Randomized Trial of Surveillance with Abbreviated MRI in Breast Cancer Survivors – Does it impact patient anxiety and cancer detection rate?

Abstract Purpose: Abbreviated breast MRI substantially reduces the image acquisition and reading times and has been reported to have similar diagnostic accuracy as a full diagnostic protocol but has not been evaluated prospectively with respect to impact on patient anxiety in breast cancer survivors and cancer outcomes.Methods: This prospective controlled trial of parallel design was performed at an academic center on women with a personal history of breast cancer who were randomized into two groups: surveillance with MG or MG plus A-MRI. Primary outcome was anxiety compared between the two and measured by four validated questionnaires at three different time-points during the study. Other parameters including the CDR, abnormal interpretation rate (AIR), and positive predictive value for biopsy (PPV3) were compared between modalities of MG and A-MRI. Tissue diagnoses or 1 year of follow-up were used to establish the reference standard. Linear mixed models were used to analyze anxiety and Fisher’s exact test to compare imaging outcomes.Results: 198 patients were allocated to either MG alone (94) or A-MRI plus MG (104). Anxiety scores in all questionnaires were similarly elevated in both groups (50.99+/-4.6 with MG vs 51.73+/-2.56 with MRI,p>0.05) and did not change over time. MRI detected 5 invasive cancers and 1 DCIS, and MG detected 1 DCIS. MRI had higher incremental CDR(48/1000(5/104) vs MG 5/1000(1/198,p=0.01)) and higher AIR 25%(26/104) vs MG 4.5%(9/198,p<0.00001), with no difference in PPV3:MRI 28.6%(6/21)vs MG 16.7%(1/6,p=0.557).Conclusion:Compared to mammography alone, A-MRI had significantly higher incremental cancer detection in breast cancer survivors. Despite a higher rate of recalls and biopsies, A-MRI had no adverse impact on anxiety.