Nissan Noam, Gluskin Jill, Ochoa-Albiztegui Rosa Elena, Fruchtman-Brot Hila, Sung Janice S, Jochelson Maxine S
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
Eur Radiol. 2025 May;35(5):2366-2375. doi: 10.1007/s00330-024-11091-x. Epub 2024 Oct 31.
To assess the diagnostic performance of breast MRI during lactation in the setting of high-risk breast cancer screening.
Screening breast MRIs performed between April 2008 and March 2024 were retrospectively reviewed. Background parenchymal enhancement (BPE) grade was compared between lactating patients and patients who recently stopped lactating using the Mann-Whitney test. Breast Imaging Reporting and Data System (BI-RADS) scores prevalence rates were compared between lactating patients and controls encompassing young non-lactating patients using the Chi-square test. Diagnostic performance was calculated for patients with a biopsy reference or a 1-year radiologic follow-up.
One-hundred forty-two screening breast MRIs were performed in lactating patients (n = 104, median age, 36.0 ± 6.0 years). Marked BPE appeared in 82% of cases (116/142), with a higher BPE grade in exams performed during lactation as compared with those performed in patients who had recently ceased lactating (p < 0.001). Screening MRIs performed during lactation had a higher rate of BI-RADS 3 scores (40/142, 28% vs. 683/8922, 7%, p < 0.001) and a lower rate of BI-RADS 1/2 scores (88/142, 62% vs. 7549/8922, 84.6%, p = 0.002) compared with those performed in controls (n = 8922). One pregnancy-associated breast cancer was detected, and one interval-cancer occurred. All MRI-guided biopsies were negative (n = 13). Screening breast MRI during lactation had 50% sensitivity (1/2), 60% specificity (72/120), 2.0% positive predictive value (1/49), and 98.6% negative predictive value (71/82).
The efficacy of breast MRI for high-risk screening during lactation is limited by prominent BPE, leading to an increased rate of BI-RADS 3 categorization and diminished overall specificity.
Question Studies on breast MRI during lactation were solely focused on studies conducted in patients with known cancer but not in the screening setting. Findings Screening breast MRI during lactation usually results in marked background parenchymal enhancement, negatively impacting its diagnostic performance. Clinical relevance Despite the lower performance, and amidst the significant risk of pregnancy-associated breast cancer, this screening approach remains relevant for lactating patients with high-risk profiles, such as BReast Cancer (BRCA) carriers. Radiologists should be familiar with the normal appearance of breast MRI during lactation.
评估哺乳期乳腺磁共振成像（MRI）在高危乳腺癌筛查中的诊断性能。
回顾性分析2008年4月至2024年3月期间进行的乳腺筛查MRI。使用曼-惠特尼检验比较哺乳期患者与近期停止哺乳患者的背景实质强化（BPE）分级。使用卡方检验比较哺乳期患者与包括年轻非哺乳期患者在内的对照组之间的乳腺影像报告和数据系统（BI-RADS）评分患病率。对有活检参考或1年影像学随访的患者计算诊断性能。
对哺乳期患者进行了142例乳腺筛查MRI（n = 104，中位年龄36.0±6.0岁）。82%的病例（116/142）出现明显BPE，与近期停止哺乳患者相比，哺乳期检查的BPE分级更高（p < 0.001）。与对照组（n = 8922）相比，哺乳期进行的筛查MRI中BI-RADS 3级评分的比例更高（40/142，28%对683/8922，7%，p < 0.001），而BI-RADS 1/2级评分的比例更低（88/142，62%对7549/8922，84.6%，p = 0.002）。检测到1例妊娠相关乳腺癌，发生1例间期癌。所有MRI引导下活检均为阴性（n = 13）。哺乳期乳腺筛查MRI的敏感性为50%（1/2），特异性为60%（72/120），阳性预测值为2.0%（1/49），阴性预测值为98.6%（71/82）。
哺乳期乳腺MRI用于高危筛查的有效性受到显著BPE的限制，导致BI-RADS 3级分类率增加，总体特异性降低。
问题 关于哺乳期乳腺MRI的研究仅集中在已知癌症患者的研究上，而非筛查环境。发现 哺乳期乳腺筛查MRI通常会导致明显的背景实质强化，对其诊断性能产生负面影响。临床意义 尽管性能较低，且存在妊娠相关乳腺癌的重大风险，但这种筛查方法对于具有高危特征的哺乳期患者，如乳腺癌（BRCA）携带者，仍然具有相关性。放射科医生应熟悉哺乳期乳腺MRI的正常表现。
