Fast and Noninvasive Characterization of Suspicious Lesions Detected at Breast Cancer X-Ray Screening: Capability of Diffusion-weighted MR Imaging with MIPs.

PURPOSE To evaluate the ability of a diagnostic abbreviated magnetic resonance (MR) imaging protocol consisting of maximum intensity projections (MIPs) from diffusion-weighted imaging with background suppression (DWIBS) and unenhanced morphologic sequences to help predict the likelihood of malignancy on suspicious screening x-ray mammograms, as compared with an abbreviated contrast material-enhanced MR imaging protocol and a full diagnostic breast MR imaging protocol. MATERIALS AND METHODS This prospective institutional review board-approved study included 50 women (mean age, 57.1 years; range, 50-69 years), who gave informed consent and who had suspicious screening mammograms and an indication for biopsy, from September 2014 to January 2015. Before biopsy, full diagnostic contrast-enhanced MR imaging was performed that included DWIBS (b = 1500 sec/mm(2)). Two abbreviated protocols (APs) based on MIPs were evaluated regarding the potential to exclude malignancy: DWIBS (AP1) and subtraction images from the first postcontrast and the unenhanced series (AP2). Diagnostic indexes of both methods were examined by using the McNemar test and were compared with those of the full diagnostic protocol and histopathologic findings. RESULTS Twenty-four of 50 participants had a breast carcinoma. With AP1 (DWIBS), the sensitivity was 0.92 (95% confidence interval [CI]: 0.73, 0.98), the specificity was 0.94 (95% CI: 0.77, 0.99), the negative predictive value (NPV) was 0.92 (95% CI: 0.75, 0.99), and the positive predictive value (PPV) was 0.93 (95% CI: 0.75, 0.99). The mean reading time was 29.7 seconds (range, 4.9-110.0 seconds) and was less than 3 seconds (range, 1.2-7.6 seconds) in the absence of suspicious findings on the DWIBS MIPs. With the AP2 protocol, the sensitivity was 0.85 (95% CI: 0.78, 0.95), the specificity was 0.90 (95% CI: 0.72, 0.97), the NPV was 0.87 (95% CI: 0.69, 0.95), the PPV was 0.89 (95% CI: 0.69, 0.97), and the mean reading time was 29.6 seconds (range, 6.0-100.0 seconds). CONCLUSION Unenhanced diagnostic MR imaging (DWIBS mammography), with an NPV of 0.92 and an acquisition time of less than 7 minutes, could help exclude malignancy in women with suspicious x-ray screening mammograms. The method has the potential to reduce unnecessary invasive procedures and emotional distress for breast cancer screening participants if it is used as a complement after the regular screening clarification procedure.

[1]  The Burden of False-Positive Results in Analog and Digital Screening Mammography: Experience of the Nova Scotia Breast Screening Program , 2014, Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes.

[2]  L. Philpotts,et al.  The patient burden of screening mammography recall. , 2014, Journal of women's health.

[3]  H. Kim,et al.  Diagnostic performance of apparent diffusion coefficient and quantitative kinetic parameters for predicting additional malignancy in patients with newly diagnosed breast cancer. , 2014, Magnetic resonance imaging.

[4]  John Kornak,et al.  High‐resolution diffusion‐weighted imaging for the separation of benign from malignant BI‐RADS 4/5 lesions found on breast MRI at 3T , 2014, Journal of magnetic resonance imaging : JMRI.

[5]  F. Sardanelli,et al.  Breast cancer detection using double reading of unenhanced MRI including T1-weighted, T2-weighted STIR, and diffusion-weighted imaging: a proof of concept study. , 2014, AJR. American journal of roentgenology.

[6]  Ralf-Dieter Hilgers,et al.  Abbreviated breast magnetic resonance imaging (MRI): first postcontrast subtracted images and maximum-intensity projection-a novel approach to breast cancer screening with MRI. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[7]  Eugenio Paci,et al.  European Breast Cancer Service Screening Outcomes: A First Balance Sheet of the Benefits and Harms , 2014, Cancer Epidemiology, Biomarkers & Prevention.

[8]  Oguzhan Alagoz,et al.  Benefits, harms, and costs for breast cancer screening after US implementation of digital mammography. , 2014, Journal of the National Cancer Institute.

[9]  T. Helbich,et al.  MRI-only lesions: application of diffusion-weighted imaging obviates unnecessary MR-guided breast biopsies , 2014, European Radiology.

[10]  C. Marsault,et al.  Diffusion-weighted MR imaging of the breast: advantages and pitfalls. , 2013, European journal of radiology.

[11]  N Houssami,et al.  Application of breast tomosynthesis in screening: incremental effect on mammography acquisition and reading time. , 2012, The British journal of radiology.

[12]  X. Liu Implications of statistical power for confidence intervals. , 2012, The British journal of mathematical and statistical psychology.

[13]  Eun-Kyung Kim,et al.  Triple-negative invasive breast cancer on dynamic contrast-enhanced and diffusion-weighted MR imaging: comparison with other breast cancer subtypes , 2012, European Radiology.

[14]  L. Tabár,et al.  Swedish two-county trial: impact of mammographic screening on breast cancer mortality during 3 decades. , 2011, Radiology.

[15]  Philippe Autier,et al.  Breast cancer mortality in neighbouring European countries with different levels of screening but similar access to treatment: trend analysis of WHO mortality database , 2011, BMJ : British Medical Journal.

[16]  Wendy B DeMartini,et al.  Characterization of ductal carcinoma in situ on diffusion weighted breast MRI , 2011, European Radiology.

[17]  Wilma van der Riet,et al.  Diffusion-weighted MR imaging with background body signal suppression (DWIBS) for the diagnosis of malignant and benign breast lesions , 2009, European Radiology.

[18]  C. Kuhl MR imaging for surveillance of women at high familial risk for breast cancer. , 2006, Magnetic resonance imaging clinics of North America.

[19]  T. Takahara,et al.  Diffusion weighted whole body imaging with background body signal suppression (DWIBS): technical improvement using free breathing, STIR and high resolution 3D display. , 2004, Radiation medicine.

[20]  G. Giles,et al.  The sensitivity, specificity, and positive predictive value of screening mammography and symptomatic status , 2000, Journal of medical screening.