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Amitai Y, Freitas VAR, Golan O, Kessner R, Shalmon T, Neeman R, Mauda-Havakuk M, Mercer D, Sklair-Levy M, Menes TS. The diagnostic performance of ultrafast MRI to differentiate benign from malignant breast lesions: a systematic review and meta-analysis. Eur Radiol 2024; 34:6285-6295. [PMID: 38512492 PMCID: PMC11399157 DOI: 10.1007/s00330-024-10690-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES To assess the diagnostic performance of ultrafast magnetic resonance imaging (UF-DCE MRI) in differentiating benign from malignant breast lesions. MATERIALS AND METHODS A comprehensive search was conducted until September 1, 2023, in Medline, Embase, and Cochrane databases. Clinical studies evaluating the diagnostic performance of UF-DCE MRI in breast lesion stratification were screened and included in the meta-analysis. Pooled summary estimates for sensitivity, specificity, diagnostic odds ratio (DOR), and hierarchic summary operating characteristics (SROC) curves were pooled under the random-effects model. Publication bias and heterogeneity between studies were calculated. RESULTS A final set of 16 studies analyzing 2090 lesions met the inclusion criteria and were incorporated into the meta-analysis. Using UF-DCE MRI kinetic parameters, the pooled sensitivity, specificity, DOR, and area under the curve (AUC) for differentiating benign from malignant breast lesions were 83% (95% CI 79-88%), 77% (95% CI 72-83%), 18.9 (95% CI 13.7-26.2), and 0.876 (95% CI 0.83-0.887), respectively. We found no significant difference in diagnostic accuracy between the two main UF-DCE MRI kinetic parameters, maximum slope (MS) and time to enhancement (TTE). DOR and SROC exhibited low heterogeneity across the included studies. No evidence of publication bias was identified (p = 0.585). CONCLUSIONS UF-DCE MRI as a stand-alone technique has high accuracy in discriminating benign from malignant breast lesions. CLINICAL RELEVANCE STATEMENT UF-DCE MRI has the potential to obtain kinetic information and stratify breast lesions accurately while decreasing scan times, which may offer significant benefit to patients. KEY POINTS • Ultrafast breast MRI is a novel technique which captures kinetic information with very high temporal resolution. • The kinetic parameters of ultrafast breast MRI demonstrate a high level of accuracy in distinguishing between benign and malignant breast lesions. • There is no significant difference in accuracy between maximum slope and time to enhancement kinetic parameters.
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Affiliation(s)
- Yoav Amitai
- Department of Medical Imaging, Tel Aviv University, Sackler School of Medicine, Sourasky Medical Center, Weizmann 6, 6423906, Tel Aviv-Yafo, Israel.
| | - Vivianne A R Freitas
- Joint Department of Medical Imaging - University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, 610 University Avenue - M5G 2M9, Toronto, Ontario, Canada
| | - Orit Golan
- Department of Medical Imaging, Tel Aviv University, Sackler School of Medicine, Sourasky Medical Center, Weizmann 6, 6423906, Tel Aviv-Yafo, Israel
| | - Rivka Kessner
- Department of Medical Imaging, Tel Aviv University, Sackler School of Medicine, Sourasky Medical Center, Weizmann 6, 6423906, Tel Aviv-Yafo, Israel
| | - Tamar Shalmon
- Department of Medical Imaging, Tel Aviv University, Sackler School of Medicine, Sourasky Medical Center, Weizmann 6, 6423906, Tel Aviv-Yafo, Israel
| | - Rina Neeman
- Department of Medical Imaging, Tel Aviv University, Sackler School of Medicine, Sourasky Medical Center, Weizmann 6, 6423906, Tel Aviv-Yafo, Israel
| | - Michal Mauda-Havakuk
- Department of Medical Imaging, Tel Aviv University, Sackler School of Medicine, Sourasky Medical Center, Weizmann 6, 6423906, Tel Aviv-Yafo, Israel
| | - Diego Mercer
- Department of Medical Imaging, Tel Aviv University, Sackler School of Medicine, Sourasky Medical Center, Weizmann 6, 6423906, Tel Aviv-Yafo, Israel
| | - Miri Sklair-Levy
- Department of Medical Imaging, Sackler School of Medicine, Chaim Sheba Medical Center, Tel Aviv University, Tel Hashomer, Derech Shiba 2, 52621, Ramat-Gan, Israel
| | - Tehillah S Menes
- Department of Surgery, Sackler School of Medicine, Chaim Sheba Medical Center, Tel Aviv University, Tel Hashomer, Derech Shiba 2, 52621, Ramat-Gan, Israel
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Ramli Hamid MT, Ab Mumin N, Abdul Hamid S, Ahmad Saman MS, Rahmat K. Abbreviated breast magnetic resonance imaging (MRI) or digital breast tomosynthesis for breast cancer detection in dense breasts? A retrospective preliminary study with comparable results. Clin Radiol 2024; 79:e524-e531. [PMID: 38267349 DOI: 10.1016/j.crad.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/08/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024]
Abstract
AIM To compare the diagnostic performance of abbreviated breast magnetic resonance (AB-MR) imaging (MRI) and digital breast tomosynthesis (DBT) for breast cancer detection in Malaysian women with dense breasts, using histopathology as the reference standard. MATERIALS AND METHODS This was a single-centre cross-sectional study of 115 women with American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BIRADS) breast density C and D on DBT with breast lesions who underwent AB-MR from June 2018 to December 2021. AB-MR was performed on a 3 T MRI system with an imaging protocol consisting of three sequences: axial T1 fat-saturated unenhanced; axial first contrast-enhanced; and subtracted first contrast-enhanced with maximum intensity projection (MIP). DBT and AB-MR images were evaluated by two radiologists blinded to the histopathology and patient outcomes. Diagnostic accuracy (sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV]) was assessed. RESULT Of the 115 women, the mean age was 50.6 years. There were 48 (41.7%) Malay, 54 (47%) Chinese, and 12 (10.4%) Indian women. The majority (n=87, 75.7%) were from the diagnostic population. Sixty-one (53.1%) were premenopausal and 54 (46.9%) postmenopausal. Seventy-eight (72.4%) had an increased risk of developing breast cancer. Ninety-one (79.1%) women had density C and 24 (20.9%) had density D. There were 164 histopathology-proven lesions; 69 (42.1%) were malignant and 95 (57.9%) were benign. There were 62.8% (n=103/164) lesions detected at DBT. All the malignant lesions 100% (n=69) and 35.7% (n=34) of benign lesions were detected. Of the 61 lesions that were not detected, 46 (75.4%) were in density C, and 15 (24.6%) were in density D. The sensitivity, specificity, PPV, and NPV for DBT were 98.5%, 34.6%, 66.3%, and 94.7%, respectively. There were 65.2% (n=107/164) lesions detected on AB-MR, with 98.6% (n=68) malignant and 41.1% (39) benign lesions detected. The sensitivity, specificity, PPV, and NPV for AB-MR were 98.5%, 43.9%, 67.2%, and 96.2%, respectively. One malignant lesion (0.6%), which was a low-grade ductal carcinoma in-situ (DCIS), was missed on AB-MR. CONCLUSION The present findings suggest that both DBT and AB-MR have comparable effectiveness as an imaging method for detecting breast cancer and have high NPV for low-risk lesions in women with dense breasts.
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Affiliation(s)
- M T Ramli Hamid
- Department of Radiology, Faculty of Medicine University Teknologi MARA, Sungai Buloh, Selangor, Malaysia.
| | - N Ab Mumin
- Department of Radiology, Faculty of Medicine University Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - S Abdul Hamid
- Department of Radiology, Faculty of Medicine University Teknologi MARA, Sungai Buloh, Selangor, Malaysia.
| | - M S Ahmad Saman
- Department of Public Health, Faculty of Medicine, University Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - K Rahmat
- Department of Biomedical Imaging, University Malaya Research Imaging Centre, Kuala Lumpur, Malaysia
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Kuhl CK. Abbreviated Breast MRI: State of the Art. Radiology 2024; 310:e221822. [PMID: 38530181 DOI: 10.1148/radiol.221822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Abbreviated MRI is an umbrella term, defined as a focused MRI examination tailored to answer a single specific clinical question. For abbreviated breast MRI, this question is: "Is there evidence of breast cancer?" Abbreviated MRI of the breast makes maximum use of the fact that the kinetics of breast cancers and of benign tissue differ most in the very early postcontrast phase; therefore, abbreviated breast MRI focuses on this period. The different published approaches to abbreviated MRI include the following three subtypes: (a) short protocols, consisting of a precontrast and either a single postcontrast acquisition (first postcontrast subtracted [FAST]) or a time-resolved series of postcontrast acquisitions with lower spatial resolution (ultrafast [UF]), obtained during the early postcontrast phase immediately after contrast agent injection; (b) abridged protocols, consisting of FAST or UF acquisitions plus selected additional pulse sequences; and (c) noncontrast protocols, where diffusion-weighted imaging replaces the contrast information. Abbreviated MRI was proposed to increase tolerability of and access to breast MRI as a screening tool. But its widening application now includes follow-up after breast cancer and even diagnostic assessment. This review defines the three subtypes of abbreviated MRI, highlighting the differences between the protocols and their clinical implications and summarizing the respective evidence on diagnostic accuracy and clinical utility.
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Affiliation(s)
- Christiane K Kuhl
- From the Department of Diagnostic and Interventional Radiology, University Hospital Aachen, RWTH Pauwelsstr 30, 52074 Aachen, Germany
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Grimm LJ, Conant EF, Dialani VM, Dontchos BN, Harvey JA, Kacharia VS, Plecha DM, Mango VL. Abbreviated Breast MRI Utilization: A Survey of the Society of Breast Imaging. JOURNAL OF BREAST IMAGING 2022; 4:506-512. [PMID: 38416950 DOI: 10.1093/jbi/wbac048] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To survey Society of Breast Imaging (SBI) membership on their use of abbreviated breast MRI to understand variability in practice patterns. METHODS A survey was developed by the SBI Patient Care and Delivery committee for distribution to SBI membership in July and August 2021. Eighteen questions queried practice demographics and then abbreviated breast MRI practices regarding initial adoption, scheduling and finances, MRI protocols, and interpretations. Comparisons between responses were made by practice demographics. RESULTS There were 321 respondents (response rate: 15.3%), of whom 25% (81/321) currently offer and 26% (84/321) plan to offer abbreviated breast MRI. Practices in the South (37/107, 35%) and Midwest (22/70, 31%) were more likely to offer abbreviated MRI (P = 0.005). Practices adopted many strategies to raise awareness, most directed at referring providers. The mean charge to patients was $414, and only 6% of practices offer financial support. The median time slot for studies is 20 minutes, with only 15% of practices using block scheduling of consecutive breast MRIs. Regarding MRI protocols, 64% (37/58) of respondents included only a single first-pass post-contrast sequence, and 90% (52/58) included T2-weighted sequences. Patient eligibility was highly varied, and a majority of respondents (37/58, 64%) do not provide any recommendations for screening intervals in non-high-risk women. CONCLUSION Abbreviated breast MRI utilization is growing rapidly, and practices are applying a variety of strategies to facilitate adoption. Although there is notable variability in patient eligibility, follow-up intervals, and costs, there is some agreement regarding abbreviated breast MRI protocols.
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Affiliation(s)
- Lars J Grimm
- Duke University Medical Center, Department of Radiology, Durham, NC, USA
| | - Emily F Conant
- University of Pennsylvania, Department of Radiology, Philadelphia, PA, USA
| | - Vandana M Dialani
- Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA, USA
| | - Brian N Dontchos
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
| | - Jennifer A Harvey
- University of Rochester Medical Center, Department of Imaging Sciences, Rochester, NY, USA
| | | | - Donna M Plecha
- Case Western Reserve University, Department of Radiology, Cleveland, OH, USA
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Stelzer P, Clauser P, Vatteroni G, Kapetas P, Helbich T, Baltzer P. How much can abbreviated protocols for breast MRI increase patient throughput? A multi-centric evaluation. Eur J Radiol 2022; 154:110436. [DOI: 10.1016/j.ejrad.2022.110436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/23/2022] [Accepted: 07/04/2022] [Indexed: 11/03/2022]
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Implementation of Abbreviated Breast MRI for Screening: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2021; 218:202-212. [PMID: 34378397 DOI: 10.2214/ajr.21.26349] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Abbreviated breast MRI (AB-MRI) is being rapidly adopted to harness the high sensitivity of screening MRI while addressing issues related to access, cost, and workflow. The successful implementation of an ABI-MRI program requires collaboration across administrative, operational, financial, technical, and clinical providers. Institutions must be thoughtful in defining AB-MRI patient eligibility and providing recommendations for screening intervals, as existing practices are heterogeneous. Similarly, there is no universally accepted AB-MRI protocol, though guiding principles should harmonize abbreviated and full protocols while being mindful of scan duration and table time. The interpretation of AB-MRI will be a new experience for many radiologists and may require a phased rollout as well as a careful audit of performance metrics over time to ensure benchmark metrics are achieved. AB-MRI finances, which are driven by patient self-payment, will require buy-in from hospital administration with the recognition that downstream revenues will be needed to support initial costs. Finally, successful startup of an AB-MRI program requires active engagement with the larger community of patients and referring providers. As AB-MRI becomes more widely accepted and available, best practices and community standards will continue to evolve to ensure high quality patient care.
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Abstract
Breast MR imaging is the most sensitive imaging method for the detection of breast cancer and detects more aggressive malignancies than mammography and ultrasound examination. Despite these advantages, breast MR imaging has low use rates for breast cancer screening. Abbreviated breast MR imaging, in which a limited number of breast imaging sequences are obtained, has been proposed as a way to solve cost and patient tolerance issues while preserving the high cancer detection rate of breast MR imaging. This review discusses abbreviated breast MR imaging, including protocols, multicenter clinical trial results, clinical workflow implementation challenges, and future directions.
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Affiliation(s)
- Laura Heacock
- Department of Radiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA.
| | - Alana A Lewin
- Department of Radiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Hildegard K Toth
- Department of Radiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Linda Moy
- Department of Radiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Beatriu Reig
- Department of Radiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA
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Hernández ML, Osorio S, Florez K, Ospino A, Díaz GM. Abbreviated magnetic resonance imaging in breast cancer: A systematic review of literature. Eur J Radiol Open 2020; 8:100307. [PMID: 33364260 PMCID: PMC7750142 DOI: 10.1016/j.ejro.2020.100307] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND : magnetic resonance imaging (MRI) has been increasingly used to study breast cancer for screening high-risk cases, pre-operative staging, and problem-solving because of its high sensitivity. However, its cost-effectiveness is still debated. Thus, the concept of abbreviated MRI (ABB-MRI) protocols was proposed as a possible solution for reducing MRI costs. PURPOSE : to investigate the role of the abbreviated MRI protocols in detecting and staging breast cancer. METHODS : a systematic search of the literature was carried out in the bibliographic databases: Scopus, PubMed, Medline, and Science Direct. RESULTS : forty-one articles were included, which described results of the assessment of fifty-three abbreviated protocols for screening, staging, recurrence assessing, and problem-solving or clarification. CONCLUSIONS : the use of ABB-MRI protocols allows reducing the acquisition and reading times, maintaining a high concordance with the final interpretation, in comparison to a complete protocol. However, larger prospective and multicentre trials are necessary to validate the performance in specific clinical environments.
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Affiliation(s)
- María Liliana Hernández
- Grupo de Investigación del Instituto de Alta Tecnología Médica (IATM), Ayudas Diagnósticas Sura, Medellín, Colombia
| | - Santiago Osorio
- Grupo de Investigación del Instituto de Alta Tecnología Médica (IATM), Ayudas Diagnósticas Sura, Medellín, Colombia
- Especialización en Radiología, Universidad CES, Medellín, Colombia
| | - Katherine Florez
- Grupo de Investigación del Instituto de Alta Tecnología Médica (IATM), Ayudas Diagnósticas Sura, Medellín, Colombia
- Especialización en Radiología, Universidad CES, Medellín, Colombia
| | - Alejandra Ospino
- Grupo de Investigación del Instituto de Alta Tecnología Médica (IATM), Ayudas Diagnósticas Sura, Medellín, Colombia
| | - Gloria M. Díaz
- MIRP Lab–Parque i, Instituto Tecnológico Metropolitano (ITM), Medellín, Colombia
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Gao Y, Heller SL. Abbreviated and Ultrafast Breast MRI in Clinical Practice. Radiographics 2020; 40:1507-1527. [DOI: 10.1148/rg.2020200006] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Yiming Gao
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Samantha L. Heller
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
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Abstract
Screening for breast cancer reduces breast cancer-related mortality and earlier detection facilitates less aggressive treatment. Unfortunately, current screening modalities are imperfect, suffering from limited sensitivity and high false-positive rates. Novel techniques in the field of breast imaging may soon play a role in breast cancer screening: digital breast tomosynthesis, contrast material-enhanced spectral mammography, US (automated three-dimensional breast US, transmission tomography, elastography, optoacoustic imaging), MRI (abbreviated and ultrafast, diffusion-weighted imaging), and molecular breast imaging. Artificial intelligence and radiomics have the potential to further improve screening strategies. Furthermore, nonimaging-based screening tests such as liquid biopsy and breathing tests may transform the screening landscape. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Ritse M Mann
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (R.H.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Department of Radiology, New York University Langone School of Medicine, New York, NY (L.M.); and Department of Radiology, New York University Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.)
| | - Regina Hooley
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (R.H.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Department of Radiology, New York University Langone School of Medicine, New York, NY (L.M.); and Department of Radiology, New York University Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.)
| | - Richard G Barr
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (R.H.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Department of Radiology, New York University Langone School of Medicine, New York, NY (L.M.); and Department of Radiology, New York University Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.)
| | - Linda Moy
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (R.H.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Department of Radiology, New York University Langone School of Medicine, New York, NY (L.M.); and Department of Radiology, New York University Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.)
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Plaza MJ, Perea E, Sanchez-Gonzalez MA. Abbreviated Screening Breast MRI in Women at Higher-than-Average Risk for Breast Cancer with Prior Normal Full Protocol MRI. JOURNAL OF BREAST IMAGING 2020; 2:343-351. [PMID: 38424958 DOI: 10.1093/jbi/wbaa032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To compare the performance of abbreviated screening breast MRI (ABMR) versus full protocol MRI (FPMR) in women at higher-than-average risk for breast cancer with a prior normal FPMR. METHODS ABMR was performed on higher-than-average-risk women who had a prior normal FPMR. ABMR protocol consisted of short inversion time inversion recovery imaging, precontrast, and two early postcontrast sequences acquired in under 10 minutes. Retrospective review of ABMR examinations performed from July 2016 to July 2018 was compared with a control group who underwent routine screening with FPMR who had a prior normal FPMR performed from July 2014 to June 2016. Screening outcome metrics were calculated and compared, adjusting for differences in patient demographics. RESULTS The study cohort included 481 ABMR examinations, while the control group included 440 FPMR studies. There was no significant difference in the abnormal interpretation rate (AIR) or cancer detection rate (CDR) for the ABMR versus the FPMR group (AIR 6.0% vs 6.8% respectively, odds ratio (OR) 0.91, 95% confidence interval (CI): 0.53-1.5, P = 0.73; CDR 8.3 vs 11 cancers detected per 1000 examinations respectively, OR 0.73, 95% CI: 0.20-2.7, P = 0.64). The PPV2 and PPV3 for the ABMR group was 19% and 21% versus 16% and 16% for the FPMR group, with no statistical difference. Sensitivity was 100% in each group with no interval cancers. There was no difference in specificity between the ABMR and FPMR groups, 93% versus 94%, respectively (P = 0.73). CONCLUSION ABMR may be used to screen higher-than-average-risk women with a prior normal FPMR as outcome metrics are equivalent to FPMR.
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Affiliation(s)
| | - Elizabeth Perea
- Ponce Health Sciences University School of Medicine, Department of Graduate Medical Education, MD Program, Ponce, Puerto Rico
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Heacock L, Reig B, Lewin AA, Toth HK, Moy L, Lee CS. Abbreviated Breast MRI: Road to Clinical Implementation. JOURNAL OF BREAST IMAGING 2020; 2:201-214. [PMID: 38424988 DOI: 10.1093/jbi/wbaa020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Indexed: 03/02/2024]
Abstract
Breast MRI offers high sensitivity for breast cancer detection, with preferential detection of high-grade invasive cancers when compared to mammography and ultrasound. Despite the clear benefits of breast MRI in cancer screening, its cost, patient tolerance, and low utilization remain key issues. Abbreviated breast MRI, in which only a select number of sequences and postcontrast imaging are acquired, exploits the high sensitivity of breast MRI while reducing table time and reading time to maximize availability, patient tolerance, and accessibility. Worldwide studies of varying patient populations have demonstrated that the comparable diagnostic accuracy of abbreviated breast MRI is comparable to a full diagnostic protocol, highlighting the emerging role of abbreviated MRI screening in patients with an intermediate and high lifetime risk of breast cancer. The purpose of this review is to summarize the background and current literature relating to abbreviated MRI, highlight various protocols utilized in current multicenter clinical trials, describe workflow and clinical implementation issues, and discuss the future of abbreviated protocols, including advanced MRI techniques.
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Affiliation(s)
- Laura Heacock
- New York University Langone Health, Department of Radiology, New York, NY
| | - Beatriu Reig
- New York University Langone Health, Department of Radiology, New York, NY
| | - Alana A Lewin
- New York University Langone Health, Department of Radiology, New York, NY
| | - Hildegard K Toth
- New York University Langone Health, Department of Radiology, New York, NY
| | - Linda Moy
- New York University Langone Health, Department of Radiology, New York, NY
- New York University Langone, Center for Advanced Imaging Innovation and Research (CAI2R), New York, NY
| | - Cindy S Lee
- New York University Langone Health, Department of Radiology, New York, NY
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Time-Driven Activity-Based Costing in Radiology: An Overview. J Am Coll Radiol 2020; 17:125-130. [DOI: 10.1016/j.jacr.2019.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/11/2019] [Indexed: 11/22/2022]
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