Comparison of abbreviated breast MRI vs digital breast tomosynthesis for breast cancer detection among women with dense breasts undergoing screening Journal Article


Authors: Comstock, C. E.; Gatsonis, C.; Newstead, G. M.; Snyder, B. S.; Gareen, I. F.; Bergin, J. T.; Rahbar, H.; Sung, J. S.; Jacobs, C.; Harvey, J. A.; Nicholson, M. H.; Ward, R. C.; Holt, J.; Prather, A.; Miller, K. D.; Schnall, M. D.; Kuhl, C. K.
Article Title: Comparison of abbreviated breast MRI vs digital breast tomosynthesis for breast cancer detection among women with dense breasts undergoing screening
Abstract: Importance: Improved screening methods for women with dense breasts are needed because of their increased risk of breast cancer and of failed early diagnosis by screening mammography. Objective: To compare the screening performance of abbreviated breast magnetic resonance imaging (MRI) and digital breast tomosynthesis (DBT) in women with dense breasts. Design, Setting, and Participants: Cross-sectional study with longitudinal follow-up at 48 academic, community hospital, and private practice sites in the United States and Germany, conducted between December 2016 and November 2017 among average-risk women aged 40 to 75 years with heterogeneously dense or extremely dense breasts undergoing routine screening. Follow-up ascertainment of cancer diagnoses was complete through September 12, 2019. Exposures: All women underwent screening by both DBT and abbreviated breast MRI, performed in randomized order and read independently to avoid interpretation bias. Main Outcomes and Measures: The primary end point was the invasive cancer detection rate. Secondary outcomes included sensitivity, specificity, additional imaging recommendation rate, and positive predictive value (PPV) of biopsy, using invasive cancer and ductal carcinoma in situ (DCIS) to define a positive reference standard. All outcomes are reported at the participant level. Pathology of core or surgical biopsy was the reference standard for cancer detection rate and PPV; interval cancers reported until the next annual screen were included in the reference standard for sensitivity and specificity. Results: Among 1516 enrolled women, 1444 (median age, 54 [range, 40-75] years) completed both examinations and were included in the analysis. The reference standard was positive for invasive cancer with or without DCIS in 17 women and for DCIS alone in another 6. No interval cancers were observed during follow-up. Abbreviated breast MRI detected all 17 women with invasive cancer and 5 of 6 women with DCIS. Digital breast tomosynthesis detected 7 of 17 women with invasive cancer and 2 of 6 women with DCIS. The invasive cancer detection rate was 11.8 (95% CI, 7.4-18.8) per 1000 women for abbreviated breast MRI vs 4.8 (95% CI, 2.4-10.0) per 1000 women for DBT, a difference of 7 (95% CI, 2.2-11.6) per 1000 women (exact McNemar P =.002). For detection of invasive cancer and DCIS, sensitivity was 95.7% (95% CI, 79.0%-99.2%) with abbreviated breast MRI vs 39.1% (95% CI, 22.2%-59.2%) with DBT (P =.001) and specificity was 86.7% (95% CI, 84.8%-88.4%) vs 97.4% (95% CI, 96.5%-98.1%), respectively (P <.001). The additional imaging recommendation rate was 7.5% (95% CI, 6.2%-9.0%) with abbreviated breast MRI vs 10.1% (95% CI, 8.7%-11.8%) with DBT (P =.02) and the PPV was 19.6% (95% CI, 13.2%-28.2%) vs 31.0% (95% CI, 17.0%-49.7%), respectively (P =.15). Conclusions and Relevance: Among women with dense breasts undergoing screening, abbreviated breast MRI, compared with DBT, was associated with a significantly higher rate of invasive breast cancer detection. Further research is needed to better understand the relationship between screening methods and clinical outcome. © 2020 American Medical Association. All rights reserved.
Keywords: adult; controlled study; human tissue; aged; middle aged; major clinical study; clinical trial; cancer risk; united states; comparative study; nuclear magnetic resonance imaging; follow up; follow-up studies; magnetic resonance imaging; cancer diagnosis; sensitivity and specificity; breast cancer; breast; randomized controlled trial; cohort analysis; cancer screening; diagnostic imaging; breast neoplasms; mammography; multicenter study; breast tumor; intermethod comparison; cross-sectional study; cross-sectional studies; neoplasm invasiveness; intraductal carcinoma; early detection of cancer; carcinoma, intraductal, noninfiltrating; germany; predictive value; breast biopsy; longitudinal study; diagnostic test accuracy study; clinical outcome; breast density; community hospital; tumor invasion; procedures; humans; human; female; priority journal; article; early cancer diagnosis; digital breast tomosynthesis
Journal Title: JAMA - Journal of the American Medical Association
Volume: 323
Issue: 8
ISSN: 0098-7484
Publisher: American Medical Association  
Date Published: 2020-02-25
Start Page: 746
End Page: 756
Language: English
DOI: 10.1001/jama.2020.0572
PUBMED: 32096852
PROVIDER: scopus
DOI/URL:
Notes: Article -- Erratum issued, see DOI: 10.1001/jama.2020.2991 -- Export Date: 1 April 2020 -- Source: Scopus
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  1. Janice Sinae Sung
    42 Sung