Screening breast magnetic resonance imaging in women with hormone replacement therapy

The objective of this study was to compare the performance of screening mammography versus magnetic resonance imaging (MRI) in hormone replacement therapy (HRT) users.

We performed a retrospective review of 4628 women who had mammography or breast MRI screening from the beginning of HRT use at three institutions from April 2005 to December 2015. Information of demographics, number of biopsies performed and pathologic outcomes were collected. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of screening mammography and MRI were compared.

Totally 11,540 screening studies were collected, including 9580 mammography studies and 1960 MRI studies. Breast cancer was diagnosed in 26 patients. Of the 26 cancers, MRI detected 24 and mammography detected 15. For mammography, the sensitivity, specificity, PPV, and NPV were 57.7%, 99.1%, 14.6%, and 99.9%, respectively; for MRI, those values were 92%, 92.5%, 14.2%, and 99.9%, respectively. MRI screening was much more sensitive than mammography screening (p < 0.05, 92% vs 57.7%). There was no difference of specificity, PPV and NPV between two modalities.

Our data showed that screening breast MRI may be a useful adjunct modality of mammography in HRT users.