1. McGraw, Mark

Article Content

A new study finds that abbreviated breast MRI (AB-MR) is well-tolerated by patients, and most women would rather undergo this scan than have a mammogram done for screening purposes. A team led by researchers at Sydney, Australia's St. Vincent's Hospital conducted a patient satisfaction survey of more than 200 asymptomatic patients, finding an overall patient preference for abbreviated breast MRI in comparison to mammography screening, with 75 percent of patients who were able to decide choosing the former.

MRI. MRI... - Click to enlarge in new windowMRI. MRI

Lead author Linda Borella, MBBS, who presented the results at the Royal Australian & New Zealand College of Radiology annual scientific meeting, noted that intravenous contrast administration was rated as an excellent or good experience in nearly 70 percent of cases.


"It is now well-established that breast MRI is the most sensitive imaging examination available for the detection of breast cancer," said Borella, noting that research has shown that breast MRI is equally sensitive to full/long protocol MRI for detecting breast cancer, and holds certain advantages over other types of imaging for breast cancer screening.


For example, it's a much shorter examination, with a scan time of less than 10 minutes, compared to the 25-30 minutes required for a full/long protocol scan, she said. "And, as it requires less time, it is more cost-effective than long protocol breast MRI."


Abbreviated breast MRI is advantageous over mammography, which is the traditional breast screening examination, "as it is more sensitive for detecting breast cancer, and requires no breast radiation and no breast compression," Borella continued. "Abbreviated breast not limited by dense breast tissue, which affects almost half the female screening population and can mask abnormalities on a mammogram."


In comparison to the total cost of a 3-D mammogram and breast ultrasound, abbreviated breast MRI is roughly the same cost at the private radiology practice where this study was performed, "yet holds significantly improved sensitivity for detecting breast cancer [versus] the mammogram and ultrasound examinations combined," said Borella. "A negative abbreviated breast MRI study has a negative predictive value of more than 99 percent, which is the greatest level of reassurance that a patient does not have breast cancer that any medical imaging test can provide."


Among the 75 percent of study participants who expressed a preference for abbreviated breast MRI, these patients shared a host of reasons why they felt that way. "For me it is about the accuracy of the results," one patient told the researchers. "Although I suffer from claustrophobia, I would still prefer an MRI if my doctor advised me that it is more accurate than a mammogram."


Another pointed out that abbreviated breast MRI was "more comfortable than the mammogram," adding that "I was also concerned when I had my mammogram, as I was called into the room a couple of extra times, and that made me nervous."


Looking ahead, Borella foresees the results of this study supporting the use of abbreviated breast MRI as an effective population-based screening, although she does note that the study was limited by sample size.


"Larger scale studies that can replicate the findings of this study could be used to validate the use of MRI for population-based screening," she said. "Early detection of breast cancer, particularly in young women with dense breasts, on abbreviated MRI may have survival benefit and reduced burden on health systems, therefore proving it to be a cost-effective screening tool."


Abbreviated breast MRI holds diagnostic advantages over mammography-including 3D tomosynthesis-in dense breast tissue that could be evaluated in larger scale studies to demonstrate cost advantage for earlier breast cancer detection and improved quality-adjusted life years, added Borella.


Karen Gladysz, co-author on this study, noted that future research will include whether abbreviated breast MRI is equally effective in comparison to long protocol breast MRI, adding that it "may be used to support the incorporation of AB-MR into Australian breast cancer screening guidelines and provision of a Medicare rebate for AB-MR as a screening tool in women at average or intermediate risk of breast cancer in Australia.


The results of this research could also be used to support the incorporation of abbreviated breast MRI into Australian breast cancer screening guidelines, said Gladysz, adding that AB-MR has been proposed as a more cost-effective alternative to traditional MRI protocols in terms of screening patients with a high familial risk. "However, the cost-effectiveness of MRI versus mammography and ultrasound has not yet been established for this."


Mark McGraw is a contributing writer.