Breast MRI superior to other supplemental methods for detecting cancer in dense breasts

Breast MRI was the most statistically valid adjunctive screening tool for detecting cancer in dense breast compared with other screening modalities. Radiology found.

Heba Hussain, MD, PhD, From the Joint Division of Medical Imaging and Breast Division, University of Toronto, and colleagues noted that while mammography detects “up to 98% of carcinomas in fatty breasts,” its sensitivity drops from 30% to 48% in dense breasts.

In previous studies, Breast density is a risk factor for breast cancer. 2007 New England Journal of Medicine One study found that women with mammogram densities of 75% or higher had an increased risk of cancer compared to women with mammogram densities of less than 10%.

“Therefore, adjunctive imaging studies have been proposed to overcome the limitations of mammography in this subgroup of patients. Increase the likelihood of detecting tumors Delayed detection is associated with decreased survival, so before symptoms appear.

The most common supplemental screening methods include handheld breast ultrasound (HHBUS), whole breast ultrasound (ABUS), digital breast tomosynthesis (DBT), and breast MRI. Each has benefits and limitations, but researchers say there is a lack of clinical guidance about which method should be used in women with dense breasts and a negative mammogram for cancer.

To ascertain which modality provided the highest level of detection in this population, Hussein and colleagues performed a meta-analysis of 22 studies consisting of 261,233 screens.

Of these patients, 132,166 had dense breasts and negative mammograms. Overall, 541 cancers were missed during mammography but were detected by additional screening.

In a meta-regression analysis, the researchers reported that breast MRI was more effective in increasing cancer detection rate (CDR) per 1,000 screens (CDR = 1.54; 95% CI, 0.74–2.33). bottom.

• HHBUS (CDR = -0.35; 95% CI, -0.77-0.08);
• ABUS (CDR = -0.26; 95% CI, -1.07-0.56); and
• DBTs (CDR = -0.14; 95% CI, -0.58-0.29).

According to the researchers, there were no differences in metrics between the remaining modalities when breast MRI was excluded.

Furthermore, the researchers found that breast MRI detected minimally invasive carcinoma (CDR = 1.31; 95% CI, 0.57-2.06) and ductal carcinoma in situ (CDR = 1.91; 95% CI, 0.1-3.72). have also been found to be superior to This “may have implications for long-term survival, according to previous studies.”

Although there were no statistically significant differences in positive predictive values ​​for modalities, Hussein and colleagues found that “the total number of cases of cancer detected was compared with the number of abnormal findings on screening tests and breast MRI was compared with HHBUS and ABUS.” showed higher values ​​for both results compared to .

“This may represent another important advantage of MRI in this setting. A high false-positive rate increases patient anxiety, prompting additional imaging, follow-up at short intervals, or This is because biopsies increase the cost burden on the healthcare system,” they wrote.

While the researchers acknowledged the superiority of breast MRI compared to their screening counterparts, they also highlighted existing barriers to increased use of MRI. This includes limited availability worldwide due to inadequate scanners and high costs.

“It is too early to raise this issue globally. Performing a supplemental MRI More studies are needed to draw conclusions about the relative efficacy of other modalities, and the efficacy of MRI has not yet been explored in terms of mortality reduction and cost-effectiveness analyses. This is the next logical step to consolidate these preliminary findings,” they concluded.

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