Emerging prospective research suggests that supplemental magnetic resonance imaging (MRI) enhances the detection of invasive breast cancer in women with dense breasts.
For the study, researchers examined the use of supplemental breast MRI after negative mammography findings for women with heterogeneously or very dense breasts (American College of Radiology (ACR) breast density categories C and D respectively). The cohort was comprised of the first 200 enrolled patients in the ongoing MA-DETECT-Study, according to preliminary trial findings, published by the European Journal of Radiology.
The researchers noted that eight women had positive findings on breast MRI, including four cases of BI-RADS 5 lesions and three cases involving BI-RADS 4 diagnoses. Subsequent image-guided biopsies confirmed four cases of invasive cancer and one case of ductal carcinoma in situ (DCIS), according to the study authors.
For the preliminary results in this cohort, the study authors found a cancer detection rate (CDR) of 20/1000 and a positive predictive value (PPV) of 50 percent with the use of supplemental MRI.
“Our results are clinically highly relevant as they demonstrate that MRI could alleviate the diagnostic drawbacks of mammography in women with dense breasts (ACR category C & D) not only in the small population with extremely dense breasts (ACR D) but also in the larger proportion of women with heterogeneously dense breasts (ACR C) that constitute up to 40 % of all screening eligible women,” wrote lead study author Clemens Kaiser, M.D., B.A., a senior consultant and head of the Division for Multimodal Breast Diagnostics at the Institute for Clinical Radiology and Nuclear Medicine at University Medical Centre Mannheim in Heidelberg, Germany, and colleagues.
Three Key Takeaways
- Enhanced detection in dense breasts. Supplemental MRI appears to significantly enhance the detection of invasive breast cancer in women with dense breasts, particularly those with heterogeneously dense breasts (ACR category C) and very dense breasts (ACR category D).
- Improved diagnostic performance. Preliminary findings suggest a promising cancer detection rate (CDR) of 20/1000 and a positive predictive value (PPV) of 50 percent with the use of supplemental MRI, indicating its potential to mitigate the diagnostic limitations of mammography in this population.
- Multiparametric MRI importance. The study notes the possible significance of multiparametric MRI (mpMRI) over abbreviated MRI protocols in achieving high diagnostic performance in this patient population. The use of mpMRI may have contributed to lower recall rates and higher PPV in comparison to related studies, suggesting its effectiveness in improving patient throughput and specificity, critical factors in MRI screening.
In comparison to four other studies examining the use of supplemental breast MRI, the researchers noted that preliminary findings for this study have demonstrated the lowest recall rate (.040), which is less than half of that reported for three of the related studies, and the highest PPV.
While two of the previous studies emphasized abbreviated MRI protocols, the researchers suggested that multiparametric MRI (mpMRI) was a significant contributing factor to their initial study results.
“This finding is important as research has shown that simply shortening the measurement time is not enough to significantly improve patient throughput as the non-value added time is critical to obtain an efficient workflow while specificity is one of the critical cost drivers in MR screening,” added Kaiser and colleagues.
(Editor’s note: For related content, see “Five Takeaways from New Breast MRI Literature Review,” “Can AI Automate BPE Assessment of Dense Breasts on MRI?” and “Contrast-Enhanced Mammography and Dense Breasts: What a New Meta-Analysis Reveals.”)
In regard to study limitations, the authors acknowledged they did not assess interval breast cancers. Noting that the initial mammography data for this study were drawn from a national breast cancer batch screening program that emphasizes digital mammography, the researchers said their findings may have limited extrapolation to countries where other modalities such as breast ultrasound are incorporated into the regular screening of women with dense breasts.
