Systematic development of an abbreviated protocol for screening breast magnetic resonance imaging

Abstract

Rationale & objectivesWe sought to develop an abbreviated protocol (AP) for breast MRI that maximizes lesion detection by assessing each lesion not seen on mammography by each acquisition from a full diagnostic protocol (FDP).Materials & methods671 asymptomatic women (mean 55.7 years, range 40–80) with a negative mammogram were prospectively enrolled in this IRB approved study. All lesions on MRI not visualized on mammography were analyzed, reported, and suspicious lesions biopsied. In parallel, all FDP MRI acquisitions were scored by lesion to eventually create a high-yield AP.ResultsFDP breast MRI detected 452 findings not visible on mammography, including 17 suspicious lesions recommended for biopsy of which seven (PPV 41.2%) were malignant in six women. Mean size of the four invasive malignancies was 1.9 cm (range 0.7–4.1), all node negative; three lesions in two women were ductal carcinoma in situ. Nine biopsied lesions were benign, mean size 1.2 cm (range 0.6–2.0). All biopsied lesions were in women with dense breasts (heterogeneously or extremely dense on mammography, n = 367), for a cancer detection rate of 16.3/1000 examinations in this subpopulation. These data were used to identify four high-yield acquisitions: T2, T1-pre-contrast, T11.5, and T16 to create the AP with a scan time of 7.5 min compared to 24 min for the FDP.ConclusionsOur analysis of a FDP MRI in a mammographically negative group identified four high-yield acquisitions that could be used for rapid screening of women for breast cancer that retains critical information on morphology, histopathology, and kinetic activity to facilitate detection of suspicious lesions.Electronic supplementary materialThe online version of this article (doi:10.1007/s10549-017-4112-0) contains supplementary material, which is available to authorized users.

Evaluation of Breast Cancer Morphology Using Diffusion‐Weighted and Dynamic Contrast‐Enhanced MRI: Intermethod and Interobserver Agreement

“…Also, in most of our subjects MRI was performed for the purpose of cancer staging. The respective mean and median tumor size were 3.8 cm and 2.8 cm for the entire study population and 1.4 cm and 1.49 cm for the smaller lesion subgroup, while in previous studies the reported sizes of mammographically occult cancers detected using MRI have been smaller, ∼1 cm . Further research is necessary to determine whether levels of agreement comparable to ours would be observed for tumors detected through a screening program.…”

Abbreviated MRI of the Breast: Does It Provide Value?

“…Given these different abbreviated MRI protocols, efforts have been made to identify the sequences that are necessary for a confident breast cancer diagnosis. Strahle et al used a full diagnostic protocol in 452 lesions to prospectively identify the most important sequences for breast MRI screening . They concluded that T 2 ‐weighted, T 1 ‐weighted precontrast, first and late postcontrast images are necessary and enable a rapid breast cancer screening with a scan time of 7.5 minutes.…”

“…Multiple investigators are evaluating if these rapid MRI exams are cost‐effective enough to provide the initial diagnosis . In breast imaging, one of the goals is to evaluate if an abbreviated breast MRI may be a first‐line exam and compete with other imaging exams such as 2D screening mammograms, digital breast tomosynthesis, and whole breast screening ultrasound exam.…”

“…In efforts to overcome these limitations and facilitate increased access to screening breast MRI, Kuhl et al initially introduced an abbreviated breast MRI protocol for screening that substantially shortened examination and reading times; at the same time, this protocol maintained a diagnostic accuracy equivalent to a full diagnostic protocol . Thereafter, several other studies have investigated different abbreviated and high‐temporal resolution MRI protocols for breast cancer diagnosis and screening, with similar results . This review will provide an overview of the current published literature on abbreviated breast MRI and its potential clinical applications and challenges.…”

Abbreviated MRI Protocols in Breast Cancer Diagnostics

“…Recently, Grimm et al investigated the addition of a second postcontrast image to an abbreviated protocol and did not detect a significant difference in diagnostic accuracy . In accordance, Strahle et al found the same intensities of lesion depiction on their first and second subtraction images . Romeo et al used an abbreviated protocol with subtraction series from three different timepoints but did not evaluate the additional benefit of the later timepoints compared with the FAST protocol…”