Abbreviated magnetic resonance imaging in breast cancer: A systematic review of literature

Hernández, María Liliana; Osorio, Sonia; Florez, Katherine; Ospino, Alejandra; Díaz, Gabriel

doi:10.1016/j.ejro.2020.100307

Cited by 30 publications

(16 citation statements)

References 80 publications

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“…The diagnostic accuracy of abMRI is similar to that of fpMRI when reported by professionals expert in fpMRI interpretation [11][12][13][14][15][16][17][18][19], whilst shorter acquisition (3-13 min abMRI vs. 15-32 fpMRI) and reading times for abMRI (0.6-3 min vs. 3-7) promise potential cost savings in comparison with fpMRI [11-14, 16, 18, 20, 21]. However, important unknowns include the feasibility of upscaling abMRI capacity [20,22].…”

Section: Introductionsupporting

confidence: 73%

Evaluating the effectiveness of abbreviated breast MRI (abMRI) interpretation training for mammogram readers: a multi-centre study assessing diagnostic performance, using an enriched dataset

Jones

Marshall²,

Elangovan³

et al. 2022

Breast Cancer Res

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Background Abbreviated breast MRI (abMRI) is being introduced in breast screening trials and clinical practice, particularly for women with dense breasts. Upscaling abMRI provision requires the workforce of mammogram readers to learn to effectively interpret abMRI. The purpose of this study was to examine the diagnostic accuracy of mammogram readers to interpret abMRI after a single day of standardised small-group training and to compare diagnostic performance of mammogram readers experienced in full-protocol breast MRI (fpMRI) interpretation (Group 1) with that of those without fpMRI interpretation experience (Group 2). Methods Mammogram readers were recruited from six NHS Breast Screening Programme sites. Small-group hands-on workstation training was provided, with subsequent prospective, independent, blinded interpretation of an enriched dataset with known outcome. A simplified form of abMRI (first post-contrast subtracted images (FAST MRI), displayed as maximum-intensity projection (MIP) and subtracted slice stack) was used. Per-breast and per-lesion diagnostic accuracy analysis was undertaken, with comparison across groups, and double-reading simulation of a consecutive screening subset. Results 37 readers (Group 1: 17, Group 2: 20) completed the reading task of 125 scans (250 breasts) (total = 9250 reads). Overall sensitivity was 86% (95% confidence interval (CI) 84–87%; 1776/2072) and specificity 86% (95%CI 85–86%; 6140/7178). Group 1 showed significantly higher sensitivity (843/952; 89%; 95%CI 86–91%) and higher specificity (2957/3298; 90%; 95%CI 89–91%) than Group 2 (sensitivity = 83%; 95%CI 81–85% (933/1120) p < 0.0001; specificity = 82%; 95%CI 81–83% (3183/3880) p < 0.0001). Inter-reader agreement was higher for Group 1 (kappa = 0.73; 95%CI 0.68–0.79) than for Group 2 (kappa = 0.51; 95%CI 0.45–0.56). Specificity improved for Group 2, from the first 55 cases (81%) to the remaining 70 (83%) (p = 0.02) but not for Group 1 (90–89% p = 0.44), whereas sensitivity remained consistent for both Group 1 (88–89%) and Group 2 (83–84%). Conclusions Single-day abMRI interpretation training for mammogram readers achieved an overall diagnostic performance within benchmarks published for fpMRI but was insufficient for diagnostic accuracy of mammogram readers new to breast MRI to match that of experienced fpMRI readers. Novice MRI reader performance improved during the reading task, suggesting that additional training could further narrow this performance gap.

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Section: Introductionsupporting

confidence: 73%

Evaluating the effectiveness of abbreviated breast MRI (abMRI) interpretation training for mammogram readers: a multi-centre study assessing diagnostic performance, using an enriched dataset

Jones

Marshall²,

Elangovan³

et al. 2022

Breast Cancer Res

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show abstract

“…The diagnostic accuracy of abMRI is similar to that of fpMRI when reported by professionals expert in fpMRI interpretation (11)(12)(13)(14)(15)(16)(17)(18)(19), while shorter acquisition (3-13 minutes abMRI vs. 15-32 fpMRI) and reading times for abMRI (0.6-3 minutes vs. 3-7) promise potential cost savings in comparison with fpMRI (11-14, 16, 18, 20, 21). However, important unknowns include the feasibility of upscaling abMRI capacity (20,22).…”

Section: Introductionsupporting

confidence: 68%

Evaluating the effectiveness of abbreviated breast MRI (abMRI) interpretation-training for mammogram-readers: a multicentre study assessing diagnostic performance, using an enriched dataset

Jones

Marshall

Elangovan

et al. 2022

Preprint

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Background: Abbreviated breast MRI (abMRI) is being introduced in breast screening trials and clinical practice, particularly for women with dense breasts. Upscaling abMRI provision requires the workforce of mammogram-readers to learn to effectively interpret abMRI. The purpose of this study was to examine the diagnostic accuracy of mammogram-readers to interpret abMRI after a single day of standardised small-group training and to compare diagnostic performance of mammogram-readers experienced in full-protocol breast MRI (fpMRI) interpretation (Group 1) with that of those without fpMRI interpretation experience (Group 2).Methods: Mammogram-readers were recruited from six NHS Breast Screening Programme sites. Small-group hands-on workstation training was provided, with subsequent prospective, independent, blinded interpretation of an enriched dataset with known outcome. A simplified form of abMRI (first-post-contrast-subtracted-images (FAST MRI), displayed as maximum-intensity-projection (MIP) and subtracted slice-stack), was used. Per-breast and per-lesion diagnostic accuracy analysis was undertaken, with comparison across groups, and double-reading simulation of a consecutive screening subset.Results: 37 readers (Group 1: 17, Group 2: 20) completed the reading task of 125 scans (250 breasts) (total = 9250 reads). Overall sensitivity was 86% (95% Confidence Interval (CI) 84-87%; 1776/2072) and specificity, 86% (95%CI 85-86%; 6140/7178). Group 1 showed significantly higher sensitivity (843/952; 89%; 95%CI 86-91%) and higher specificity (2957/3298; 90%; 95%CI 89-91%) than Group 2 (sensitivity = 83%; 95%CI 81-85% (933/1120) p<0.0001; specificity = 82%; 95%CI 81-83% (3183/3880) p<0.0001). Inter-reader agreement was higher for Group 1 (kappa = 0.73; 95%CI 0.68-0.79) than for Group 2 (kappa = 0.51; 95%CI 0.45-0.56). Specificity improved for Group 2, from the first 55 cases (81%) to the remaining 70 (83%) (p=0.02) but not for Group 1 (90% to 89% p=0.44); whereas sensitivity remained consistent for both Group 1 (88% to 89%) and Group 2 (83% to 84%).Conclusions: Single day abMRI interpretation-training for mammogram-readers achieved an overall diagnostic performance within benchmarks published for fpMRI but was insufficient for diagnostic accuracy of mammogram-readers new to breast MRI to match that of experienced fpMRI readers. Novice MRI reader performance improved during the reading task, suggesting additional training could further narrow this performance gap.

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“…It is important because one of the main barriers to implementing MRI in diagnosing breast cancer is its high cost. However, our results allow us to suppose that the abbreviated protocols, recently proposed in the literature [ 42 , 43 ], could be equally useful in these cases. Because the BIRADS category of most of the findings was resolved by morphological analysis or by the absence of contrast enhancement, which can be observed in early sequences of DCE, the use of abbreviated protocols could improve the cost-effectiveness of using MRI as a problem-solving tool in breast cancer screening.…”

Section: Discussionmentioning

confidence: 73%

Magnetic resonance imaging in diagnosis of indeterminate breast (BIRADS 3 & 4A) in a general population

et al. 2021

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Objective Currently, mammography and ultrasonography are the most used imaging techniques for breast cancer screening. However, these examinations report many indeterminate studies with a low probability of being malignant, i.e., BIRADS 3 and 4A. This prospective study aims to evaluate the value of breast magnetic resonance imaging (MRI) to clarify the BIRADS categorization of indeterminate mammography or ultrasonography studies. Methods MRI studies acquired prospectively from 105 patients previously classified as BIRADS 3 or 4A were analyzed independently by four radiologists with different experience levels. Interobserver agreement was determined by the first-order agreement coefficient (AC1), and divergent results were re-analyzed for consensus. The possible correlation between the MRI and the mammography/ultrasound findings was evaluated, and each study was independently classified in one of the five BIRADS categories (BIRADS 1 to 5). In lesions categorized as BIRADS 4 or 5 at MRI, histopathological diagnosis was established by image-guided biopsy; while short-term follow-up was performed in lesions rated as BIRADS 3. Results Breast MRI was useful in diagnosing three invasive ductal carcinomas, upgraded from BIRADS 4A to BIRADS 5. It also allowed excluding malignancy in 86 patients (81.9%), avoiding 22 unnecessary biopsies and 64 short-term follow-ups. The MRI showed good diagnostic performance with the area under roc curve, sensitivity, specificity, PPV, and NPV of 0.995, 100%, 83.5%, 10.5%, and 100%, respectively. Conclusions MRI showed to be useful as a problem-solving tool to clarify indeterminate findings in breast cancer screening and avoiding unnecessary short-follow-ups and percutaneous biopsies.

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Abbreviated magnetic resonance imaging in breast cancer: A systematic review of literature

Cited by 30 publications

References 80 publications

Evaluating the effectiveness of abbreviated breast MRI (abMRI) interpretation training for mammogram readers: a multi-centre study assessing diagnostic performance, using an enriched dataset

Evaluating the effectiveness of abbreviated breast MRI (abMRI) interpretation training for mammogram readers: a multi-centre study assessing diagnostic performance, using an enriched dataset

Evaluating the effectiveness of abbreviated breast MRI (abMRI) interpretation-training for mammogram-readers: a multicentre study assessing diagnostic performance, using an enriched dataset

Magnetic resonance imaging in diagnosis of indeterminate breast (BIRADS 3 & 4A) in a general population

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