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Fast MRI breast cancer screening – Ready for prime time

Published:November 30, 2019DOI:https://doi.org/10.1016/j.clinimag.2019.10.013

      Highlights

      • Novel breast MRI protocols include abbreviated DCE MRI, Ultrafast breast MRI, and DWI.
      • Abbreviated MRI protocols have shown similar sensitivities and specificities to a full MRI protocol.
      • Ultrafast DCE MRI significantly reduced acquisition and reading times compared to a full MRI protocol.
      • Ultrafast DCE MRI showed increased specificity and similar sensitivity compared to a full MRI protocol.
      • DWI provided additional non-invasive characterization of breast tumors compared to DCE MRI.
      • The Fast MRI screening program has potential to increase the number of breast cancers detected.

      Abstract

      Objective

      The manuscript discusses landmark studies using abbreviated MRI for breast cancer screening. This includes abbreviated dynamic contrast enhanced MRI and diffusion weighted imaging. Our institutional experience with abbreviated MR protocol for breast cancer screening is also described.

      Conclusion

      Abbreviated MRI protocols were found to demonstrate value for screening of breast cancer. It has been shown that abbreviated protocol MRI provides similar diagnostic sensitivities to full protocol MRI for breast cancer in women with increased lifetime risk. Our institutional abbreviated MRI protocol for breast cancer offers improved time and workflow efficiencies and has the potential to increase the number of breast cancers detected and the detection of pathologically relevant invasive breast cancer at earlier stages.

      Keywords

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      References

        • Siegel RL
        • Miller KD
        • Jemal A
        Cancer statistics, 2018.
        CA Cancer J Clin. 2018; 68: 7-30https://doi.org/10.3322/caac.21442
        • Saslow D
        • Boetes C
        • Burke W
        • Harms S
        • Leach MO
        • Lehman CD
        • et al.
        American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography.
        CA Cancer J Clin. 2007; 57: 75-89
        • Siu AL
        • on behalf of the US Preventive Services Task Force
        Screening for breast Cancer: U.S. preventive services task force recommendation statement.
        Ann Intern Med. 2016; 164: 279-296https://doi.org/10.7326/M15-2886
        • Oeffinger KC
        • Fontham ETH
        • Etzioni R
        • et al.
        Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society.
        JAMA. 2015; 314: 1599-1614https://doi.org/10.1001/jama.2015.12783
        • Kolb TM
        • Lichy J
        • Newhouse JH
        Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations.
        Radiology. 2002; 225: 165-175
        • Mandelson MT
        • Oestreicher N
        • Porter PL
        • et al.
        Breast density as a predictor of mammographic detection: comparison of interval- and screen-detected cancers. JNCI.
        J Natl Cancer Inst. 2000; 92: 1081-1087
        • Kelly KM
        • Dean J
        • Comulada WS
        • Lee SJ
        Breast cancer detection using automated whole breast ultrasound and mammography in radiographically dense breasts.
        Eur Radiol. 2010; 20: 734-742https://doi.org/10.1007/s00330-009-1588-y
        • Welch HG
        • Prorok PC
        • O’Malley AJ
        • Kramer BS
        Breast-cancer tumor size, overdiagnosis, and mammography screening effectiveness.
        N Engl J Med. 2016; 375: 1438-1447
        • Kuhl CK
        Abbreviated breast MRI for screening women with dense breast: The EA1141 Trial.
        Br J Radiol. 2017; (20170441)https://doi.org/10.1259/bjr.20170441
        • Menezes GL
        • Knuttel FM
        • Stehouwer BL
        • Pijnappel RM
        • van den Bosch MA
        Magnetic resonance imaging in breast cancer: a literature review and future perspectives.
        World J Clin Oncol. 2014; 5: 61-70https://doi.org/10.5306/wjco.v5.i2.61
        • Peters NH
        • Borel Rinkes IH
        • Zuithoff NP
        • Mali WP
        • Moons KG
        • Peeters PH
        Meta-analysis of MR imaging in the diagnosis of breast lesions.
        Radiology. 2008; 246: 116-124
        • Kuhl CK
        • Schrading S
        • Leutner CC
        • Morakkabati-Spitz N
        • Wardelmann E
        • Fimmers R
        • et al.
        Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer.
        J Clin Oncol. 2005; 23: 8469-8476
        • Turnbull LW
        Dynamic contrast-enhanced MRI in the diagnosis and management of breast cancer.
        NMR Biomed. 2009; 22: 28-39https://doi.org/10.1002/nbm.1273
        • Hlawatsch A
        • Teifke A
        • Schmidt M
        • Thelen M
        Preoperative assessment of breast cancer: sonography versus MR imaging.
        AJR Am J Roentgenol. 2002; 179: 1493-1501
        • Wernli K.J.
        • DeMartini W.B.
        • Ichikawa L.
        • et al.
        Patterns of breast magnetic resonance imaging use in community practice.
        JAMA Intern Med. 2014; 174: 125-132
        • Cott Chubiz J.E.
        • Lee J.M.
        • Gilmore M.E.
        • et al.
        Cost-effectiveness of alternating magnetic resonance imaging and digital mammography screening in BRCA1 and BRCA2 gene mutation carriers..
        Cancer. 2013; 119: 1266-1276https://doi.org/10.1002/cncr.27864
        • Panigrahi B
        • Mullen L
        • Falomo E
        • Panigrahi B
        • Harvey S
        An abbreviated protocol for high-risk screening breast magnetic resonance imaging: impact on performance metrics and BI-RADS assessment.
        Acad Radiol. 2017; 24: 1132-1138https://doi.org/10.1016/j.acra.2017.03.014
        • Machida Y
        • Shimauchi A
        • Kanemaki Y
        • Igarashi T
        • Harada M
        • Fukuma E
        Feasibility and potential limitations of abbreviated breast MRI: an observer study using an enriched cohort.
        Breast Cancer. 2017; 24: 411-419
        • Chen SQ
        • Huang M
        • Shen YY
        • Liu CL
        • Xu CX
        • Cx X
        Abbreviated MRI protocols for detecting breast cancer in women with dense breasts.
        Korean J Radiol. 2017; 18: 470-475
        • Chen SQ
        • Huang M
        • Shen YY
        • Liu CL
        • Xu CX
        Application of abbreviated protocol of magnetic resonance imaging for breast cancer screening in dense breast tissue.
        Acad Radiol. 2017; 24: 316-320
        • Moschetta M
        • Telegrafo M
        • Rella L
        • Stabile Ianora AA
        • Angelelli G
        Abbreviated combined MR protocol: a new faster strategy for characterizing breast lesions.
        Clin Breast Cancer. 2016; 16: 207-211
        • Grimm LJ
        • Soo MS
        • Yoon S
        • Kim C
        • Ghate SV
        • Johnson KS
        Abbreviated screening protocol for breast MRI: a feasibility study.
        Acad Radiol. 2015; 22: 1157-1162
        • Kuhl CK
        • Schrading S
        • Strobel K
        • Schild HH
        • Hilgers R-D
        • Bieling HB
        Abbreviated breast magnetic resonance imaging (MRI): first postcontrast subtracted images and maximum-intensity projection—a novel approach to breast cancer screening with MRI.
        J Clin Oncol. 2014; 32: 2304-2310https://doi.org/10.1200/JCO.2013.52.5386
        • Strahle DA
        • Pathak DR
        • Sierra A
        • Saha S
        • Strahle C
        • Devisetty K
        Systematic development of an abbreviated protocol for screening breast magnetic resonance imaging.
        Breast Cancer Res Treat. 2017; 162: 283-295
        • Harvey SC
        • Di Carlo PA
        • Lee B
        • Obadina E
        • Sippo D
        • Mullen L
        An abbreviated protocol for high-risk screening breast MRI saves time and resources.
        J Am Coll Radiol. 2016; 13: R74-R80
        • Heacock L
        • Melsaether AN
        • Heller SL
        • Gao Y
        • Pysarenko KM
        • Babb JS
        • et al.
        Evaluation of a known breast cancer using an abbreviated breast MRI protocol: correlation of imaging characteristics and pathology with lesion detection and conspicuity.
        Eur J Radiol. 2016; 85: 815-823
        • Mango VL
        • Morris EA
        • David Dershaw D
        • Abramson A
        • Fry C
        • Moskowitz CS
        • et al.
        Abbreviated protocol for breast MRI: are multiple sequences needed for cancer detection?.
        Eur J Radiol. 2015; 84: 65-70
        • Partridge SC
        • Mullins CD
        • Kurland BF
        • et al.
        Apparent diffusion coefficient values for discriminating benign and malignant breast MRI lesions: effects of lesion type and size.
        AJR Am J Roentgenol. 2010 Jun; 194: 1664-1673
        • Mann R.M.
        • Mus R.D.
        • van Zelst J.
        • Geppert C.
        • Karssemeijer N.
        • Platel B.A.
        Novel approach to contrast-enhanced breast magnetic resonance imaging for screening.
        Invest Radiol. 2014; 49: 579-585
        • van Zelst J.
        • Vreemann S.
        • Witt H.J.
        • Gubern-Merida A.
        • Dorrius M.D.
        • Duvivier K.
        • et al.
        Multireader study on the diagnostic accuracy of ultrafast breast magnetic resonance imaging for breast cancer screening.
        Invest Radiol. 2018; 53: 579-586
        • Abe H
        • Mori N
        • Tsuchiya K
        • Schacht DV
        • Pineda FD
        • Jiang Y
        • et al.
        Kinetic analysis of benign and malignant breast lesions with ultrafast dynamic contrast-enhanced MRI: comparison with standard kinetic assessment.
        Am J Roentgenol. 2016; 207: 1159-1166
        • McDonald ES
        • Hammersley JA
        • Chou S-HS
        • Rahbar H
        • Scheel JR
        • Lee CI
        • et al.
        Performance of DWI as a rapid unenhanced technique for detecting mammographically occult breast cancer in elevated-risk women with dense breasts.
        Am J Roentgenol. 2016; 207: 205-216
      1. What to Expect n.d. https://stanfordhealthcare.org/medical-tests/m/mri/what-to-expect.html [accessed June 27, 2019].

      2. Magnetic Resonance Imaging - Special Subjects - Merck Manuals Professional Edition. Merck Manuals Professional Edition n.d. https://www.merckmanuals.com/professional/special-subjects/principles-of-radiologic-imaging/magnetic-resonance-imaging [accessed June 27, 2019].

        • Santamaría G
        • Velasco M
        • Bargalló X
        • Caparrós X
        • Farrús B
        • Luis Fernández P
        Radiologic and pathologic findings in breast tumors with high signal intensity on T2-weighted MR images.
        Radiographics. 2010; 30: 533-548https://doi.org/10.1148/rg.302095044
        • Kuhl CK
        • Mielcareck P
        • Klaschik S
        • et al.
        Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions?.
        Radiology. 1999; 211: 101-110https://doi.org/10.1148/radiology.211.1.r99ap38101
        • Kuhl CK
        • Strobel K
        • Bieling H
        • Leutner C
        • Schild HH
        • Schrading S
        Supplemental breast MR imaging screening of women with average risk of breast cancer.
        Radiology. 2017; 283: 361-370
        • Mann RM
        • Kuhl CK
        • Kinkel K
        • Boetes C
        Breast MRI: guidelines from the European Society of Breast Imaging.
        Eur Radiol. 2008; 18: 1307-1318
        • Le Bihan D
        • Breton E
        • Lallemand D
        • Aubin ML
        • Vignaud J
        • Laval-Jeantet M
        Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging.
        Radiology. 1988 Aug; 168: 497-505
        • Partridge SC
        • McDonald ES
        Diffusion weighted MRI of the breast: protocol optimization, guidelines for interpretation, and potential clinical applications.
        Magn Reson Imaging Clin N Am. 2013; 21: 601-624
        • Woodhams R
        • Matsunaga K
        • Kan S
        • et al.
        ADC mapping of benign and malignant breast tumors.
        Magn Reson Med Sci. 2005; 4: 35-42
        • Rahbar H
        • Partridge SC
        • Eby PR
        • et al.
        Characterization of ductal carcinoma in situ on diffusion weighted breast MRI.
        Eur Radiol. 2011 Sep; 21: 2011-2019
        • Baltzer PA
        • Benndorf M
        • Dietzel M
        • Gajda M
        • Camara O
        • Kaiser WA
        Sensitivity and specificity of unenhanced MR mammography (DWI combined with T2-weighted TSE imaging, ueMRM) for the differentiation of mass lesions.
        Eur Radiol. 2010 May; 20: 1101-1110
        • Chen X
        • Li W
        • Zhang Y
        • Wu Q
        • Guo Y
        • Bai Z
        Meta-analysis of quantitative diffusion-weighted MR imaging in the differential diagnosis of breast lesions.
        BMC Cancer. 2010; 10: 693https://doi.org/10.1186/1471-2407-10-693
        • Pinker K
        • Moy L
        • Sutton EJ
        • Mann RM
        • Weber M
        • Thakur SB
        • et al.
        Diffusion-weighted imaging with apparent diffusion coefficient mapping for breast cancer detection as a stand-alone parameter: comparison with dynamic contrast-enhanced and multiparametric magnetic resonance imaging.
        Invest Radiol. 2018; 53: 587-595
        • Christou A
        • Ghiatas A
        • Priovolos D
        • Veliou K
        • Bougias H
        Accuracy of diffusion kurtosis imaging in characterization of breast lesions.
        Br J Radiol. 2017; 90: 20160873https://doi.org/10.1259/bjr.20160873
        • Kul S
        • Cansu A
        • Alhan E
        • Dinc H
        • Gunes G
        • Reis A
        Contribution of diffusion-weighted imaging to dynamic contrast-enhanced MRI in the characterization of breast tumors.
        AJR Am J Roentgenol. 2011; 196: 210-217
        • Bickelhaupt S
        • Jaeger PF
        • Laun FB
        • Lederer W
        • Daniel H
        • Kuder TA
        • et al.
        Radiomics based on adapted diffusion kurtosis imaging helps to clarify most mammographic findings suspicious for cancer.
        Radiology. 2018; 287: 761-770
        • Sun K
        • Chen X
        • Chai W
        • et al.
        Breast cancer: diffusion kurtosis MR imaging-diagnostic accuracy and correlation with clinical-pathologic factors.
        Radiology. 2015; 277: 46-55
        • Schellinger PD
        • Bryan RN
        • Caplan LR
        • Detre JA
        • Edelman RR
        • Jaigobin C
        • et al.
        Evidence-based guideline: the role of diffusion and perfusion MRI for the diagnosis of acute ischemic stroke: report of the therapeutics and technology assessment Subcommittee of the American Academy of Neurology.
        Neurology. 2010; 75: 177-185
        • Brunser AM
        • Hoppe A
        • Illanes S
        • Díaz V
        • Muñoz P
        • Cárcamo D
        • et al.
        Accuracy of diffusion-weighted imaging in the diagnosis of stroke in patients with suspected cerebral infarct.
        Stroke. 2013; 44: 1169-1171
        • Simonsen CZ
        • Madsen MH
        • Schmitz ML
        • Mikkelsen IK
        • Fisher M
        • Andersen G
        Sensitivity of diffusion- and perfusion-weighted imaging for diagnosing acute ischemic stroke is 97.5%.
        Stroke. 2015; 46: 98-101
        • Berg WA
        • Zhang Z
        • Lehrer D
        • et al.
        Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk.
        JAMA. 2012; 307: 1394-1404https://doi.org/10.1001/jama.2012.388
        • Friedewald SM
        • Rafferty EA
        • Rose SL
        • et al.
        Breast cancer screening using tomosynthesis in combination with digital mammography.
        JAMA. 2014; 311: 2499-2507
        • ECOG-ACRIN Cancer Research Group
        EA1141—educational materials.
        (Available from:)
        • Leithner D
        • Moy L
        • Morris EA
        • Marino MA
        • Helbich TH
        • Pinker K
        Abbreviated MRI of the breast: does it provide value?.
        J Magn Reson Imaging. 2019; 49: e85-100
        • Romeo V.
        • Cuocolo R.
        • Liuzzi R.
        • et al.
        Preliminary Results of a Simplified Breast MRI Protocol to Characterize Breast Lesions: Comparison with a Full Diagnostic Protocol and a Review of the Current Literature.
        Acad Radiol. 2017; 24: 1387-1394