Randomized Trial of Surveillance with Abbreviated MRI in Breast Cancer Survivors – Does it impact patient anxiety and cancer detection rate?

Purpose: Abbreviated breast MRI substantially reduces the image acquisition and reading times and has been reported to have similar diagnostic accuracy as a full diagnostic protocol but has not been evaluated prospectively with respect to impact on patient anxiety in breast cancer survivors and cancer outcomes.Methods: This prospective controlled trial of parallel design was performed at an academic center on women with a personal history of breast cancer who were randomized into two groups: surveillance with MG or MG plus A-MRI. Primary outcome was anxiety compared between the two and measured by four validated questionnaires at three different time-points during the study. Other parameters including the CDR, abnormal interpretation rate (AIR), and positive predictive value for biopsy (PPV3) were compared between modalities of MG and A-MRI. Tissue diagnoses or 1 year of follow-up were used to establish the reference standard. Linear mixed models were used to analyze anxiety and Fisher’s exact test to compare imaging outcomes.Results: 198 patients were allocated to either MG alone (94) or A-MRI plus MG (104). Anxiety scores in all questionnaires were similarly elevated in both groups (50.99+/-4.6 with MG vs 51.73+/-2.56 with MRI,p>0.05) and did not change over time. MRI detected 5 invasive cancers and 1 DCIS, and MG detected 1 DCIS. MRI had higher incremental CDR(48/1000(5/104) vs MG 5/1000(1/198,p=0.01)) and higher AIR 25%(26/104) vs MG 4.5%(9/198,p<0.00001), with no difference in PPV3:MRI 28.6%(6/21)vs MG 16.7%(1/6,p=0.557).Conclusion:Compared to mammography alone, A-MRI had significantly higher incremental cancer detection in breast cancer survivors. Despite a higher rate of recalls and biopsies, A-MRI had no adverse impact on anxiety.

Screening Breast MRI Primer: Indications, Current Protocols, and Emerging Techniques

Breast dynamic contrast-enhanced MRI (DCE-MRI) is the most sensitive imaging modality for the detection of breast cancer. Screening MRI is currently performed predominantly in patients at high risk for breast cancer, but it could be of benefit in patients at intermediate risk for breast cancer and patients with dense breasts. Decreasing scan time and image interpretation time could increase cost-effectiveness, making screening MRI accessible to a larger group of patients. Abbreviated breast MRI (Ab-MRI) reduces scan time by decreasing the number of sequences obtained, but as multiple delayed contrast enhanced sequences are not obtained, no kinetic information is available. Ultrafast techniques rapidly acquire multiple sequences during the first minute of gadolinium contrast injection and provide information about both lesion morphology and vascular kinetics. Diffusion-weighted imaging is a noncontrast MRI technique with the potential to detect mammographically occult cancers. This review article aims to discuss the current indications of breast MRI as a screening tool, examine the standard breast DCE-MRI technique, and explore alternate screening MRI protocols, including Ab-MRI, ultrafast MRI, and noncontrast diffusion-weighted MRI, which can decrease scan time and interpretation time.

Cost-Effectiveness of Digital Breast Tomosynthesis vs. Abbreviated Breast MRI for Screening Women with Intermediate Risk of Breast Cancer—How Low-Cost Must MRI Be?

Background: Digital breast tomosynthesis (DBT) and abbreviated breast MRI (AB-MRI) offer superior diagnostic performance compared to conventional mammography in screening women with intermediate risk of breast cancer due to dense breast tissue. The aim of this model-based economic evaluation was to analyze whether AB-MRI is cost-effective in this cohort compared to DBT. Methods: Decision analysis and Markov simulations were used to model the cumulative costs and quality-adjusted life-years (QALYs) over a time horizon of 30 years. Model input parameters were adopted from recent literature. Deterministic and probabilistic sensitivity analyses were applied to test the stability of the model. Results: In the base-case scenario, the costs of an AB-MRI examination were defined to equal the costs of a full protocol acquisition. Two-yearly screening of women with dense breasts resulted in cumulative discounted costs of $8798 and $9505 for DBT and AB-MRI, and cumulative discounted effects of 19.23 and 19.27 QALYs, respectively, with an incremental cost-effectiveness ratio of $20,807 per QALY gained in the base-case scenario. By reducing the cost of an AB-MRI examination below a threshold of $241 in sensitivity analyses, AB-MRI would become cost-saving compared to DBT. Conclusion: In comparison to DBT, AB-MRI can be considered cost-effective up to a price per examination of $593 in screening patients at intermediate risk of breast cancer.