Comparison between an abbreviated and full MRI protocol for detecting additional disease when doing breast cancer staging

Abstract

Background Previous studies have shown that abbreviated magnetic resonance imaging (aMRI) compares well to full‐protocol MRI (fpMRI) in breast cancer (BC) screening, with the potential advantage of a less costly and complex examination. To our knowledge, the role for aMRI in staging BC has been poorly investigated, especially in assessing additional disease (ie, additional lesions compared to the index one prompting the examination). Purpose To compare aMRI and fpMRI in detecting additional disease in BC staging. Study type Retrospective monocentric cohort study. Population In all, 87 patients with 89 biopsy‐proven index lesions referred to staging fpMRI between January–June 2016. Field Strength/Sequence A 1.5T magnet using short tau inversion recovery (STIR) T2‐weighted imaging, echoplanar diffusion‐weighted imaging, and 3D fast long angle shot (FLASH) T1‐weighted imaging. Assessment During independent sessions, four readers with 1.5–20 years of experience in breast imaging, blinded to the pathological examination and previous imaging, assessed multifocal, multicentric, and contralateral additional lesions on fpMRI and aMRI (including precontrast T1‐weighted 3D FLASH sequence, first postcontrast subtracted T1‐weighted 3D FLASH sequence, and a transverse maximum intensity projection reconstruction). Statistical Tests We calculated the per‐lesion cancer detection rate (CDR), positive predictive value (PPV), and false discovery rate (FDR) for additional disease, assessing the significance of intrareader differences in CDR with the McNemar test. Results Pathological analysis found 36 additional lesions (multifocal, multicentric, and contralateral in 20, 15, and 1 cases, respectively). Readers' CDR was comparably high using aMRI (range 88.9–94.4%) or fpMRI (range 91.7–94.4%) (P > 0.05). PPV and FDR of aMRI (ranges 76.2–84.6% and 15.4–23.8%, respectively), and fpMRI (ranges 76.7–82.9% and 17.2–23.3%, respectively) were comparable on an intrareader basis. Using aMRI, two out of four readers induced two false‐negative cases (one case each) with presumably limited impact on surgical planning (multifocal cancers <1 cm in size). Data Conclusion aMRI was comparable to fpMRI in staging additional BC. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:e222–e230.

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

“…In two others, the evaluation of recurrency was addressed [52,60]. Two of the articles evaluating the use of ABB-MRI for the extent of the disease assessing [57,61], and the other one for detecting additional lesions in confirmed breast cancer patients [74]. A total of 15, 680 breast MRI studies were evaluated in the includes studies, 4934 of which were acquired prospectively.…”

“…Six aimed to evaluate the feasibility of using abbreviated protocols to screening high risk women [35,46,59,39,53,55]; and 7 others, to women with a personal or family history of breast cancer [71,36,43,37,58,44,60]. Additionally, 3 studies established as inclusion criteria to present lesions previously identified by another imaging modality [69,70,67]; and the other 4, focused on pathologically proven breast cancer studies [74,57,68,61].…”

Comparing the diagnostic accuracy, reading time, and inter-rater agreement of breast MRI abbreviated and full protocols: a multi-reader study

“…This knowledge may have influenced the readers’ assessment. Our study is not unique in this regard, and approximately half of the published studies on this topic have a cancer-enriched cohort ( 7 , 10 , 11 , 13 – 15 , 17 – 19 , 29 – 31 ). There were relatively few lesions with benign histology, most likely because of exclusion of all women with prior breast surgery.…”

Abbreviated breast MRI for evaluating breast cancer before initiation of neoadjuvant chemotherapy: A cross-sectional study

“…So, the abbreviated protocol could be reliably applied in identifying disease extension. Another study by Girometti et al, compared the abbreviated and the standard protocol for additional diseases during breast cancer staging in 87 patients with 89 biopsy-proven main lesions [22] . The authors showed that abbreviated MRI was comparable to standard MRI in staging additional breast cancers (multifocal, multicentric, and contralateral) which further indicates the imperative role of the shortened breast MRI protocol in the future clinical practice.…”