Optimizing Abbreviated Breast MRI for Surveillance in Women with Personal History of Breast Cancer

Background/Objectives: Breast MRI surveillance for women with a personal history of breast cancer (PHBC) is often limited by costs and acquisition times. This study aims to identify the optimal abbreviated breast MR (ABMR) protocol for this population by assessing the diagnostic performance of different sequence additions. Methods: This retrospective study included 1002 women with PHBC who underwent postoperative breast MRI with ultrafast sequences. Propensity score matching using 12 variables yielded recurrence (n = 21) and nonrecurrence (n = 42) groups with balanced characteristics. Four ABMR protocols were simulated by sequentially combining sequences: Step 1 (FAST protocol) included precontrast T1-weighted imaging (T1WI), early-phase T1WI, and subtracted maximal intensity projection (MIP). Step 2 added ultrafast MIP; Step 3 incorporated delayed-phase T1WI; and Step 4 included T2WI and diffusion weighted imaging (DWI). Three expert breast radiologists independently reviewed MRIs. Sensitivity, specificity, accuracy, and area under the curve (AUC) were assessed. Results: Sensitivity, specificity, and accuracy for ABMR protocols ranged from 76.2% to 90.5%, 88.1% to 92.9%, and 85.7% to 90.5%, respectively. The FAST protocol alone provided reliable performance (sensitivity: 81%; specificity: 88.1-90.5%; accuracy: 85.7-87.3%). Additional sequences yielded modest improvements, but no statistically significant differences were observed across all 3 readers (p > 0.05). ABMR protocols demonstrated equivalent diagnostic performance for PHBC surveillance. Conclusions: The FAST protocol alone provided reliable results, indicating its potential as a primary ABMR protocol. While additional sequences slightly improved specificity, they did not significantly enhance diagnostic accuracy.