Screening in patients with increased risk of breast cancer (part 2). Where are we now? Actual MRI screening controversies

Roca, S. Alonso; Laguna, A.B. Delgado; Lexarreta, J. Arantzeta; Campo, Begoña Cajal; Ruiz, Antonio

doi:10.1016/j.rxeng.2020.04.006

Cited by 2 publications

(5 citation statements)

References 78 publications

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“…For example, some high-resolution techniques for neural imaging may be applicable to breast imaging ( 33 , 34 ). The greater accuracy and applicability in the detection of benign and malignant lesions using STIR with DWI and DCE-MRI when compared to DM has also been reported in other studies ( 35 - 39 ). Our findings demonstrate a novel combination of STIR-DWI that can be used to determine the safety and efficacy of the modality in patients with a BI-RADS category 0 in DMs.…”

Section: Discussionsupporting

confidence: 73%

The value of noncontrast MRI in evaluating breast imaging reporting and data system category 0 lesions on digital mammograms

Zhang¹,

Xu²,

Zhou³

et al. 2022

Quant Imaging Med Surg

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Background Benign and malignant diagnosis of nonpalpable breast imaging reporting and data system (BI-RADS) category 0 lesions on digital mammograms (DMs) is very important. We compared the diagnostic performance of non-contrast-enhanced magnetic resonance imaging (MRI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for them. We sought to evaluate BI-RADS category 0 lesions using 3 MRI sequences: short tau inversion recovery (STIR), STIR combined with high b value diffusion-weighted imaging (STIR-DWI), and DCE-MRI. Methods We retrospectively reviewed 114 breast DMs rated as nonpalpable BI-RADS category 0 lesions in 112 patients from January 2014 to June 2019. STIR, high b value DWI, and DCE-MRI were performed for all patients. Two breast radiologists read individual sequences (STIR, DWI, DCE-MRI) and pairs of sequences (STIR-DWI) to detect BI-RADS category 0 lesions in DMs. Receiver operating characteristic (ROC) curve analysis was used to assess diagnostic performance according to a best valuable comparator that combined MRI imaging, clinical, and pathological data. Results Among of 114 lesions (the median age of patients was 47 years; the median size of the lesion was 19 mm), 32 (48.5%) malignant lesions were missed by STIR, 9 (13.6%) malignant lesions were missed by STIR-DWI, and 3 (4.5%) malignant lesions were missed by DCE-MRI. The principal finding of our study was that STIR-DWI and DCE-MRI showed higher diagnostic accuracy than did STIR (P<0.01). STIR-DWI showed higher accuracy [area under the curve (AUC) =0.858; sensitivity =87.8%] for BI-RADS category 0 lesions in DMs than did STIR (AUC =0.754; sensitivity =51.5%), while the performance was comparable to that of DCE-MRI (AUC =0.884; sensitivity =95.5%). Conclusions Using pairs of sequences (STIR-DWI) is a non-contrast-enhanced MRI technique and had an equal diagnostic performance in distinguishing benign from malignant lesions among nonpalpable BI-RADS category 0 lesions to that of DCE-MRI. As a result, STIR-DWI as having the potential to improve the safety and efficacy in of breast cancer screening, especially in nonpalpable BI-RADS category 0 lesions at in DMs.

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Section: Discussionsupporting

confidence: 73%

The value of noncontrast MRI in evaluating breast imaging reporting and data system category 0 lesions on digital mammograms

Zhang¹,

Xu²,

Zhou³

et al. 2022

Quant Imaging Med Surg

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“…Breast cancer screening with MRI has already been applied in several studies with high sensitivity and specificity in high-risk and average-risk women 5–7,32–34 . Meanwhile, breast MRI is an accepted annually performed screening tool in high-risk patients, 7,35 although it is not recommended in national screening programs for women at normal risk.…”

Section: Discussionmentioning

confidence: 99%

“…Breast cancer screening with MRI has already been applied in several studies with high sensitivity and specificity in high-risk and average-risk women. [5][6][7][32][33][34] Meanwhile, breast MRI is an accepted annually performed screening tool in high-risk patients, 7,35 although it is not recommended in national screening programs for women at normal risk. Concerns for implementing breast MRI in normal-risk screening include risk of overdiagnosis, limited availability of scanners and breast experts, need for contrast agent administration, high cost, and long examination duration.…”

Section: Discussionmentioning

confidence: 99%

“…Indications for use include the classifying of breast lesions, planning of treatment, staging of carcinomas, and detecting of metastases or secondary cancers (eg, in the contralateral breast) 1–4 . Moreover, lesion detection in intensified early diagnostics (eg, in the case of hereditary breast cancer due to a gene mutation) is often performed on an annual basis 5–7 …”

mentioning

confidence: 99%

“…[1][2][3][4] Moreover, lesion detection in intensified early diagnostics (eg, in the case of hereditary breast cancer due to a gene mutation) is often performed on an annual basis. [5][6][7] In this context, disadvantages of using MRI as a screening method include the high associated costs as well as the long examination time, with a scanner schedule time slot requirement of up to 30 minutes for a full protocol at our institution. Because of the monetary and practical downsides of conventional MRI protocols, the diagnostic accuracy of abbreviated MRI protocols was examined.…”

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confidence: 99%

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Ultra-High b-Value Diffusion-Weighted Imaging-Based Abbreviated Protocols for Breast Cancer Detection

et al. 2021

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Objectives: Contrast-enhanced (CE) magnetic resonance imaging (MRI) is the most effective imaging modality for breast cancer detection. A contrast agent-free examination technique would be desirable for breast MRI screening. The purpose of this study was to evaluate the capability to detect and characterize suspicious breast lesions with an abbreviated, non-contrast-enhanced MRI protocol featuring ultra-high b-value diffusion-weighted imaging (DWI) compared with CE images. Materials and Methods: The institutional review board-approved prospective study included 127 female subjects with different clinical indications for breast MRI. Magnetic resonance imaging examinations included DWI sequences with b-values of 1500 s/mm 2 (b1500) and 2500 s/mm 2 (b2500), native T1-and T2-weighted images, and CE sequences at 1.5 T and 3 T scanners. Two reading rounds were performed, including either the b1500 or the b2500 DWI in consecutive assessment steps: (A) maximum intensity projections (MIPs) of DWI, (B) DWI and apparent diffusion coefficient maps, (C) as (B) but with additional native T1-and T2-weighted images, and (D) as (C) but with additional CE images (full-length protocol). Two readers independently determined the presence of a suspicious lesion. Histological confirmation was obtained for conspicuous lesions, whereas the full MRI data set was obtained for inconspicuous and clearly benign lesions. Statistical analysis included calculation of diagnostic accuracy and interrater agreement via the intraclass correlation coefficient. Results: The cohort comprised 116 cases with BI-RADS 1 findings and 138 cases with BI-RADS ≥2 findings, including 38 histologically confirmed malignancies. For (A), breasts without pathological findings could be recognized with high diagnostic accuracy (negative predictive value, ≥97.0%; sensitivity, ≥92.1% for both readers), but with a limited specificity (≥58.3%; positive predictive value, ≥28.6%). Within the native readings, approach (C) with b2500 performed best (negative predictive value, 99.5%; sensitivity, 97.4%; specificity, 88.4%). The intraclass correlation coefficient was between 0.683 (MIP b1500) and 0.996 (full protocol). Conclusions: A native abbreviated breast MRI protocol with advanced high b-value DWI might allow nearly equivalent diagnostic accuracy as CE breast MRI and seems to be well suited for lesion detection purposes.

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Screening in patients with increased risk of breast cancer (part 2). Where are we now? Actual MRI screening controversies

Cited by 2 publications

References 78 publications

The value of noncontrast MRI in evaluating breast imaging reporting and data system category 0 lesions on digital mammograms

The value of noncontrast MRI in evaluating breast imaging reporting and data system category 0 lesions on digital mammograms

Ultra-High b-Value Diffusion-Weighted Imaging-Based Abbreviated Protocols for Breast Cancer Detection

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