Optimal Timing of Breast MRI Examinations for Premenopausal Women Who Do Not Have a Normal Menstrual Cycle

Richard L. Ellis

Disclosures

Am J Roentgenol. 2009;193(6):1738-1740. 

In This Article

Abstract and Introduction

Abstract

Objective. The objective of this article is to describe a method for timing breast MRI examinations corresponding to the follicular phase of the menstrual cycle in premenopausal women without cyclical menses, thereby reducing the number of false-positive findings and nondiagnostic examinations.
Conclusion. Serum progesterone concentrations corresponding to the follicular phase of a normal menstrual cycle can aid in optimal scheduling of breast MRI examinations for premenopausal women who lack cyclical menses.

Introduction

The use of breast MRI has grown substantially over the last 10 years as has the number of breast-MRI-related citations listed in medical literature. The uses of breast MRI range from the screening of high-risk patients to helping determine tumor size and focality of disease when conventional imaging is not adequate.[1–4] Screening breast MRI guidelines recently published by the American Cancer Society have dramatically increased the number of women eligible for breast MRI.[5] Moreover, some radiologists predict that breast MRI will evolve from an adjunct examination into a primary screening examination[6] for an even larger segment of the population. It is likely, then, that the number of breast MRI examinations performed will continue to increase.

A limitation of breast MRI in premenopausal women is that hormonal fluctuations during the menstrual cycle have shown an uptake of gadolinium in normal breast tissue that can render dynamic breast MRI examinations difficult to interpret, due to false-positive findings.[7,8] Delille et al.[9] found that performing scans during the follicular phase of the menstrual cycle (days 3–14 of a normal 28-day menstrual cycle; Fig. 1) minimized tissue enhancement resulting from hormonal fluctuations. For premenopausal women with normal menses, patient menstrual history usually provides sufficient guidance to time the breast MRI examination appropriately. However, some women lack a normal cyclical menses on which to base optimal timing of MRI examinations—for example, premenopausal women who have undergone a hysterectomy but retain normally functioning ovaries; premenopausal women with induced irregular menstrual cycles due to oral or injectable contraceptives; premenopausal women undergoing chemotherapy with induced perimenopausal status; and, perimenopausal women with irregular menstrual cycles. They are, nonetheless, subject to cyclical hormonal fluctuations that correspond to the phases of the menstrual cycle such that, if scanned during the interval corresponding to the luteal phase of their menstrual cycle, the uptake of gadolinium could cause false-positive findings on MRI.

Figure 1.

Depicts variation through menstrual cycle of major hormones involved, basal body temperature, and relative endometrial thickness. Average values are shown; durations and values may differ between different women and different cycles. This Wikipedia and Wikimedia Commons image is from user Chris 73 and is freely available at http://commons.wikimedia.org/wiki/Image:MenstrualCycle.png under creative commons cc-by-sa 2.5 license.

In practice, many clinicians scan premenopausal women who lack normal menses without regard to the timing of their hormonal cycle. If the resultant MRI findings suggest an abnormal amount of normal tissue background enhancement or a false-positive finding, they simply rescan the patient in 2 weeks to determine whether the areas of assumed abnormal enhancement are due to hormonal fluctuation of normal breast tissue. In our experience, this practice resulted in many nondiagnostic examinations and repeat scans due to a disproportionate amount of background tissue enhancement (which resolved on repeat scan).

Thus, building on the work of Delille et al.,[9] we hypothesized that serum concentration of progesterone could be used to help appropriately time breast MRI examinations for these women during the corresponding follicular phase of their menstrual cycle. In February 2006, we began to use serum progesterone concentrations to time examinations in premenopausal women who did not have a normal menstrual cycle.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....