Utility of surveillance MRI in women with a personal history of breast cancer ☆ Audree Tadros a,b , Brittany Arditi b , Christina Weltz a,b , Elisa Port a,b , Laurie R. Margolies b,c , Hank Schmidt a,b, ⁎ a Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States b Dubin Breast Center at the Tisch Cancer Institute, New York, NY, United States c Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States abstract article info Article history: Received 8 May 2017 Received in revised form 19 June 2017 Accepted 28 June 2017 Available online xxxx Purpose: To determine the utility and rate of biopsy in women with a positive history of breast cancer screened with MRI. Methods: Retrospective review of 491 breast MRI screening examinations in women with a personal history of breast cancer. Results: In total, 107 biopsies were performed, an average of 0.09 biopsies per person year. The positive predictive value for biopsies prompted by MRI findings was 0.24 (95% C.I. 0.10–0.38). Eight of the nine subsequent cancers were initially identified on screening MRI alone. Conclusion: Surveillance MRI in breast cancer survivors may increase detection of subsequent cancers while increasing rate of biopsy. © 2017 Elsevier Inc. All rights reserved. Keywords: Breast cancer MRI Screening Biopsy 1. Introduction Guidelines regarding surveillance MRI in women with a personal history of breast cancer remain controversial. Screening MRIs are cur- rently recommended for those with a 20–25% lifetime risk of developing breast cancer, including patients with a strong family history or genetic risk factor, as well as patients with a history of mantle radiation for Hodgkin's lymphoma. Currently the American Cancer Society (ACS) and the National Comprehensive Cancer Network (NCCN) do not rec- ommend for or against the use of breast MRI for screening in women with a personal history of breast cancer [1,2]. These women, however, are at increased risk for developing a subsequent breast cancer and early detection of these recurrent breast cancers can lead to improved survival [3]. The question remains whether screening with MRI in this population will allow us to detect additional mammographically occult cancers with an acceptable positive predictive value. A recent report demonstrated that screening MRI for patients with a personal history of breast cancer has both a higher specificity and a lower false positive exam rate when compared to those patients with ei- ther genetic risk factors or family history [4]. There was no statistically significant difference in sensitivity or cancer detection rate and the au- thors conclude that screening MRI should be considered as a supplement to mammography in women with a personal history of breast cancer. As there remains a limited amount of data regarding this question, we further investigate the role of screening MRI for pa- tients with a personal history of breast cancer and examine the biopsy rate, cancer detection rate and positive predictive value. 2. Materials & methods 2.1. Subjects A retrospective review of all patients with a personal history of breast cancer who underwent surveillance MRI as part of routine fol- low-up from 2007 to 2015 was performed. Initially 225 patients were identified from our institutional database. All breast imaging reports were reviewed. Thirty-nine patients were excluded if MRI was diagnos- tic rather than screening, metastatic disease was present at primary di- agnosis, non-breast cancer malignant histology was present at primary diagnosis, or there was inadequate follow up information. For the 186 remaining patients who form the cohort for this study, baseline charac- teristics including age, menopausal status, family history, genetics, pri- mary histology, primary stage, and history of radiation therapy, chemotherapy or endocrine therapy were reviewed. Following the ini- tial diagnosis of breast cancer, the number of screening mammograms was calculated along with the number of biopsies. The post breast can- cer screening algorithm was not uniform or performed on a protocol. The screening schedule for mammogram plus MRI was made as a joint decision between the physician and patient after carefully Clinical Imaging 46 (2017) 33–36 ☆ The authors report no conflicts of interest. ⁎ Corresponding author at: Department of Surgery, Dubin Breast Center, Mount Sinai Medical Center, 5 East 98th Street, Floor 12, New York, NY 10029, United States. E-mail address: hank.schmidt@mountsinai.org (H. Schmidt). http://dx.doi.org/10.1016/j.clinimag.2017.06.007 0899-7071/© 2017 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Clinical Imaging journal homepage: http://www.clinicalimaging.org