Multireader Study on the Diagnostic Accuracy of Ultrafast Breast Magnetic Resonance Imaging for Breast Cancer Screeningvan Zelst, J. C. M., Vreemann, S., Witt, H-J., Gubern-Merida, A., Dorrius, M. D., Duvivier, K., Lardenoije-Broker, S., Lobbes, M. B. I., Loo, C., Veldhuis, W., Veltman, J., Drieling, D., Karssemeijer, N. & Mann, R. M., Oct-2018, In : Investigative Radiology. 53, 10, p. 579-586 8 p.
Research output: Contribution to journal › Article › Academic › peer-review
Objectives: Breast cancer screening using magnetic resonance imaging (MRI) has limited accessibility due to high costs of breast MRI. Ultrafast dynamic contrast-enhanced breast MRI can be acquired within 2 minutes. We aimed to assess whether screening performance of breast radiologist using an ultrafast breast MRI-only screening protocol is as good as performance using a full multiparametric diagnostic MRI protocol (FDP).
Materials and Methods: The institutional review board approved this study, and waived the need for informed consent. Between January 2012 and June 2014, 1791 consecutive breast cancer screening examinations from 954 women with a lifetime risk of more than 20% were prospectively collected. All women were scanned using a 3 T protocol interleaving ultrafast breast MRI acquisitions in a full multiparametric diagnostic MRI protocol consisting of standard dynamic contrast-enhanced sequences, diffusion-weighted imaging, and T2-weighted imaging. Subsequently, a case set was created including all biopsied screen-detected lesions in this period (31 malignant and 54 benign) and 116 randomly selected normal cases with more than 2 years of follow-up. Prior examinations were included when available. Seven dedicated breast radiologists read all 201 examinations and 153 available priors once using the FDP and once using ultrafast breast MRI only in 2 counterbalanced and crossed-over reading sessions.
Results: For reading the FDP versus ultrafast breast MRI alone, sensitivity was 0.86 (95% confidence interval [CI], 0.81-0.90) versus 0.84 (95% CI, 0.78-0.88) (P = 0.50), specificity was 0.76 (95% CI, 0.74-0.79) versus 0.82 (95% CI, 0.79-0.84) (P = 0.002), positive predictive value was 0.40 (95% CI, 0.36-0.45) versus 0.45 (95% CI, 0.41-0.50) (P = 0.14), and area under the receiver operating characteristics curve was 0.89 (95% CI, 0.82-0.96) versus 0.89 (95% CI, 0.82-0.96) (P = 0.83). Ultrafast breast MRI reading was 22.8% faster than reading FDP (P <0.001). Interreader agreement is significantly better for ultrafast breast MRI (kappa = 0.730; 95% CI, 0.699-0.761) than for the FDP (kappa = 0.665; 95% CI, 0.633-0.696).
Conclusions: Breast MRI screening using only an ultrafast breast MRI protocol is noninferior to screening with an FDP and may result in significantly higher screening specificity and shorter reading time.
|Number of pages||8|
|Publication status||Published - Oct-2018|
- breast MRI, screening, breast cancer, ultrafast breast MRI, abbreviated breast MRI, multireader, multicase study, HIGH FAMILIAL RISK, COST-EFFECTIVENESS, MUTATION CARRIERS, MRI, WOMEN, MAMMOGRAPHY, BRCA1, PROTOCOL, SOCIETY, POPULATION