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Niell BL, Jochelson MS, Amir T, Brown A, Adamson M, Baron P, Bennett DL, Chetlen A, Dayaratna S, Freer PE, Ivansco LK, Klein KA, Malak SF, Mehta TS, Moy L, Neal CH, Newell MS, Richman IB, Schonberg M, Small W, Ulaner GA, Slanetz PJ. ACR Appropriateness Criteria® Female Breast Cancer Screening: 2023 Update. J Am Coll Radiol 2024; 21:S126-S143. [PMID: 38823941 DOI: 10.1016/j.jacr.2024.02.019] [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: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Early detection of breast cancer from regular screening substantially reduces breast cancer mortality and morbidity. Multiple different imaging modalities may be used to screen for breast cancer. Screening recommendations differ based on an individual's risk of developing breast cancer. Numerous factors contribute to breast cancer risk, which is frequently divided into three major categories: average, intermediate, and high risk. For patients assigned female at birth with native breast tissue, mammography and digital breast tomosynthesis are the recommended method for breast cancer screening in all risk categories. In addition to the recommendation of mammography and digital breast tomosynthesis in high-risk patients, screening with breast MRI is recommended. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Bethany L Niell
- Panel Chair, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
| | | | - Tali Amir
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ann Brown
- Panel Vice Chair, University of Cincinnati, Cincinnati, Ohio
| | - Megan Adamson
- Clinica Family Health, Lafayette, Colorado; American Academy of Family Physicians
| | - Paul Baron
- Lenox Hill Hospital, Northwell Health, New York, New York; American College of Surgeons
| | | | - Alison Chetlen
- Penn State Health Hershey Medical Center, Hershey, Pennsylvania
| | - Sandra Dayaratna
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; American College of Obstetricians and Gynecologists
| | | | | | | | | | - Tejas S Mehta
- UMass Memorial Medical Center/UMass Chan Medical School, Worcester, Massachusetts
| | - Linda Moy
- NYU Clinical Cancer Center, New York, New York
| | | | - Mary S Newell
- Emory University Hospital, Atlanta, Georgia; RADS Committee
| | - Ilana B Richman
- Yale School of Medicine, New Haven, Connecticut; Society of General Internal Medicine
| | - Mara Schonberg
- Harvard Medical School, Boston, Massachusetts; American Geriatrics Society
| | - William Small
- Loyola University Chicago, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, Illinois; Commission on Radiation Oncology
| | - Gary A Ulaner
- Hoag Family Cancer Institute, Newport Beach, California; University of Southern California, Los Angeles, California; Commission on Nuclear Medicine and Molecular Imaging
| | - Priscilla J Slanetz
- Specialty Chair, Boston University School of Medicine, Boston, Massachusetts
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2
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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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3
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Ahmadinejad N, Azhdeh S, Arian A, Eslami B, Mehrabinejad MM. Implementation of abbreviated breast MRI in diagnostic and screening settings. Acta Radiol 2023; 64:987-992. [PMID: 35938611 DOI: 10.1177/02841851221114434] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Abbreviated magnetic resonance imaging (MRI) includes fewer sequences than standard MRI, which could be utilized for breast cancer detection. PURPOSE To evaluate the diagnostic accuracy of abbreviated MRI protocol in screening and diagnostic settings. MATERIAL AND METHODS All women with screening and diagnostic (problem-solving and preoperative staging) MRI examination were recruited from 2017 to 2020. Two expert radiologists assessed designed abbreviated protocol (fat-saturated T1-weighted [T1W] pre-contrast and two first fat-saturated T1W post-contrast series with reconstruction of their subtraction) including maximum intensity projection (MIP) and then evaluated standard protocol of breast MRI. Associated findings, including axillary lymphadenopathy and invasion to nipple, skin, or pectoralis muscle were also evaluated. The concordance rate of abbreviated with standard protocol in screening and diagnostic settings were also compared, based on BI-RADS classification. Diagnostic accuracy, sensitivity, specificity, and positive and negative predictive value were calculated. RESULTS A total of 108 (26.5%) of 408 patients (mean age = 43 ± 9 years) were classified as BI-RADS 4-5 and considered positive findings based on suspicious enhancement (mass or non-mass enhancement). Compared to standard protocol, abbreviated protocol revealed >98% accuracy in the diagnostic setting as well as 100% accuracy in the screening setting. Concordance rates in screening and diagnostic settings were 99.6% and 98.1%, respectively. There was no discordance between abbreviated and standard protocol in the evaluation of associated findings. CONCLUSION Abbreviated MRI protocol possesses substantial diagnostic accuracy in both screening and diagnostic settings. Additional information provided by standard protocol might not require for cancer detection.
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Affiliation(s)
- Nasrin Ahmadinejad
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Shilan Azhdeh
- Department of Radiology, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Arvin Arian
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, 48439Tehran University of Medical Sciences, Tehran, Iran
- Breast Disease Research Center, Cancer Institute, Tehran University of Medical Science, Tehran, Iran
| | - Bita Eslami
- Breast Disease Research Center, Cancer Institute, Tehran University of Medical Science, Tehran, Iran
| | - Mohammad-Mehdi Mehrabinejad
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, 48439Tehran University of Medical Sciences, Tehran, Iran
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4
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Jones LI, Marshall A, Elangovan P, Geach R, McKeown-Keegan S, Vinnicombe S, Harding SA, Taylor-Phillips S, Halling-Brown M, Foy C, O’Flynn E, Ghiasvand H, Hulme C, Dunn JA. Evaluating the effectiveness of abbreviated breast MRI (abMRI) interpretation training for mammogram readers: a multi-centre study assessing diagnostic performance, using an enriched dataset. Breast Cancer Res 2022; 24:55. [PMID: 35907862 PMCID: PMC9338668 DOI: 10.1186/s13058-022-01549-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Abbreviated breast MRI (abMRI) is being introduced in breast screening trials and clinical practice, particularly for women with dense breasts. Upscaling abMRI provision requires the workforce of mammogram readers to learn to effectively interpret abMRI. The purpose of this study was to examine the diagnostic accuracy of mammogram readers to interpret abMRI after a single day of standardised small-group training and to compare diagnostic performance of mammogram readers experienced in full-protocol breast MRI (fpMRI) interpretation (Group 1) with that of those without fpMRI interpretation experience (Group 2). METHODS Mammogram readers were recruited from six NHS Breast Screening Programme sites. Small-group hands-on workstation training was provided, with subsequent prospective, independent, blinded interpretation of an enriched dataset with known outcome. A simplified form of abMRI (first post-contrast subtracted images (FAST MRI), displayed as maximum-intensity projection (MIP) and subtracted slice stack) was used. Per-breast and per-lesion diagnostic accuracy analysis was undertaken, with comparison across groups, and double-reading simulation of a consecutive screening subset. RESULTS 37 readers (Group 1: 17, Group 2: 20) completed the reading task of 125 scans (250 breasts) (total = 9250 reads). Overall sensitivity was 86% (95% confidence interval (CI) 84-87%; 1776/2072) and specificity 86% (95%CI 85-86%; 6140/7178). Group 1 showed significantly higher sensitivity (843/952; 89%; 95%CI 86-91%) and higher specificity (2957/3298; 90%; 95%CI 89-91%) than Group 2 (sensitivity = 83%; 95%CI 81-85% (933/1120) p < 0.0001; specificity = 82%; 95%CI 81-83% (3183/3880) p < 0.0001). Inter-reader agreement was higher for Group 1 (kappa = 0.73; 95%CI 0.68-0.79) than for Group 2 (kappa = 0.51; 95%CI 0.45-0.56). Specificity improved for Group 2, from the first 55 cases (81%) to the remaining 70 (83%) (p = 0.02) but not for Group 1 (90-89% p = 0.44), whereas sensitivity remained consistent for both Group 1 (88-89%) and Group 2 (83-84%). CONCLUSIONS Single-day abMRI interpretation training for mammogram readers achieved an overall diagnostic performance within benchmarks published for fpMRI but was insufficient for diagnostic accuracy of mammogram readers new to breast MRI to match that of experienced fpMRI readers. Novice MRI reader performance improved during the reading task, suggesting that additional training could further narrow this performance gap.
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Affiliation(s)
- Lyn I. Jones
- North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB UK
| | - Andrea Marshall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL UK
| | - Premkumar Elangovan
- Scientific Computing, Royal Surrey County Hospital NHS Foundation Trust, Guildford, GU2 7XX UK
| | - Rebecca Geach
- North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB UK
| | - Sadie McKeown-Keegan
- North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB UK
| | - Sarah Vinnicombe
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, GL53 7AS UK
| | - Sam A. Harding
- North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB UK
| | | | - Mark Halling-Brown
- Scientific Computing, Royal Surrey County Hospital NHS Foundation Trust, Guildford, GU2 7XX UK
| | - Christopher Foy
- Research Design Service South West Gloucester Office, National Institute for Health Research (NIHR) Leadon House, Gloucestershire Royal Hospital, Gloucester, GL1 3NN UK
| | - Elizabeth O’Flynn
- St George’s University Hospitals Foundation Trust, London, SW17 0QT UK
| | - Hesam Ghiasvand
- Institute of Health Research, University of Exeter Medical School, Exeter, EX1 2LU UK
| | - Claire Hulme
- Institute of Health Research, University of Exeter Medical School, Exeter, EX1 2LU UK
| | - Janet A. Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL UK
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5
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Jugniot N, Massoud TF, Dahl JJ, Paulmurugan R. Biomimetic nanobubbles for triple-negative breast cancer targeted ultrasound molecular imaging. J Nanobiotechnology 2022; 20:267. [PMID: 35689262 PMCID: PMC9185914 DOI: 10.1186/s12951-022-01484-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/25/2022] [Indexed: 01/04/2023] Open
Abstract
Triple-negative breast cancer (TNBC) is a highly heterogeneous breast cancer subtype with poor prognosis. Although anatomical imaging figures prominently for breast lesion screening, TNBC is often misdiagnosed, thus hindering early medical care. Ultrasound (US) molecular imaging using nanobubbles (NBs) capable of targeting tumor cells holds great promise for improved diagnosis and therapy. However, the lack of conventional biomarkers in TNBC impairs the development of current targeted agents. Here, we exploited the homotypic recognition of cancer cells to synthesize the first NBs based on TNBC cancer cell membrane (i.e., NBCCM) as a targeted diagnostic agent. We developed a microfluidic technology to synthesize NBCCM based on the self-assembly property of cell membranes in aqueous solutions. In vitro, optimal NBCCM had a hydrodynamic diameter of 683 ± 162 nm, showed long-lasting US contrast enhancements and homotypic affinity. In vivo, we demonstrated that NBCCM showed increased extravasation and retention in a TNBC mouse model compared to non-targeted NBs by US molecular imaging. Peak intensities and areas under the curves from time-intensity plots showed a significantly enhanced signal from NBCCM compared to non-targeted NBs (2.1-fold, P = 0.004, and, 3.6-fold, P = 0.0009, respectively). Immunofluorescence analysis further validated the presence of NBCCM in the tumor microenvironment. Circumventing the challenge for universal cancer biomarker identification, our approach could enable TNBC targeting regardless of tumor tissue heterogeneity, thus improving diagnosis and potentially gene/drug targeted delivery. Ultimately, our approach could be used to image many cancer types using biomimetic NBs prepared from their respective cancer cell membranes.
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Affiliation(s)
- Natacha Jugniot
- Molecular Imaging Program at Stanford (MIPS), and Bio-X Program, Department of Radiology, School of Medicine, Stanford University, Stanford, CA, 94305-5427, USA.,Canary Center at Stanford for Cancer Early Detection, Department of Radiology, School of Medicine, Stanford University, Stanford, CA, 94305-5427, USA
| | - Tarik F Massoud
- Molecular Imaging Program at Stanford (MIPS), and Bio-X Program, Department of Radiology, School of Medicine, Stanford University, Stanford, CA, 94305-5427, USA
| | - Jeremy J Dahl
- Canary Center at Stanford for Cancer Early Detection, Department of Radiology, School of Medicine, Stanford University, Stanford, CA, 94305-5427, USA
| | - Ramasamy Paulmurugan
- Molecular Imaging Program at Stanford (MIPS), and Bio-X Program, Department of Radiology, School of Medicine, Stanford University, Stanford, CA, 94305-5427, USA. .,Canary Center at Stanford for Cancer Early Detection, Department of Radiology, School of Medicine, Stanford University, Stanford, CA, 94305-5427, USA. .,Molecular Imaging Program at Stanford (MIPS), Canary Center for Cancer Early Detection at Stanford, Stanford University School of Medicine, 3155 Porter Drive, Palo Alto, CA, 94304, USA.
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6
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Naranjo ID, Sogani J, Saccarelli C, Horvat JV, Sevilimedu V, Hughes MC, Gullo RL, Jochelson MS, Reiner J, Pinker K. MRI Screening of BRCA Mutation Carriers: Comparison of Standard Protocol and Abbreviated Protocols With and Without T2-Weighted Images. AJR Am J Roentgenol 2022; 218:810-820. [PMID: 34935399 PMCID: PMC9422039 DOI: 10.2214/ajr.21.27022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND. Increasing evidence supports the role of abbreviated MRI protocols for breast cancer detection. However, abbreviated protocols have been poorly studied in patients who are BRCA1 or BRCA2 mutation carriers. Furthermore, the need for T2-weighted sequences in abbreviated protocols remains controversial. OBJECTIVE. The purpose of this study was to compare, in the evaluation of patients with BRCA mutations, the diagnostic performance of a standard full breast MRI protocol with the performance of abbreviated protocols that included and did not include a T2-weighted sequence. METHODS. This retrospective study included 292 patients (mean age, 47.9 years) who were BRCA1 or BRCA2 mutation carriers who underwent 427 screening breast MRI examinations according to a standard full protocol who could be classified as having benign (n = 407) or malignant (n = 20) findings based on histopathology or imaging follow-up. Four readers independently assessed examinations in three separate sessions (theoretic abbreviated protocol, which included the first postcontrast acquisition; theoretic abbreviated protocol with addition of a T2-weighted sequence; and the standard full protocol) and assigned BI-RADS categories. Categories 3-5 were considered to represent positive examinations. Interreader agreement was assessed, and diagnostic performance was compared by use of pooled reader data. RESULTS. Interreader agreement on BI-RADS category, expressed as kappa values, was 0.55 for the standard, 0.45 for the abbreviated, and 0.57 for the abbreviated plus T2-weighted protocols. Pooled sensitivity was 94% for the standard, 92% for the abbreviated, and 90% for the abbreviated plus T2-weighted protocols (all p > .001). Pooled specificity was 80% for the standard, 71% for the abbreviated, and 83% for the abbreviated plus T2-weighted protocols (p < .001 for abbreviated plus T2-weighted compared with both standard and abbreviated). Pooled PPV was 19% for the standard, 14% for the abbreviated, and 20% for the abbreviated plus T2-weighted protocols (p < .001 for abbreviated compared with both standard and abbreviated). Pooled NPV was 100% for the standard, 99% for the abbreviated, and 99% for the abbreviated plus T2-weighted (all p > .001) protocols. Pooled accuracy was 80% for the standard, 73% for the abbreviated, and 83% for the abbreviated plus T2-weighted protocols (p < .001 for abbreviated compared with both standard and abbreviated plus T2-weighted). CONCLUSION. The abbreviated protocol without T2-weighted imaging had suboptimal performance. However, addition of the T2-weighted sequence yielded comparable sensitivity and accuracy and a small increase in specificity compared with the full protocol. CLINICAL IMPACT. The findings support implementation of abbreviated MRI with T2-weighted imaging for breast cancer screening of patients with BRCA mutations.
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Affiliation(s)
- Isaac Daimiel Naranjo
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY 10065
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Julie Sogani
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY 10065
| | - Carolina Saccarelli
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY 10065
| | - Joao V Horvat
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY 10065
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mary C Hughes
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY 10065
| | - Roberto Lo Gullo
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY 10065
| | - Maxine S Jochelson
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY 10065
| | - Jeffrey Reiner
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY 10065
| | - Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY 10065
- Department of Biomedical Imaging and Image-Guided Therapy, Molecular and Structural Preclinical Imaging, Medical University Vienna, Vienna, Austria
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7
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Liu Z, Liang K, Zhang L, Lai C, Li R, Yi L, Li R, Zhang L, Long W. Small lesion classification on abbreviated breast MRI: training can improve diagnostic performance and inter-reader agreement. Eur Radiol 2022; 32:5742-5751. [PMID: 35212772 DOI: 10.1007/s00330-022-08622-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/25/2021] [Accepted: 01/29/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine whether the diagnostic performance and inter-reader agreement for small lesion classification on abbreviated breast MRI (AB-MRI) can be improved by training, and can achieve the level of full diagnostic protocol MRI (FDP-MRI). METHODS This retrospective study enrolled 1165 breast lesions (≤ 2 cm; 409 malignant and 756 benign) from 1165 MRI examinations for reading test. Twelve radiologists were assigned into a trained group and a non-trained group. They interpreted each AB-MRI twice, which was extracted from FDP-MRI. After the first read, the trained group received a structured training for AB-MRI interpretation while the non-trained group did not. FDP-MRIs were interpreted by the trained group after the second read. BI-RADS category for each lesion was compared to the standard of reference (histopathological examination or follow-up) to calculate diagnostic accuracy. Inter-reader agreement was assessed using multirater k analysis. Diagnostic accuracy and inter-reader agreement were compared between the trained and non-trained groups, between the first and second reads, and between AB-MRI and FDP-MRI. RESULTS After training, the diagnostic accuracy of AB-MRI increased from 77.6 to 84.4%, and inter-reader agreement improved from 0.410 to 0.579 (both p < 0.001), which were higher than those of the non-trained group (accuracy, 84.4% vs 78.0%; weighted k, 0.579 vs 0.461; both p < 0.001). The post-training accuracy and inter-reader agreement of AB-MRI were lower than those of FDP-MRI (accuracy, 84.4% vs 92.8%; weighted k, 0.579 vs 0.602; both p < 0.001). CONCLUSIONS Training can improve the diagnostic performance and inter-reader agreement for small lesion classification on AB-MRI; however, it remains inferior to those of FDP-MRI. KEY POINTS • Training can improve the diagnostic performance for small breast lesions on AB-MRI. • Training can reduce inter-observer variation for breast lesion classification on AB-MRI, especially among junior radiologists. • The post-training diagnostic performance and inter-reader agreement of AB-MRI remained inferior to those of FDP-MRI.
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Affiliation(s)
- Zhuangsheng Liu
- Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, 601 West Huangpu Street, Tianhe District, Guangzhou, 510630, Guangdong, China.,Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, 529000, China
| | - Keming Liang
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, 529000, China
| | - Ling Zhang
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Chan Lai
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, 529000, China
| | - Ruqiong Li
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, 529000, China
| | - Lilei Yi
- Department of Radiology, Foshan Hospital of Traditional Chinese Medicine, Foshan, 528000, China
| | - Ronggang Li
- Department of Pathology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, 529000, China
| | - Ling Zhang
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, 510060, China.
| | - Wansheng Long
- Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, 601 West Huangpu Street, Tianhe District, Guangzhou, 510630, Guangdong, China. .,Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, 529000, China.
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8
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Gilbert FJ, Hickman SE, Baxter GC, Allajbeu I, James J, Caraco C, Vinnicombe S. Opportunities in cancer imaging: risk-adapted breast imaging in screening. Clin Radiol 2021; 76:763-773. [PMID: 33820637 DOI: 10.1016/j.crad.2021.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/19/2021] [Indexed: 12/17/2022]
Abstract
In the UK, women between 50-70 years are invited for 3-yearly mammography screening irrespective of their likelihood of developing breast cancer. The only risk adaption is for women with >30% lifetime risk who are offered annual magnetic resonance imaging (MRI) and mammography, and annual mammography for some moderate-risk women. Using questionnaires, breast density, and polygenic risk scores, it is possible to stratify the population into the lowest 20% risk, who will develop <4% of cancers and the top 4%, who will develop 18% of cancers. Mammography is a good screening test but has low sensitivity of 60% in the 9% of women with the highest category of breast density (BIRADS D) who have a 2.5- to fourfold breast cancer risk. There is evidence that adding ultrasound to the screening mammogram can increase the cancer detection rate and reduce advanced stage interval and next round cancers. Similarly, alternative tests such as contrast-enhanced mammography (CESM) or abbreviated MRI (ABB-MRI) are much more effective in detecting cancer in women with dense breasts. Scintimammography has been shown to be a viable alternative for dense breasts or for follow-up in those with a personal history of breast cancer and scarring as result of treatment. For supplemental screening to be worthwhile in these women, new technologies need to reduce the number of stage II cancers and be cost effective when tested in large scale trials. This article reviews the evidence for supplemental imaging and examines whether a risk-stratified approach is feasible.
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Affiliation(s)
- F J Gilbert
- Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK; Department of Radiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - S E Hickman
- Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - G C Baxter
- Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - I Allajbeu
- Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK; Department of Radiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J James
- Nottingham Breast Institute, City Hospital, Nottingham, UK
| | - C Caraco
- Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - S Vinnicombe
- Thirlestaine Breast Centre, Cheltenham, UK; Ninewells Hospital and Medical School, University of Dundee, UK
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9
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Baxter GC, Selamoglu A, Mackay JW, Bond S, Gray E, Gilbert FJ. A meta-analysis comparing the diagnostic performance of abbreviated MRI and a full diagnostic protocol in breast cancer. Clin Radiol 2021; 76:154.e23-154.e32. [PMID: 33032820 DOI: 10.1016/j.crad.2020.08.036] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/07/2020] [Indexed: 12/18/2022]
Abstract
AIM To undertake a meta-analysis of the diagnostic performance of abbreviated (ABB) magnetic resonance imaging (MRI) and full diagnostic protocol MRI (FDP-MRI) in breast cancer. MATERIALS AND METHODS This meta-analysis was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Diagnostic Test Accuracy (PRISMA-DTA) guidelines. The PubMed and EMBASE databases were searched through August 2019 for studies comparing the diagnostic performance of ABB-MRI and FDP-MRI in the breast. Studies were reviewed by two authors independently according to eligibility and exclusion criteria and split into two subgroups (screening population studies and studies using cohorts enriched with known cancers) to avoid bias. Quality assessment and bias for diagnostic accuracy was determined with Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). The diagnostic accuracy for each subgroup was pooled using a bivariate random effects model and summary receiver operating characteristic (sROC) curves produced. Sensitivities and specificities were compared using a paired t-test. RESULTS Five screening (62/2,588 cancers/patients) and eight enriched cohort (540/1,432 cancers/patients) studies were included in the meta-analysis. QUADAS-2 assessment showed a low risk of bias in most studies. The pooled sensitivity/specificity/area under the receiver operating characteristic curve (AUC) for screening studies was 0.90/0.92/0.94 for ABB-MRI and 0.92/0.95/0.97 for FDP-MRI. The pooled sensitivity/specificity/AUC for enriched cohort studies was 0.93/0.83/0.94 for ABB-MRI and 0.93/0.84/0.95 for FDP-MRI. There was no significant difference in sensitivity or specificity using ABB-MRI or FDP-MRI (p=0.18 and 0.27, p=0.18 and 0.93, respectively). CONCLUSION The diagnostic performances of the ABB-MRI and FDP-MRI protocols used in either screening or enriched cohorts were comparable. There was a large variation in patient population, study methodology, and abbreviated protocols reported.
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Affiliation(s)
- G C Baxter
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - A Selamoglu
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - J W Mackay
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - S Bond
- National Institute for Health Research, Cambridge Clinical Trials Unit, Cambridge, UK
| | - E Gray
- University of Edinburgh, Edinburgh, UK
| | - F J Gilbert
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK; National Institute for Health Research, Cambridge Clinical Trials Unit, Cambridge, UK.
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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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11
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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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