Breast cancers not detected by MRI in a high and intermediate risk screening program

S. Vreemann, A. Gubern-Mérida, S. Lardenoije, B. Platel, N. Karssemeijer and R. Mann

Annual Meeting of the Radiological Society of North America 2015.


The purpose of this study was to evaluate the visibility of MR screen detected cancers on prior MR examinations in a population with an elevated risk for breast cancer.


An IRB approved, retrospective review of patient files from women screened with breast MRI between 2003 and 2013 was conducted at our academic center. We selected all cases detected in MRI with a prior negative MR examination performed between 6 and 24 months before a cancer was revealed (mean: 12.8 A-A?A 1/2 3.7 months). This yielded 43 cancers (3 invasive lobular-, 33 invasive ductal carcinomas, 5 ductal carcinoma in situ and 2 others) in 41 patients (age: 49 A-A?A 1/2 9.8 years, 21 BRCA patients). The MR scans where the cancers were detected (diagnostic MR scan) and the prior MR scans were evaluated side-by-side in consensus by two dedicated breast radiologists. The visibility of the cancers on prior scans was rated as: visible (BIRADS 4/5), minimal sign (BIRADS 2/3), or invisible (BIRADS 1). Chi-square tests were used to test the correlation between patient and cancer characteristics, image quality (IQ), background parenchymal enhancement (BPE), and visibility of the tumor in the prior MR scan.


All lesions were retrospectively evident on the diagnostic MR scan. Review of the prior examinations of the 43 cancers detected in follow-up rounds revealed that 11 lesions (26%) were visible in the prior MRI and should have been recalled at the time of this scan. 15 lesions (35%) showed a minimal sign in the prior MRI. Only 17 lesions (40%) were completely invisible. High grade, ER negative, and PR negative tumors were more often invisible in the prior scan (p=0.016, p=0.005, and p=0.002). Moreover, tumors in BRCA patients were more likely to be invisible in the prior scan, than in non-BRCA carriers (p=0.025). IQ and BPE were not significantly related to the visibility of tumors in the prior scan.


About 26% of the breast cancers could have been recalled earlier and only 40% of the breast cancers were invisible in retrospect.


To prevent screening errors regular auditing of clinical practice is indicated. Moreover, like in mammography, structural double reading of MRI screening examinations may be recommended.