Select breast cancer patients may benefit from addition of MRI to mammogram
medwireNews: Adding magnetic resonance imaging (MRI) to mammography screening can increase detection of early-stage breast cancer for women who underwent breast conservation therapy (BCT) at age 50 years or younger, Korean researchers report.
The observational study also found that there was an increased detection rate when ultrasonography was added to mammography, compared with mammography alone, but this did not reach statistical significance. Even so, it could be considered for women who are unable to undergo MRI, the researchers remark.
In total, 754 women who were age 50 years or younger at initial breast cancer diagnosis and BCT underwent three annual mammography, ultrasonography, and MRI screenings of both the conserved and contralateral breasts.
During this time, 17 cancers were diagnosed, the majority (76%) of which were stage 0 or 1.
Two cancers were detected by mammography alone, three by MRI alone, one by mammogram and MRI, five by ultrasonography and MRI, and six by all three imaging modalities. No cancers were detected by ultrasonography alone.
Compared with mammography alone, the overall cancer detection rate was significantly higher with both mammography plus MRI and mammography plus ultrasound, at rates of 8.2 and 6.8 versus 4.4 per 1000 examinations.
Sensitivity was also significantly higher with mammography plus MRI, at 100%, versus mammography alone (52.9%), but not with additional ultrasound (82.4%).
By contrast, the specificity of mammography with MRI or ultrasonography was significantly lower than that with mammography alone, at 87% and 88% versus 96%
The recall, biopsy, and short-term follow-up rates all increased significantly with the addition of MRI or ultrasound compared with mammography alone, but this was at the cost of positive predictive values, which decreased significantly for both recall and biopsy.
However, Woo Kyung Moon (Seoul National University College of Medicine) and colleagues say: “Considering the harms caused by false-negative findings, the false-positive findings caused by MRI screening examinations might be within acceptable ranges if informed women choose them.”
The researchers also point out that no interval cancer was detected during the study period, which they say can be “a useful intermediate surrogate measure for screening benefits.”
Writing in JAMA Oncology, Moon et al conclude: “Our study results can be used not only to inform patient and clinician decision making regarding the best methods of screening after BCT but also to develop more personalized screening guidelines and recommendations for women at increased risk for breast cancer.”
By Laura Cowen
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