cases of patients who had given birth within the previous 12 months. Breast MRI showed a sensitivity of 98% and changed surgical management for 28% of those patients. The authors said the results show that breast MRI may play an important role in the management of pregnancy-associated breast cancers.
"Pregnancy-associated breast cancer—breast cancer diagnosed during pregnancy or in the first year postpartum—unfortunately usually presents as a palpable mass," Myers said. "In this study, only women within the first year postpartum underwent MRI, as MRI during pregnancy is not recommended."
In the AJR article, titled "Imaging Appearance and Clinical Impact of Preoperative Breast MRI in Pregnancy-Associated Breast Cancer," the study included 53 women, nine of whom presented during pregnancy and 44 during the first year postpartum. The nine women who presented during pregnancy underwent MRI only following delivery or termination of their pregnancies. The sensitivity rate of MRI was 98%, or 52 of the 53 patients.
MRI was not used to detect the cancers. The majority were detected by mammogram or ultrasound. MRI was performed to evaluate the extent of disease and to find other areas of cancer in that same breast or the contralateral breast.
"It is important to note though that we were able to see the primary tumor by MRI, even though in most cases MRI was not done to detect the primary tumor," Myers said.
The authors said the study markedly expands on the current literature regarding breast MRI for patients with pregnancy-associated breast cancer. Although the study covered only 53 patients, the authors said it is to their knowledge the largest series of breast MRI examinations performed in the setting of pregnancy-associated breast cancer, showing that further research is warranted. Myers said, however, she does not believe that all women should undergo an MRI exam after giving birth to detect breast cancer.
"I would not apply our study to a screening population," she said. "Rather, I think our study suggests that pre-operative breast MRI may be useful in postpartum women with a new diagnosis of pregnancy-associated breast cancer.
"This is in contrast to the common assumption that background enhancement in this population would limit the utility of breast MRI," she added.
"Preoperative planning is especially important for patients with pregnancy-associated breast cancer because of the often aggressive nature of these cancers," the study said. "In contrast to the previous assumption that breast MRI would be of limited utility in this population, we found that it showed a pathologically proven larger tumor size or greater extent of disease in 23% of patients."
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