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Breast
Imaging
Special Topics in Screening and Diagnostic Imaging
Screening MR
Screening MR
Haydee Ojeda-Fournier, MD; Wendie A. Berg, MD, PhD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Definitions

            • Contrast-enhanced MR of breasts, using dedicated breast coil, in asymptomatic women usually at high risk for breast cancer
              • As annual supplement to mammography (MMG)
                • In women 25-29 years old, primary screening modality is MR
                  • Radiation risk to MMG and no proven benefit
            • Definitions of high risk vary; check American Cancer Society, National Comprehensive Cancer Network (NCCN), National Institute for Health and Care Excellence (NICE, UK) guidelines for MR screening
              • Known pathogenic mutation in BRCA1 or BRCA2
              • 1st-degree relative has known pathogenic mutation in BRCA1 or BRCA2, but patient is untested
              • Known or 1st-degree relative with
                • Li-Fraumeni syndrome (TP53 pathogenic mutation): Begin annual MR at age 20; consider MMG ≥ age 30
                  • NICE guidelines: Avoid MMG due to radiation risk
                • PTEN-hamartoma syndrome (Cowden, other): Begin annual MR + MMG at age 30
              • Personal history of high-risk mutation: Supplemental MR
                • Consider annual MR for ATM, PALB2, CHEK2 depending on specifics of family history
                • Pathogenic CDH1 mutation: Begin MR at age 30 [~ 50% lifetime risk (LTR) of invasive lobular breast cancer (ILC)]
                • Neurofibromatosis-1 (NF1): Annual MR ages 30-50 then MMG alone
                • STK11 (Peutz-Jeghers syndrome): Annual MR beginning at age 25
              • Chest radiation therapy (XRT) at least 8 years earlier, prior to age 30 (e.g., Hodgkin lymphoma therapy)
              • Use risk models that consider family history of breast and ovarian cancer to predict risk of pathogenic BRCA1 or BRCA2 mutation (Claus, Tyrer-Cuzick, BOADICEA, BRCAPRO); estimate LTR of breast cancer for purposes of MR screening
                • Women with LTR > 20-25% should consider supplemental annual MR screening
                • Life expectancy ≥ 10 years, age ≤ 70
              • Strong family history of breast &/or ovarian cancer: Consider referral to high-risk program, genetics
                • ↑ number of relatives, closeness (1st-degree vs. 2nd- or 3rd-degree relatives) and premenopausal age at relative's diagnosis ↑ risk to patient
                • Male relative with breast cancer
                • Ashkenazi Jewish ancestry and family history of breast or ovarian cancer
            • American College of Radiology (ACR) also recommends annual MR
              • Personal history of breast cancer (PHBC) diagnosed by age 50 or dense breasts
                • ↑ specificity and positive predictive value (PPV) compared to other high-risk cohorts
            • Consider MR for personal history of lobular carcinoma in situ (LCIS) at time of diagnosis and annually, especially if additional risk factors
            • Consider MR for personal history of other atypical biopsy
              • No proven benefit to MR in this setting; no proven issues with ↑ interval cancer rates nor advanced stage at diagnosis in such patients

          IMAGING

          • Mammographic Findings

            • Ultrasonographic Findings

              • MR Findings

                • Imaging Recommendations

                  CLINICAL ISSUES

                  • Presentation

                    • Demographics

                      • Natural History & Prognosis

                        • Treatment

                          DIAGNOSTIC CHECKLIST

                          • Consider

                            • Image Interpretation Pearls

                              Selected References

                              1. Guindalini RS et al: Intensive surveillance with bi-annual dynamic contrast-enhanced magnetic resonance imaging downstages breast cancer in BRCA1 mutation carriers. Clin Cancer Res. ePub, 2018
                              2. Kuhl CK: Abbreviated breast MRI for screening women with dense breast: the EA1141 trial. Br J Radiol. 91(1090):20170441, 2018
                              3. Monticciolo DL et al: Breast cancer screening in women at higher-than-average risk: recommendations from the ACR. J Am Coll Radiol. 15(3 Pt A):408-14, 2018
                              4. Park VY et al: Breast magnetic resonance imaging for surveillance of women with a personal history of breast cancer: outcomes stratified by interval between definitive surgery and surveillance MR imaging. BMC Cancer. 18(1):91, 2018
                              5. Roark AA et al: Journal club: performance of screening breast MRI after negative full-field digital mammography versus after negative digital breast tomosynthesis in women at higher than average risk for breast cancer. AJR Am J Roentgenol. 1-9, 2018
                              6. Vreemann S et al: Influence of risk category and screening round on the performance of an MR imaging and mammography screening program in carriers of the BRCA mutation and other women at increased risk. Radiology. 286(2):443-51, 2018
                              7. Cho N et al: Breast cancer screening with mammography plus ultrasonography or magnetic resonance imaging in women 50 years or younger at diagnosis and treated with breast conservation therapy. JAMA Oncol. 3(11):1495-1502, 2017
                              8. Kuhl CK et al: Supplemental breast MR imaging screening of women with average risk of breast Cancer. Radiology. 283(2):361-370, 2017
                              9. Lo G et al: Evaluation of the utility of screening mammography for high-risk women undergoing screening breast MR imaging. Radiology. 285(1):36-43, 2017
                              10. Strigel RM et al: Screening breast MRI outcomes in routine clinical practice: comparison to BI-RADS benchmarks. Acad Radiol. 24(4):411-417, 2017
                              11. van Zelst JCM et al: Surveillance of women with the BRCA1 or BRCA2 mutation by using biannual automated breast US, MR imaging, and mammography. Radiology. 285(2):376-388, 2017
                              12. Destounis S et al: Personal history of premenopausal breast cancer as a risk factor for referral to screening breast MRI. Acad Radiol. 23(3):353-7, 2016
                              13. Lehman CD et al: Screening MRI in women with a personal history of breast cancer. J Natl Cancer Inst. 108(3), 2016
                              14. Narayan AK et al: Comparative effectiveness of breast MRI and mammography in screening young women with elevated risk of developing breast cancer: a retrospective cohort study. Breast Cancer Res Treat. 158(3):583-9, 2016
                              15. Phi XA et al: Contribution of mammography to MRI screening in BRCA mutation carriers by BRCA status and age: individual patient data meta-analysis. Br J Cancer. 114(6):631-7, 2016
                              16. Siu AL et al: Screening for breast cancer: U.S. preventive services task force recommendation statement. Ann Intern Med. 164(4):279-96, 2016
                              17. Sung JS et al: Breast cancers detected at screening MR imaging and mammography in patients at high risk: method of detection reflects tumor histopathologic results. Radiology. 280(3):716-22, 2016
                              18. Emaus MJ et al: MR imaging as an additional screening modality for the detection of breast cancer in women aged 50-75 years with extremely dense breasts: the DENSE trial study design. Radiology. 277(2):527-37, 2015
                              19. Giess CS et al: Screening breast MRI in patients previously treated for breast cancer: diagnostic yield for cancer and abnormal interpretation rate. Acad Radiol. 22(11):1331-7, 2015
                              20. Grimm LJ et al: Abbreviated screening protocol for breast MRI: a feasibility study. Acad Radiol. 22(9):1157-62, 2015
                              21. Othman E et al: Comparison of false positive rates for screening breast magnetic resonance imaging (MRI) in high risk women performed on stacked versus alternating schedules. Springerplus. 4:77, 2015
                              22. Phi XA et al: Magnetic resonance imaging improves breast screening sensitivity in BRCA mutation carriers age ≥ 50 years: evidence from an individual patient data meta-analysis. J Clin Oncol. 33(4):349-56, 2015
                              23. Raikhlin A et al: Breast MRI as an adjunct to mammography for breast cancer screening in high-risk patients: retrospective review. AJR Am J Roentgenol. 204(4):889-97, 2015
                              24. Riedl CC et al: Triple-modality screening trial for familial breast cancer underlines the importance of magnetic resonance imaging and questions the role of mammography and ultrasound regardless of patient mutation status, age, and breast density. J Clin Oncol. 33(10):1128-35, 2015
                              25. Saadatmand S et al: Survival benefit in women with BRCA1 mutation or familial risk in the MRI screening study (MRISC). Int J Cancer. 137(7):1729-38, 2015
                              26. Ahern CH et al: Cost-effectiveness of alternative strategies for integrating MRI into breast cancer screening for women at high risk. Br J Cancer. 111(8):1542-51, 2014
                              27. Chiarelli AM et al: Effectiveness of screening with annual magnetic resonance imaging and mammography: results of the initial screen from the ontario high risk breast screening program. J Clin Oncol. 32(21):2224-30, 2014
                              28. Evans DG et al: MRI breast screening in high-risk women: cancer detection and survival analysis. Breast Cancer Res Treat. 145(3):663-72, 2014
                              29. Gillman J et al: The role of dynamic contrast-enhanced screening breast MRI in populations at increased risk for breast cancer. Womens Health (Lond). 10(6):609-22, 2014
                              30. Gweon HM et al: Breast MR imaging screening in women with a history of breast conservation therapy. Radiology. 272(2):366-73, 2014
                              31. Hollingsworth AB et al: An alternative approach to selecting patients for high-risk screening with breast MRI. Breast J. 20(2):192-7, 2014
                              32. Kuhl CK et al: Abbreviated breast magnetic resonance imaging (MRI): first postcontrast subtracted images and maximum-intensity projection-a novel approach to breast cancer screening with MRI. J Clin Oncol. 32(22):2304-10, 2014
                              33. Lourenco AP et al: Improving outcomes of screening breast MRI with practice evolution: initial clinical experience with 3T compared to 1.5T. J Magn Reson Imaging. 39(3):535-9, 2014
                              34. Onega T et al: Breast cancer screening in an era of personalized regimens: a conceptual model and National Cancer Institute initiative for risk-based and preference-based approaches at a population level. Cancer. 120(19):2955-64, 2014
                              35. Santoro F et al: MRI screening of women with hereditary predisposition to breast cancer: diagnostic performance and survival analysis. Breast Cancer Res Treat. 147(3):685-7, 2014
                              36. Spick C et al: Diagnostic utility of second-look US for breast lesions identified at MR imaging: systematic review and meta-analysis. Radiology. 273(2):401-9, 2014
                              37. Tharmaratnam K et al: MRI screening of women with hereditary predisposition to breast cancer: diagnostic performance and survival analysis. Breast Cancer Res Treat. 148(3):687-8, 2014
                              38. Giess CS et al: Patterns of nonmasslike enhancement at screening breast MR imaging of high-risk premenopausal women. Radiographics. 33(5):1343-60, 2013
                              39. Kam JK et al: Five-year analysis of magnetic resonance imaging as a screening tool in women at hereditary risk of breast cancer. J Med Imaging Radiat Oncol. 57(4):400-6, 2013
                              40. Ozanne EM et al: Which risk model to use? Clinical implications of the ACS MRI screening guidelines. Cancer Epidemiol Biomarkers Prev. 22(1):146-9, 2013
                              41. Berg WA et al: Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA 307(13):1394-404, 2012
                              42. Heijnsdijk EA et al: Differences in natural history between breast cancers in BRCA1 and BRCA2 mutation carriers and effects of MRI screening-MRISC, MARIBS, and Canadian studies combined. Cancer Epidemiol Biomarkers Prev. 21(9):1458-68, 2012
                              43. Pickles MD et al: Breast MRI at 3.0 T in a high-risk familial breast cancer screening cohort: comparison with 1.5 T screening studies. Br J Radiol. 85(1015):990-5, 2012
                              44. Schrading S et al: MR screening of women at average risk of breast cancer. Presented at: RSNA; Chicago, IL. November 27, 2012
                              45. Hambly NM et al: Background parenchymal enhancement on baseline screening breast MRI: impact on biopsy rate and short-interval follow-up. AJR Am J Roentgenol. 196(1):218-24, 2011
                              46. Le-Petross HT et al: Effectiveness of alternating mammography and magnetic resonance imaging for screening women with deleterious BRCA mutations at high risk of breast cancer. Cancer. 117(17):3900-7, 2011
                              47. Sardanelli F et al: Multicenter surveillance of women at high genetic breast cancer risk using mammography, ultrasonography, and contrast-enhanced magnetic resonance imaging (the high breast cancer risk Italian 1 study): final results. Invest Radiol. 2011 Feb;46(2):94-105
                              48. Sung JS et al: Screening breast MR imaging in women with a history of chest irradiation. Radiology. 259(1):65-71, 2011
                              49. Sung JS et al: Screening breast MR imaging in women with a history of lobular carcinoma in situ. Radiology. 261(2):414-20, 2011
                              50. Warner E et al: Prospective study of breast cancer incidence in women with a BRCA1 or BRCA2 mutation under surveillance with and without magnetic resonance imaging. J Clin Oncol. 29(13):1664-9, 2011
                              51. Berg WA et al: Reasons women at elevated risk of breast cancer refuse breast MR imaging screening: ACRIN 6666. Radiology. 254(1):79-87, 2010
                              52. Brennan S et al: Breast MRI screening of women with a personal history of breast cancer. AJR Am J Roentgenol. 195(2):510-6, 2010
                              53. Henderson TO et al: Systematic review: surveillance for breast cancer in women treated with chest radiation for childhood, adolescent, or young adult cancer. Ann Intern Med. 152(7):444-55; W144-54, 2010
                              54. Lee CH et al: Breast cancer screening with imaging: recommendations from the Society of Breast Imaging and the ACR on the use of mammography, breast MRI, breast ultrasound, and other technologies for the detection of clinically occult breast cancer. J Am Coll Radiol. 7(1):18-27, 2010
                              55. Rijnsburger AJ et al: BRCA1-associated breast cancers present differently from BRCA2-associated and familial cases: long-term follow-up of the Dutch MRISC Screening Study. J Clin Oncol. 28(36):5265-73, 2010
                              56. Saslow D et al: American Cancer Society guidelines for breast screening with MR as an adjunct to mammography. CA Cancer J Clin. 57(2): 75-89, 2007
                              57. Lehman CD et al: Cancer yield of mammography, MR, and US in high-risk women: prospective multi-institution breast cancer screening study. Radiology. 244(2):381-8, 2007
                              58. Sardanelli F et al: Multicenter comparative multimodality surveillance of women at genetic-familial high risk for breast cancer (HIBCRIT study): interim results. Radiology. 242(3):698-715, 2007
                              59. Plevritis SK et al: Cost-effectiveness of screening BRCA1/2 mutation carriers with breast magnetic resonance imaging. JAMA. 295(20):2374-84, 2006
                              60. Preda L et al: Magnetic resonance mammography in the evaluation of recurrence at the prior lumpectomy site after conservative surgery and radiotherapy. Breast Cancer Res. 8(5):R53, 2006
                              61. Amir E et al: Evaluation of breast cancer risk assessment packages in the family history evaluation and screening programme. J Med Genet. 40(11):807-14, 2003
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Imaging

                                  • Clinical Issues

                                    • Diagnostic Checklist

                                      TERMINOLOGY

                                      • Definitions

                                        • Contrast-enhanced MR of breasts, using dedicated breast coil, in asymptomatic women usually at high risk for breast cancer
                                          • As annual supplement to mammography (MMG)
                                            • In women 25-29 years old, primary screening modality is MR
                                              • Radiation risk to MMG and no proven benefit
                                        • Definitions of high risk vary; check American Cancer Society, National Comprehensive Cancer Network (NCCN), National Institute for Health and Care Excellence (NICE, UK) guidelines for MR screening
                                          • Known pathogenic mutation in BRCA1 or BRCA2
                                          • 1st-degree relative has known pathogenic mutation in BRCA1 or BRCA2, but patient is untested
                                          • Known or 1st-degree relative with
                                            • Li-Fraumeni syndrome (TP53 pathogenic mutation): Begin annual MR at age 20; consider MMG ≥ age 30
                                              • NICE guidelines: Avoid MMG due to radiation risk
                                            • PTEN-hamartoma syndrome (Cowden, other): Begin annual MR + MMG at age 30
                                          • Personal history of high-risk mutation: Supplemental MR
                                            • Consider annual MR for ATM, PALB2, CHEK2 depending on specifics of family history
                                            • Pathogenic CDH1 mutation: Begin MR at age 30 [~ 50% lifetime risk (LTR) of invasive lobular breast cancer (ILC)]
                                            • Neurofibromatosis-1 (NF1): Annual MR ages 30-50 then MMG alone
                                            • STK11 (Peutz-Jeghers syndrome): Annual MR beginning at age 25
                                          • Chest radiation therapy (XRT) at least 8 years earlier, prior to age 30 (e.g., Hodgkin lymphoma therapy)
                                          • Use risk models that consider family history of breast and ovarian cancer to predict risk of pathogenic BRCA1 or BRCA2 mutation (Claus, Tyrer-Cuzick, BOADICEA, BRCAPRO); estimate LTR of breast cancer for purposes of MR screening
                                            • Women with LTR > 20-25% should consider supplemental annual MR screening
                                            • Life expectancy ≥ 10 years, age ≤ 70
                                          • Strong family history of breast &/or ovarian cancer: Consider referral to high-risk program, genetics
                                            • ↑ number of relatives, closeness (1st-degree vs. 2nd- or 3rd-degree relatives) and premenopausal age at relative's diagnosis ↑ risk to patient
                                            • Male relative with breast cancer
                                            • Ashkenazi Jewish ancestry and family history of breast or ovarian cancer
                                        • American College of Radiology (ACR) also recommends annual MR
                                          • Personal history of breast cancer (PHBC) diagnosed by age 50 or dense breasts
                                            • ↑ specificity and positive predictive value (PPV) compared to other high-risk cohorts
                                        • Consider MR for personal history of lobular carcinoma in situ (LCIS) at time of diagnosis and annually, especially if additional risk factors
                                        • Consider MR for personal history of other atypical biopsy
                                          • No proven benefit to MR in this setting; no proven issues with ↑ interval cancer rates nor advanced stage at diagnosis in such patients

                                      IMAGING

                                      • Mammographic Findings

                                        • Ultrasonographic Findings

                                          • MR Findings

                                            • Imaging Recommendations

                                              CLINICAL ISSUES

                                              • Presentation

                                                • Demographics

                                                  • Natural History & Prognosis

                                                    • Treatment

                                                      DIAGNOSTIC CHECKLIST

                                                      • Consider

                                                        • Image Interpretation Pearls

                                                          Selected References

                                                          1. Guindalini RS et al: Intensive surveillance with bi-annual dynamic contrast-enhanced magnetic resonance imaging downstages breast cancer in BRCA1 mutation carriers. Clin Cancer Res. ePub, 2018
                                                          2. Kuhl CK: Abbreviated breast MRI for screening women with dense breast: the EA1141 trial. Br J Radiol. 91(1090):20170441, 2018
                                                          3. Monticciolo DL et al: Breast cancer screening in women at higher-than-average risk: recommendations from the ACR. J Am Coll Radiol. 15(3 Pt A):408-14, 2018
                                                          4. Park VY et al: Breast magnetic resonance imaging for surveillance of women with a personal history of breast cancer: outcomes stratified by interval between definitive surgery and surveillance MR imaging. BMC Cancer. 18(1):91, 2018
                                                          5. Roark AA et al: Journal club: performance of screening breast MRI after negative full-field digital mammography versus after negative digital breast tomosynthesis in women at higher than average risk for breast cancer. AJR Am J Roentgenol. 1-9, 2018
                                                          6. Vreemann S et al: Influence of risk category and screening round on the performance of an MR imaging and mammography screening program in carriers of the BRCA mutation and other women at increased risk. Radiology. 286(2):443-51, 2018
                                                          7. Cho N et al: Breast cancer screening with mammography plus ultrasonography or magnetic resonance imaging in women 50 years or younger at diagnosis and treated with breast conservation therapy. JAMA Oncol. 3(11):1495-1502, 2017
                                                          8. Kuhl CK et al: Supplemental breast MR imaging screening of women with average risk of breast Cancer. Radiology. 283(2):361-370, 2017
                                                          9. Lo G et al: Evaluation of the utility of screening mammography for high-risk women undergoing screening breast MR imaging. Radiology. 285(1):36-43, 2017
                                                          10. Strigel RM et al: Screening breast MRI outcomes in routine clinical practice: comparison to BI-RADS benchmarks. Acad Radiol. 24(4):411-417, 2017
                                                          11. van Zelst JCM et al: Surveillance of women with the BRCA1 or BRCA2 mutation by using biannual automated breast US, MR imaging, and mammography. Radiology. 285(2):376-388, 2017
                                                          12. Destounis S et al: Personal history of premenopausal breast cancer as a risk factor for referral to screening breast MRI. Acad Radiol. 23(3):353-7, 2016
                                                          13. Lehman CD et al: Screening MRI in women with a personal history of breast cancer. J Natl Cancer Inst. 108(3), 2016
                                                          14. Narayan AK et al: Comparative effectiveness of breast MRI and mammography in screening young women with elevated risk of developing breast cancer: a retrospective cohort study. Breast Cancer Res Treat. 158(3):583-9, 2016
                                                          15. Phi XA et al: Contribution of mammography to MRI screening in BRCA mutation carriers by BRCA status and age: individual patient data meta-analysis. Br J Cancer. 114(6):631-7, 2016
                                                          16. Siu AL et al: Screening for breast cancer: U.S. preventive services task force recommendation statement. Ann Intern Med. 164(4):279-96, 2016
                                                          17. Sung JS et al: Breast cancers detected at screening MR imaging and mammography in patients at high risk: method of detection reflects tumor histopathologic results. Radiology. 280(3):716-22, 2016
                                                          18. Emaus MJ et al: MR imaging as an additional screening modality for the detection of breast cancer in women aged 50-75 years with extremely dense breasts: the DENSE trial study design. Radiology. 277(2):527-37, 2015
                                                          19. Giess CS et al: Screening breast MRI in patients previously treated for breast cancer: diagnostic yield for cancer and abnormal interpretation rate. Acad Radiol. 22(11):1331-7, 2015
                                                          20. Grimm LJ et al: Abbreviated screening protocol for breast MRI: a feasibility study. Acad Radiol. 22(9):1157-62, 2015
                                                          21. Othman E et al: Comparison of false positive rates for screening breast magnetic resonance imaging (MRI) in high risk women performed on stacked versus alternating schedules. Springerplus. 4:77, 2015
                                                          22. Phi XA et al: Magnetic resonance imaging improves breast screening sensitivity in BRCA mutation carriers age ≥ 50 years: evidence from an individual patient data meta-analysis. J Clin Oncol. 33(4):349-56, 2015
                                                          23. Raikhlin A et al: Breast MRI as an adjunct to mammography for breast cancer screening in high-risk patients: retrospective review. AJR Am J Roentgenol. 204(4):889-97, 2015
                                                          24. Riedl CC et al: Triple-modality screening trial for familial breast cancer underlines the importance of magnetic resonance imaging and questions the role of mammography and ultrasound regardless of patient mutation status, age, and breast density. J Clin Oncol. 33(10):1128-35, 2015
                                                          25. Saadatmand S et al: Survival benefit in women with BRCA1 mutation or familial risk in the MRI screening study (MRISC). Int J Cancer. 137(7):1729-38, 2015
                                                          26. Ahern CH et al: Cost-effectiveness of alternative strategies for integrating MRI into breast cancer screening for women at high risk. Br J Cancer. 111(8):1542-51, 2014
                                                          27. Chiarelli AM et al: Effectiveness of screening with annual magnetic resonance imaging and mammography: results of the initial screen from the ontario high risk breast screening program. J Clin Oncol. 32(21):2224-30, 2014
                                                          28. Evans DG et al: MRI breast screening in high-risk women: cancer detection and survival analysis. Breast Cancer Res Treat. 145(3):663-72, 2014
                                                          29. Gillman J et al: The role of dynamic contrast-enhanced screening breast MRI in populations at increased risk for breast cancer. Womens Health (Lond). 10(6):609-22, 2014
                                                          30. Gweon HM et al: Breast MR imaging screening in women with a history of breast conservation therapy. Radiology. 272(2):366-73, 2014
                                                          31. Hollingsworth AB et al: An alternative approach to selecting patients for high-risk screening with breast MRI. Breast J. 20(2):192-7, 2014
                                                          32. Kuhl CK et al: Abbreviated breast magnetic resonance imaging (MRI): first postcontrast subtracted images and maximum-intensity projection-a novel approach to breast cancer screening with MRI. J Clin Oncol. 32(22):2304-10, 2014
                                                          33. Lourenco AP et al: Improving outcomes of screening breast MRI with practice evolution: initial clinical experience with 3T compared to 1.5T. J Magn Reson Imaging. 39(3):535-9, 2014
                                                          34. Onega T et al: Breast cancer screening in an era of personalized regimens: a conceptual model and National Cancer Institute initiative for risk-based and preference-based approaches at a population level. Cancer. 120(19):2955-64, 2014
                                                          35. Santoro F et al: MRI screening of women with hereditary predisposition to breast cancer: diagnostic performance and survival analysis. Breast Cancer Res Treat. 147(3):685-7, 2014
                                                          36. Spick C et al: Diagnostic utility of second-look US for breast lesions identified at MR imaging: systematic review and meta-analysis. Radiology. 273(2):401-9, 2014
                                                          37. Tharmaratnam K et al: MRI screening of women with hereditary predisposition to breast cancer: diagnostic performance and survival analysis. Breast Cancer Res Treat. 148(3):687-8, 2014
                                                          38. Giess CS et al: Patterns of nonmasslike enhancement at screening breast MR imaging of high-risk premenopausal women. Radiographics. 33(5):1343-60, 2013
                                                          39. Kam JK et al: Five-year analysis of magnetic resonance imaging as a screening tool in women at hereditary risk of breast cancer. J Med Imaging Radiat Oncol. 57(4):400-6, 2013
                                                          40. Ozanne EM et al: Which risk model to use? Clinical implications of the ACS MRI screening guidelines. Cancer Epidemiol Biomarkers Prev. 22(1):146-9, 2013
                                                          41. Berg WA et al: Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA 307(13):1394-404, 2012
                                                          42. Heijnsdijk EA et al: Differences in natural history between breast cancers in BRCA1 and BRCA2 mutation carriers and effects of MRI screening-MRISC, MARIBS, and Canadian studies combined. Cancer Epidemiol Biomarkers Prev. 21(9):1458-68, 2012
                                                          43. Pickles MD et al: Breast MRI at 3.0 T in a high-risk familial breast cancer screening cohort: comparison with 1.5 T screening studies. Br J Radiol. 85(1015):990-5, 2012
                                                          44. Schrading S et al: MR screening of women at average risk of breast cancer. Presented at: RSNA; Chicago, IL. November 27, 2012
                                                          45. Hambly NM et al: Background parenchymal enhancement on baseline screening breast MRI: impact on biopsy rate and short-interval follow-up. AJR Am J Roentgenol. 196(1):218-24, 2011
                                                          46. Le-Petross HT et al: Effectiveness of alternating mammography and magnetic resonance imaging for screening women with deleterious BRCA mutations at high risk of breast cancer. Cancer. 117(17):3900-7, 2011
                                                          47. Sardanelli F et al: Multicenter surveillance of women at high genetic breast cancer risk using mammography, ultrasonography, and contrast-enhanced magnetic resonance imaging (the high breast cancer risk Italian 1 study): final results. Invest Radiol. 2011 Feb;46(2):94-105
                                                          48. Sung JS et al: Screening breast MR imaging in women with a history of chest irradiation. Radiology. 259(1):65-71, 2011
                                                          49. Sung JS et al: Screening breast MR imaging in women with a history of lobular carcinoma in situ. Radiology. 261(2):414-20, 2011
                                                          50. Warner E et al: Prospective study of breast cancer incidence in women with a BRCA1 or BRCA2 mutation under surveillance with and without magnetic resonance imaging. J Clin Oncol. 29(13):1664-9, 2011
                                                          51. Berg WA et al: Reasons women at elevated risk of breast cancer refuse breast MR imaging screening: ACRIN 6666. Radiology. 254(1):79-87, 2010
                                                          52. Brennan S et al: Breast MRI screening of women with a personal history of breast cancer. AJR Am J Roentgenol. 195(2):510-6, 2010
                                                          53. Henderson TO et al: Systematic review: surveillance for breast cancer in women treated with chest radiation for childhood, adolescent, or young adult cancer. Ann Intern Med. 152(7):444-55; W144-54, 2010
                                                          54. Lee CH et al: Breast cancer screening with imaging: recommendations from the Society of Breast Imaging and the ACR on the use of mammography, breast MRI, breast ultrasound, and other technologies for the detection of clinically occult breast cancer. J Am Coll Radiol. 7(1):18-27, 2010
                                                          55. Rijnsburger AJ et al: BRCA1-associated breast cancers present differently from BRCA2-associated and familial cases: long-term follow-up of the Dutch MRISC Screening Study. J Clin Oncol. 28(36):5265-73, 2010
                                                          56. Saslow D et al: American Cancer Society guidelines for breast screening with MR as an adjunct to mammography. CA Cancer J Clin. 57(2): 75-89, 2007
                                                          57. Lehman CD et al: Cancer yield of mammography, MR, and US in high-risk women: prospective multi-institution breast cancer screening study. Radiology. 244(2):381-8, 2007
                                                          58. Sardanelli F et al: Multicenter comparative multimodality surveillance of women at genetic-familial high risk for breast cancer (HIBCRIT study): interim results. Radiology. 242(3):698-715, 2007
                                                          59. Plevritis SK et al: Cost-effectiveness of screening BRCA1/2 mutation carriers with breast magnetic resonance imaging. JAMA. 295(20):2374-84, 2006
                                                          60. Preda L et al: Magnetic resonance mammography in the evaluation of recurrence at the prior lumpectomy site after conservative surgery and radiotherapy. Breast Cancer Res. 8(5):R53, 2006
                                                          61. Amir E et al: Evaluation of breast cancer risk assessment packages in the family history evaluation and screening programme. J Med Genet. 40(11):807-14, 2003
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