Highlights
- •Initial screening MRIs were subject to more abnormal interpretations and biopsies compared to subsequent MRIs.
- •However, sensitivity and cancer detection rates were significantly higher for initial screening MRIs.
- •The higher rate of abnormal interpretations at initial screen are likely justified by the higher cancer detection rate.
- •Patients may be counseled on the higher likelihood of recall from an initial MRI balanced with the higher cancer detection.
- •Findings also support the importance of having prior MRI images for comparison to decrease false positives.
Abstract
Purpose
To compare the characteristics, outcomes, and performance metrics in women undergoing
initial breast MRI screening versus subsequent screening.
Methods
A retrospective database search identified screening MRIs performed at an academic
practice from 2013 to 2015. MRIs were divided into two groups: (1) initial screens
and (2) subsequent screens (interpreted with at least one prior MRI for comparison).
Benignity was confirmed with pathology or >1-year follow-up. Malignancy was confirmed
by pathology. Performance metrics were calculated. Comparisons were made using Binomial
and Fisher's exact tests.
Results
We observed a higher rate of abnormal interpretations (52% vs. 19%; p < 0.001) and rate of biopsy (49% vs. 15%; p < 0.001) in the initial versus subsequent screen group. The positive predictive value
of biopsy was slightly lower at initial versus subsequent screen (17% vs. 19%, p = 0.99). However, the cancer detection rate was higher at initial than at subsequent
screen (85 vs. 29/1000, p = 0.08). Sensitivity was higher at initial (100%) versus subsequent (88%) screen.
However, the specificity at initial screen was low (55%) compared to subsequent screen
(83%).
Conclusions
The higher rate of abnormal interpretations in the initial versus subsequent screen
group in part reflects a prevalence screening. Although we observed more abnormal
interpretations in the initial screen, this was likely justified by the significantly
higher cancer detection. This evidence may be used to counsel patients and referring
providers on the expected higher likelihood of recall from an initial screening MRI
balanced with higher detection of malignancies. Findings also highlight the importance
of having comparison MRIs to decrease false positives.
Keywords
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Article Info
Publication History
Published online: May 15, 2020
Accepted:
May 14,
2020
Received in revised form:
May 6,
2020
Received:
February 22,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
