Screening Breast MRI Outcomes in Routine Clinical Practice

Strigel, Roberta M.; Rollenhagen, Jennifer; Burnside, Elizabeth S.; Elezaby, Mai; Fowler, Amy M.; Kelcz, Frederick; Salkowski, Lonie R.; DeMartini, Wendy B.

doi:10.1016/j.acra.2016.10.014

Cited by 35 publications

(21 citation statements)

References 28 publications

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“…We identified breast MRI screening examinations, which were defined as MRI examinations of patients without symptoms with a personal or family history of a known genetic mutation, a family history of breast cancer, a personal history of treated breast cancer, a history of chest radiation, or a prior biopsy result indicating the presence of atypia or lobular carcinoma in situ [6]. Of the 1437 breast MRI examinations performed during the study, 532 were categorized as diagnostic and were excluded.…”

Section: Methodsmentioning

confidence: 99%

“…Of the 1437 breast MRI examinations performed during the study, 532 were categorized as diagnostic and were excluded. Also excluded were 21 unenhanced examinations performed to evaluate the integrity of a silicone implant, 22 non-diagnostic examinations (for reasons including the inability of patients to complete the examination, contrast extravasation or injection failure, and extreme patient motion), and two examinations without a final BI-RADS assessment [6]. Of the remaining 860 screening breast MRI examinations, 82 were assessed as BI-RADS category 4 and comprised the examinations evaluated in this study.…”

Section: Methodsmentioning

confidence: 99%

“…All study examinations were performed using a 1.5-T MRI scanner (Signa HDxt, GE Healthcare) with a dedicated 7-(Invivo) or 8-(Sentinelle) channel breast coil [6]. A weight-based dose of the gadolinium-based contrast agent gadobenate dimeglumine (0.1 mmol/kg of body weight; MultiHance, Bracco Diagnostics) was administered by power injection at a rate of 2 mL/s, followed by a 20-mL saline flush.…”

Section: Methodsmentioning

confidence: 99%

“…All breast MRI examinations were prospectively interpreted and reported as part of routine clinical practice according to BI-RADS, in conjunction with the patient’s clinical history and other available breast imaging studies, including prior breast MRI, mammography, and ultrasound examinations [6]. The examinations in our study were interpreted using the BI-RADS fourth edition [7], because the BI-RADS fifth edition was published in 2013 and was introduced into clinical practice in early 2014 [8].…”

Section: Methodsmentioning

confidence: 99%

“…Importantly, patients undergoing screening breast MRI typically have a significantly increased risk of malignancy compared with the typical mammography screening population. Screening breast MRI typically is performed for patients with the following characteristics: a genetic mutation that predisposes them to breast cancer, a lifetime risk for breast cancer of 20% or greater on the basis of family history, a history of chest radiation, a personal history of treated breast cancer, or a diagnosis of atypia or lobular carcinoma in situ [4–6]. …”

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confidence: 99%

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Utility of BI-RADS Assessment Category 4 Subdivisions for Screening Breast MRI

Strigel

Burnside

Elezaby

et al. 2017

American Journal of Roentgenology

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OBJECTIVE BI-RADS for mammography and ultrasound subdivides category 4 assessments by likelihood of malignancy into categories 4A (> 2% to ≤ 10%), 4B (> 10% to ≤ 50%), and 4C (> 50% to < 95%). Category 4 is not subdivided for breast MRI because of a paucity of data. The purpose of the present study is to determine the utility of categories 4A, 4B, and 4C for MRI by calculating their positive predictive values (PPVs) and comparing them with BI-RADS–specified rates of malignancy for mammography and ultrasound. MATERIALS AND METHODS All screening breast MRI examinations performed from July 1, 2010, through June 30, 2013, were included in this study. We identified in medical records prospectively assigned MRI BI-RADS categories, including category 4 subdivisions, which are used routinely in our practice. Benign versus malignant outcomes were determined by pathologic analysis, findings from 12 months or more clinical or imaging follow-up, or a combination of these methods. Distribution of BI-RADS categories and positive predictive value level 2 (PPV2; based on recommendation for tissue diagnosis) for categories 4 (including its subdivisions) and 5 were calculated. RESULTS Of 860 screening breast MRI examinations performed for 566 women (mean age, 47 years), 82 with a BI-RADS category 4 assessment were identified. A total of 18 malignancies were found among 84 category 4 and 5 assessments, for an overall PPV2 of 21.4% (18/84). For category 4 subdivisions, PPV2s were as follows: for category 4A, 2.5% (1/40); for category 4B, 27.6% (8/29); for category 4C, 83.3% (5/6); and for category 4 (not otherwise specified), 28.6% (2/7). CONCLUSION Category 4 subdivisions for MRI yielded malignancy rates within BI-RADS–specified ranges, supporting their use for benefits to patient care and more meaningful practice audits.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Utility of BI-RADS Assessment Category 4 Subdivisions for Screening Breast MRI

Strigel

Burnside

Elezaby

et al. 2017

American Journal of Roentgenology

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Breast Cancer Screening Using Mammography, Digital Breast Tomosynthesis, and Magnetic Resonance Imaging by Breast Density

Stout,

Miglioretti,

et al. 2024

JAMA Intern Med

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ImportanceInformation on long-term benefits and harms of screening with digital breast tomosynthesis (DBT) with or without supplemental breast magnetic resonance imaging (MRI) is needed for clinical and policy discussions, particularly for patients with dense breasts.ObjectiveTo project long-term population-based outcomes for breast cancer mammography screening strategies (DBT or digital mammography) with or without supplemental MRI by breast density.Design, Setting, and ParticipantsCollaborative modeling using 3 Cancer Intervention and Surveillance Modeling Network (CISNET) breast cancer simulation models informed by US Breast Cancer Surveillance Consortium data. Simulated women born in 1980 with average breast cancer risk were included. Modeling analyses were conducted from January 2020 to December 2023.InterventionAnnual or biennial mammography screening with or without supplemental MRI by breast density starting at ages 40, 45, or 50 years through age 74 years.Main outcomes and MeasuresLifetime breast cancer deaths averted, false-positive recall and false-positive biopsy recommendations per 1000 simulated women followed-up from age 40 years to death summarized as means and ranges across models.ResultsBiennial DBT screening for all simulated women started at age 50 vs 40 years averted 7.4 vs 8.5 breast cancer deaths, respectively, and led to 884 vs 1392 false-positive recalls and 151 vs 221 false-positive biopsy recommendations, respectively. Biennial digital mammography had similar deaths averted and slightly more false-positive test results than DBT screening. Adding MRI for women with extremely dense breasts to biennial DBT screening for women aged 50 to 74 years increased deaths averted (7.6 vs 7.4), false-positive recalls (919 vs 884), and false-positive biopsy recommendations (180 vs 151). Extending supplemental MRI to women with heterogeneously or extremely dense breasts further increased deaths averted (8.0 vs 7.4), false-positive recalls (1088 vs 884), and false-positive biopsy recommendations (343 vs 151). The same strategy for women aged 40 to 74 years averted 9.5 deaths but led to 1850 false-positive recalls and 628 false-positive biopsy recommendations. Annual screening modestly increased estimated deaths averted but markedly increased estimated false-positive results.Conclusions and relevanceIn this model-based comparative effectiveness analysis, supplemental MRI for women with dense breasts added to DBT screening led to greater benefits and increased harms. The balance of this trade-off for supplemental MRI use was more favorable when MRI was targeted to women with extremely dense breasts who comprise approximately 10% of the population.

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Contrast‐enhanced MRI for breast cancer screening

Mann

Kuhl²,

Moy

2019

Magnetic Resonance Imaging

233

154

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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.

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Screening Breast MRI Outcomes in Routine Clinical Practice

Cited by 35 publications

References 28 publications

Utility of BI-RADS Assessment Category 4 Subdivisions for Screening Breast MRI

Utility of BI-RADS Assessment Category 4 Subdivisions for Screening Breast MRI

Breast Cancer Screening Using Mammography, Digital Breast Tomosynthesis, and Magnetic Resonance Imaging by Breast Density

Contrast‐enhanced MRI for breast cancer screening

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