Study suggests MRI is the best breast cancer screening modality for dense breasts

MRI was the most effective supplement breast cancer Methods of screening women with dense breast tissue and negative mammogram results, according to a review and meta-analysis published in Radiology.

Mammography is the standard imaging modality for breast cancer screening and can detect up to 98% of cancers in fatty breasts, the authors say. However, mammography sensitivity for very dense breasts is only 30% to 48%. Given that an estimated 47% of screened individuals in the United States have dense breasts, which is also a risk factor for developing breast cancer, to increase the likelihood of identifying breast cancer at an early stage, Supplemental screening in this population is recommended.

“Our study was designed to assess the role of various adjunctive screening tests in women with average or intermediate risk of breast cancer, negative mammogram screening, and dense breast tissue. study co-author Vivianne Freitas, MD, MSc, assistant professor at the University. A staff radiologist at the University of Toronto, Canada and the Joint Department of Medical Imaging in Toronto said: statementOn mammograms, both breast cancer and breast tissue appear white, which makes identifying the cancer more difficult in these patients, she explained.

A systematic review evaluated data from 22 randomized clinical trials and prospective observational studies involving a total of 261,233 screened patients. A total of 132,166 patients had dense breast tissue, negative mammograms, average or intermediate cancer risk, and met all inclusion criteria. 541 cancer cases were missed by mammography but were detected by additional screening.

The authors reviewed incremental cancer detection rate (CDR), positive predictive value for recall (PPV1), positive predictive value for biopsies performed (PPV3), and interval CDR for various supplemental imaging modalities. These include digital breast tomosynthesis, handheld ultrasound, automated whole breast ultrasound, and MRI.

In this study, MRI outperformed other adjunctive screening modalities, demonstrating an incremental CDR of 1.54 per 1,000 screens (95% CI, 0.74-2.33; P. < .001). CDR for invasive disease was 1.31 per 1,000 screens (95% CI, 0.57–2.06; P. < .001), CDR for ductal carcinoma in situ was 1.91 per 1000 screens (95% CI, 0.10–3.72; P. < .04).

Incremental CDR for handheld ultrasound was -0.35 (95% CI, -0.7 to 0.08; P. = .11), the incremental CDR for automated whole-breast ultrasound was -0.26 (95% CI, -1.07 to 0.56; P. = .53), the incremental CDR for digital breast tomosynthesis was -0.14 (95% CI, -0.58 to 0.29; P. = .51).

In this study, no differences were found between PPV1 and PPV3, and due to the relatively small number of studies, the authors were unable to assess interval cancer indices. Except for MRI, there were no statistically significant differences among the remaining imaging modalities.

“MRI is far superior to handheld ultrasound, automated ultrasound, and digital breast tomosynthesis in terms of cancer detection,” says Freitas. “Our results on the role of MRI in supplemental screening will allow stakeholders to guide health policy and direct further research in this setting.”

The authors point out that MRI still has advantages and disadvantages to consider. A limiting factor in using MRI for secondary screening is its high cost compared to other modalities. Another limitation is the lack of sufficient numbers of his MRI scanners worldwide, making it less accessible compared to other methods, they added. Another possible concern is the need for contrast injections and the consequent accumulation of gadolinium in the brain, but the clinical significance of this aspect is uncertain, according to the authors.

“The cost-effectiveness, mortality reduction, and other effects of breast MRI compared to other techniques need to be further evaluated before advocating broader application of breast MRI in these women,” Freitas said. Stated. “Currently, the availability and cost of breast MRI are the biggest barriers to widespread adoption.”

reference

Hussein H, Abbas E, Keshavarji S, et al. Adjunctive breast cancer screening in women with dense breasts and negative mammography: a systematic review and meta-analysis. Radiology. Published online January 31, 2023. doi:10.1148/radiol.221785