MRI of the Breast as Part of the Assessment in Population-Based Mammography Screening

Abstract

Purpose: To evaluate the indications and impact of MRI of the breast as an assessment modality in population-based mammography screening. Materials and Methods: 135 consecutive contrast-enhanced MRI exams of the breast, which were performed between April 2007 and October 2012 as part of the assessment at one mammography screening unit before issuance of a final management recommendation (e.?g. definitely benign or malignant), were retrospectively reviewed. Overall, the cases with an MRI exam of the breast during assessment represent less than 2?% of all assessment cases at this screening unit. All MRI exams were performed as part of the routine clinical care on a 1.5?T or 3?T whole-body magnet using a standard dynamic breast MRI protocol. Results: In the 135 study patients, a total of 30?malignancies in 28 patients were found, including two bilateral cancers. One patient was diagnosed with a non-Hodgkin lymphoma, and of the remaining 29 malignant lesions, 3 (10?%) were in-situ cancers (DCIS) and 26 (90?%) were invasive breast cancers including 3 multifocal or multicentric cancers. All 26 detected invasive cancers were lymph-node negative and 25/29 (86?%) of the detected breast cancer were early stage cancers (stage 0 or 1). 53 of the 135 MRI exams (39.3?%) were suspicious for malignancy (BIRADS 4 or 5) with no cancer missed by MRI. The sensitivity, specificity, positive predictive value, and negative predictive value of the MRI on a per patient basis were 100?%, 77?%, 0.53, and 1, respectively. Conclusion: MRI is a useful problem-solving tool in mammography screening assessment with a high sensitivity and an acceptable positive predictive value. Citation Format:

Diagnostic Performance of Breast Magnetic Resonance Imaging in Non-Calcified Equivocal Breast Findings: Results from a Systematic Review and Meta-Analysis

“…Studies included primarily unclear BI-RADS 0 or 3 finding analogs, whereas some studies also included lesions labeled as BI-RADS 4. In the latter, however, the lesions could not be localized for biopsy and as such qualify as equivocal lesions [ 13 , 18 , 23 ]. Four studies indicated detailed reasons for referral to breast MRI (e.g.…”

“…Four studies indicated detailed reasons for referral to breast MRI (e.g. the exact type of clinical or imaging findings) [ 15 , 23 , 25 , 26 ], two of which stratified breast MRI results by indication [ 25 , 26 ]. The remaining ten studies did not specify detailed indications for breast MRI referral [ 13 , 16 – 22 , 24 ].…”

“…Regarding applicability of the analyzed studies to the research question, bias was deemed low in the majority of studies. An assignment of unclear applicability bias was assigned to the two studies with patients lost to follow-up [ 19 , 23 ], and to one study investigating only BI-RADS 4 findings [ 26 ]. Detailed QUADAS-2 assessment results are given in S1 Fig .…”

Mammographically screen‐detected asymmetric densities with architectural distortion and normal ultrasound at assessment: Value of MRI as a problem‐solving tool

“…The recent German article from Bick et al . reported detection of 30 malignancies in 28 patients (2 bilateral) from 135 consecutive MRI studies (22%) with an overall PPV of 53%, and observed that MRI was used in less than 2% of all assessment cases …”

“…To summarise, use of problem‐solving breast MRI is not advocated for indeterminate lesions that can be readily biopsied such as palpable or sonographic masses or microcalcifications. Equivocal findings where MRI may be appropriate include subtle asymmetric densities, particularly if seen on only one projection, with this group accounting for almost half of cases in previous studies . Architectural distortion should always be regarded with suspicion but differentiation from summation artefact is problematic.…”