Breast MRI for those of us at a higher risk

Krisc

In April, I had my annual breast MRI at a different facility than the usual imaging place that I have had my previous MRI's since being diagnosed with LCIS in 2009.  The radiologist saw 3 areas of concern and recommended an MRI biopsy of all 3 areas.  My breast surgeon and oncologist were not overly convinced of the need and in fact did not think the areas looked to be of a major concern.  (although of course I was told that the only way to be sure was a biopsy).  My breast surgeon referred me to a teaching center for a second opion.  It is UNC Hospital in Chapel Hill.  I had a very thorough clinical exam by a breast oncology surgeon and a digital mammogram there.  The chief radiologist for breast imaging in the Cancer Center, another radiologist, and the breast cancer surgeon read my MRI from April and agreed with my breast surgeon.  The radiologist explained certain features that would be suspicious of maligancy and did not find those features on the areas noted from the radiologist from home.  Of course she also stated it was my decision to be 100 % sure but did not see the need at this time and recommended a repeat MRI in 6 months.  Has this ever happened to anyone else, do you take the advice of specialists and repeat in 6 months? The radiologist explained the false positives in a breast MRI and someone with "busy breasts" as I have will almost always have areas that light up with contrast.  Also, has anyone with LCIS finished taking Evista and is now taking nothing?  I have only used Evista since I was post menopausal at diagnosis. 

ballet12

Hi Kris, I don't have LCIS, but I did have an MRI done after I was diagnosed, and it was rated BIRADS4, with a recommendation for a biopsy.  When I went to another facility (an NCI-designated facility), they looked at the same MRI and gave it a BIRADS3, and they saw the nodule, but it didn't look very suspicious after all.  I began to be treated there, and was given a repeat MRI after 6 months as recommended.  By then, they rated it a BIRADS2, which means that it's stable and totally fine.  They can see it, but are sure it's benign.  This was in the non-diagnosed breast. I didn't ever have three simultaneous areas of concern in one breast.

Beesie

So you are saying that 1 radiologist recommended the biopsies, while 2 radiologists, 2 breast surgeons and 1 oncologist all feel that there is nothing to be concerned about?

Personally I've had enough biopsies over my life that I'm happy to avoid one when I can.  So I'd take the 5 expert opinions over the 1.  But then I've done the "watchful waiting" many times and have never had a problem as a result. I'm also relatively risk tolerant, even though I know that there are no guarantees.  My experience has been that if there really is a concern, my doctors won't let me get out of having the biopsy.  I've had that happen often enough - sometimes with benign results but that's also how my cancer was found. 

Krisc

Thank you both for your replies.  Yes, Bessie, I agree with you!  Just have been under an assumption that  breast biopsies are almost always done when seen on MRI, thus the "false positives."   Wishing you both well!

ganzgirl2010

I was dx with LCIS March 2013. I had a lumpectomy. The plan for treatment was followup with MRI and mammos every 6 months. I had a mammo in November 2013, it was normal. I just had the Mri last week and the results were : Regional asymmetric non masslike enhancement" with recommended mri guided biopsy, which is scheduled for next week. Birads 4. Im scared to death...someone please tell me what all this means ?

Anonymous

Kris--I was diagnosed with LCIS almost 11 years ago; had a lumpectomy, took tamoxifen for 5 years (I was pre-meno the first 1.5 years, post-meno the  remaining 3.5 years after surgical menopause); have been taking evista for about 5 years.  Docs all say I can take it indefinitely, as women do for osteoporosis.

Ganzgirl----enhancement can mean many things, many of which can turn out benign.  It could just be more LCIS (as LCIS is multifocal); praying it is nothing more than LCIS.

anne

ganzgirl2010

Thank you Ann...still not very comforting

leaf

Of course you're worried.  That's only natural to be worried.  You do have a chance of having breast cancer.  I would also be worried if I was in your shoes.  But, overall, the statistics are in your favor for not having anything worse.

MRIs are notorious for giving false positives.  

All screening tests are associated with overdiagnosis. MRI is a highly sensitive test, especially in expert hands. As the
New England Journal of Medicine article would indicate,² MRI would find abnormalities in at least 12.5% of patients with normal physical exam and mammography. Four biopsies were
performed for every malignant lesion diagnosed.....

In fact, even in high-risk women, MRI-directed biopsies that proved
benign outnumbered the cancer diagnoses by 3 to 1.   ....

A recent MRI study showed that 40% of MRI-detected cancers
were DCIS.....

http://jop.ascopubs.org/content/4/1/18.full

(emphasis mine)