Contrast‐enhanced MRI for breast cancer screening

Abstract

Multiple studies in the first decade of the 21st century have established contrast‐enhanced breast MRI as a screening modality for women with a hereditary or familial increased risk for the development of breast cancer. In recent studies, in women with various risk profiles, the sensitivity ranges between 81% and 100%, which is approximately twice as high as the sensitivity of mammography. The specificity increases in follow‐up rounds to around 97%, with positive predictive values for biopsy in the same range as for mammography. MRI preferentially detects the more aggressive/invasive types of breast cancer, but has a higher sensitivity than mammography for any type of cancer. This performance implies that in women screened with breast MRI, all other examinations must be regarded as supplemental. Mammography may yield ~5% additional cancers, mostly ductal carcinoma in situ, while slightly decreasing specificity and increasing the costs. Ultrasound has no supplemental value when MRI is used. Evidence is mounting that in other groups of women the performance of MRI is likewise superior to more conventional screening techniques. Particularly in women with a personal history of breast cancer, the gain seems to be high, but also in women with a biopsy history of lobular carcinoma in situ and even women at average risk, similar results are reported. Initial outcome studies show that breast MRI detects cancer earlier, which induces a stage‐shift increasing the survival benefit of screening. Cost‐effectiveness is still an issue, particularly for women at lower risk. Since costs of the MRI scan itself are a driving factor, efforts to reduce these costs are essential. The use of abbreviated MRI protocols may enable more widespread use of breast MRI for screening. Level of Evidence: 1 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;50:377–390.

Multiparametric radiomics methods for breast cancer tissue characterization using radiological imaging

“…Finally, the mpRad demonstrated excellent sensitivity and specificity with increased AUC metrics compared to single radiomic features. The IsoSVM mpRad AUCs were comparable with those AUCs discussed in the literature for discriminating benign from malignant lesions from radiologist [42,43]. In general, multiparametric imaging for applications such as brain, breast, and prostate MRI produce large number of images corresponding to each slice location resulting in high-dimensional image space.…”

A meta‐analysis of contrast‐enhanced spectral mammography versus MRI in the diagnosis of breast cancer

“…MRI in the diagnois of breast cancer has high sensitivity but low specificity. However, MRI examination is time‐consuming and expensive, and is not the first treatment of choice in breast cancer screening or diagnosis . CESM is a new technique based on traditional mammography and intravenous iodine contrast technology.…”

The supplemental value of mammographic screening over breast MRI alone in BRCA2 mutation carriers

“…The poor MRI screening results of this meta-analysis can likely be explained by the fact that some of the included studies were multicenter studies starting with breast MRI screening at the beginning of the MRI-era and, therefore, were conducted in centers with little MRI screening experience. MR screening performance has clearly improved since then [2,4,21,22].…”

“…In women with a high familial or genetic risk, breast MRI was originally introduced as an adjunct to mammographic screening. However, increasing breast MR expertise and technologic advances over the years have made that breast MR nowadays outperforms mammography in the early detection of invasive breast cancer as well as in the detection of ductal carcinoma in situ (DCIS) [2]. Recent studies demonstrate that, especially in BRCA1 mutation carriers under the age of 40, there is little benefit of mammographic screening when MRI screening is also performed [3][4][5].…”