Women approve of abbreviated breast MRI
In a patient satisfaction survey of 200 asymptomatic patients at moderate to intermediate risk of breast cancer, there was an overall patient preference for abbreviated breast MRI (75%) over mammography screening (25%) .
Intravenous contrast administration was considered an excellent / good experience 68% of the time, reported Dr Linda Borella, radiologist at St. Vincent’s Private Hospital in Sydney, in an electronic poster presentation at the recent Royal Australian & New Zealand College of Annual Scientific Meeting of Radiology (RANZCR).
Overall, abbreviated breast MRI had a high cancer detection rate in nine out of 200 cases (4.5%), with a recall rate of 9% and a higher positive predictive value (PPV) than mammography. 44% screening. Cancer detection was not limited by breast density.
“The results of this study can be used to inform further research to assess the cost-effectiveness of abbreviated breast MRI for broader screening in a larger population and to support the incorporation of abbreviated breast MRI in Australian breast cancer screening guidelines, ”noted Borella, who led the research with his colleague Dr K. Gladysz.
Behind lung cancer, breast cancer is the second leading cause of cancer death in Australian women, and it remains the leading cause of death in women aged 45 to 64, the authors explained. The limitations of mammography are now well recognized, and MRI has been shown to offer significantly higher sensitivity and thus improve the diagnosis of breast cancer compared to mammography.
All the examinations were carried out on a 3 Tesla MRI scanner using dedicated breast antennas with patients in the prone position; 7.5 ml of intravenous gadobutrol (1 mmol / ml) was administered during the examination.
The study population included 199 women and one man, aged 18 to 85 (mean 53 years; standard deviation ± 12.5). Of these, 172 (86%) were classified as BIRADS 1 and 2, the remaining 28 (14%) being BIRADS 3-5.
A total of 155 patients were recommended to revert to routine screening, and 28 patients identified as BIRADS ≥ 3 were recommended for further investigation, although 45 patients were subsequently investigated.
“The disparity in the number of more in-depth exams has been attributed to patients seeking additional exams through GPs or other specialists after abbreviated breast MRI results. These exams were not recommended in the reports. MRI, ”said Borella.
There was no significant difference between breast density groups with light, moderate and marked density percentages of 33.5%, 32% and 34.5%, respectively. The background enhancement showed greater variability, with the mild, moderate, and severe categories being 66.5%, 24%, and 9.5%, respectively.
Nine breast cancers were identified in eight patients among the 200 abbreviated breast MRI scans performed, resulting in a cancer detection rate of 9/200 (4.5%) with a recall rate of 9% and a 44% higher PPV than screening mammography.
The 9 cancers identified all belonged to the group of patients recommended for further investigations by the radiologists (28 patients), no cancer having been identified in the remaining 17 patients who underwent additional investigations with their general practitioners / other specialists referred.
Final diagnoses were obtained from surgical reports and are shown below.
|Benign breast tissue||1|
|Benign fibrocystic changes||2|
|Ductal carcinoma in situ (DCIS)||3|
In the cancer group there were seven women and one man with an average age of 60 years. A family history of breast cancer was reported in three of the eight patients and no patient had a family history of ovarian cancer.
The Kuhl verdict
This is a fairly small study involving retrospective analysis, but it provides good evidence to corroborate that the concept of abbreviated MRI works, Dr Christiane Kuhl, director and professor in the Department of Diagnostic and Interventional Radiology at the RWTH Aachen University Hospital in Germany, said AuntMinnieEurope.com.
“What’s new here is that the authors asked the women about their preference, and it’s quite remarkable that three-quarters of them preferred MRI,” she said. “I guess women weren’t told when they asked that MRI was much better at detecting cancer – because with that information maybe even more women” would prefer “an abbreviated MRI.”
Kuhl is a longtime proponent of abbreviated MRI, having written one of the first articles on the subject in the Journal of Clinical Oncology in 2014.
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