Patterns of Breast Magnetic Resonance Imaging Use in Community Practice

Wernli, Karen J.; DeMartini, Wendy B.; Ichikawa, Laura; Lehman, Constance D.; Onega, Tracy; Kerlikowske, Karla; Henderson, Louise M.; Geller, Berta M.; Hofmann, Michael; Yankaskas, Bonnie C.

doi:10.1001/jamainternmed.2013.11963

Cited by 128 publications

(105 citation statements)

References 25 publications

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“…Compared with mammography, however, breast MRI has a modest specificity that leads to high false-positive rates; it is also more expensive and requires the use of intravenous contrast medium. 48 Some have suggested that the future lies in risk-based screening, because normal-and low-risk women potentially have lower true-positive recall rates and lower true-positive biopsy rates. The relative benefits of screening diminish when applied to populations without sufficient risk.…”

Section: Not Less Detection But More Informationmentioning

confidence: 99%

Implications of Overdiagnosis: Impact on Screening Mammography Practices

Morris

Feig

Drexler

et al. 2015

Population Health Management

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This review article explores the issue of overdiagnosis in screening mammography. Overdiagnosis is the screen detection of a breast cancer, histologically confirmed, that might not otherwise become clinically apparent during the lifetime of the patient. While screening mammography is an imperfect tool, it remains the best tool we have to diagnose breast cancer early, before a patient is symptomatic and at a time when chances of survival and options for treatment are most favorable. In 2015, an estimated 231,840 new cases of breast cancer (excluding ductal carcinoma in situ) will be diagnosed in the United States, and some 40,290 women will die. Despite these data, screening mammography for women ages 40-69 has contributed to a substantial reduction in breast cancer mortality, and organized screening programs have led to a shift from late-stage diagnosis to early-stage detection. Current estimates of overdiagnosis in screening mammography vary widely, from 0% to upwards of 30% of diagnosed cancers. This range reflects the fact that measuring overdiagnosis is not a straightforward calculation, but usually one based on different sets of assumptions and often biased by methodological flaws. The recent development of tomosynthesis, which creates high-resolution, three-dimensional images, has increased breast cancer detection while reducing false recalls. Because the greatest harm of overdiagnosis is overtreatment, the key goal should not be less diagnosis but better treatment decision tools. (Population Health Management 2015;18:S3-S11)

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Section: Not Less Detection But More Informationmentioning

confidence: 99%

Implications of Overdiagnosis: Impact on Screening Mammography Practices

Morris

Feig

Drexler

et al. 2015

Population Health Management

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“…described rapid expansion of breast pMRI use in the United States, 4,5,[19][20][21] ranging from a 3-4 to 20-fold 5 increase in the past 10 years. To our knowledge, there are no large-scale studies demonstrating the potential associated downstream negative consequences associated with pMRI in routine clinical practice.…”

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confidence: 99%

Use of Preoperative Magnetic Resonance Imaging for Breast Cancer

et al. 2015

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“…reast magnetic resonance (MR) imaging increased 16-fold between 2000 and 2011, and screening indications account for an increasing number of examinations in recent years (1)(2)(3). Compared with mammographic imaging, breast MR imaging achieves higher sensitivity but lower…”

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confidence: 99%

Extramammary Findings on Breast MR Examinations: Frequency, Clinical Relevance, and Patient Outcomes

Niell¹,

Bennett²,

Sharma³

et al. 2015

Radiology

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Amita Sharma, MBBS G. Scott Gazelle, MD, MPH, PhD Purpose:To evaluate the frequency of extramammary findings on breast magnetic resonance (MR) images, recommendations for further imaging evaluation of each finding, and the subsequent effect on patient outcomes and health care expenditures. Materials and Methods:Institutional review board approval was acquired for this HIPAA-compliant study. Informed consent was waived.Review of the institutional database identified 2324 breast MR examinations performed in women from January 1, 2010, to December 31, 2010. Breast MR imaging reports were reviewed for extramammary findings. Extramammary findings were categorized by using the computed tomography (CT) colonography reporting and data system (C-RADS). The electronic medical record was reviewed for each patient with a C-RADS category E3 and E4 finding to assess clinical relevance and pathologic outcome. If an E3 or E4 finding was previously described and evaluated, the finding was downgraded and assigned a final C-RADS E2 category. The cost of additional imaging was estimated by using the Medicare physician fee schedule. Statistical significance was assessed by using x 2 statistics. A P value less than .05 indicated statistical significance, and 95% exact confidence intervals (CIs) were constructed. Results:Extramammary findings were identified in 391 of 2324 breast MR examinations (16.8%), which included 105 patients (4.5%) with E3 or E4 findings. Of the 2324 patients, 86 patients (3.7% [95% CI: 3.0%, 4.5%]) were recommended to undergo further imaging. After undergoing evaluation for additional imaging, a clinically important finding was found in nine patients (0.4% [95% CI: 0.2%, 0.7%]). Most frequently, hepatic lesions were the indication for additional imaging. Abdominal MR examinations accounted for 55% of costs related to additional imaging. Averaged across the entire cohort, further imaging evaluation and follow-up of incidental findings contributed an additional $16 to each breast MR imaging performed.

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Patterns of Breast Magnetic Resonance Imaging Use in Community Practice

Cited by 128 publications

References 25 publications

Implications of Overdiagnosis: Impact on Screening Mammography Practices

Implications of Overdiagnosis: Impact on Screening Mammography Practices

Use of Preoperative Magnetic Resonance Imaging for Breast Cancer

Extramammary Findings on Breast MR Examinations: Frequency, Clinical Relevance, and Patient Outcomes

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