MRI screening of BRCA mutation carriers: Comparison of standard protocol and abbreviated protocols with and without T2-weighted images Journal Article
| Authors: | Naranjo, I. D.; Sogani, J.; Saccarelli, C.; Horvat, J. V.; Sevilimedu, V.; Hughes, M. C.; Lo Gullo, R.; Jochelson, M. S.; Reiner, J.; Pinker, K. |
| Article Title: | MRI screening of BRCA mutation carriers: Comparison of standard protocol and abbreviated protocols with and without T2-weighted images |
| Abstract: | BACKGROUND. Increasing evidence supports the role of abbreviated MRI protocols for breast cancer detection. However, abbreviated protocols have been poorly studied in patients who are BRCA1 or BRCA2 mutation carriers. Furthermore, the need for T2-weighted sequences in abbreviated protocols remains controversial. OBJECTIVE. The purpose of this study was to compare, in the evaluation of patients with BRCA mutations, the diagnostic performance of a standard full breast MRI protocol with the performance of abbreviated protocols that included and did not include a T2-weighted sequence. METHODS. This retrospective study included 292 patients (mean age, 47.9 years) who were BRCA1 or BRCA2 mutation carriers who underwent 427 screening breast MRI examinations according to a standard full protocol who could be classified as having benign (n = 407) or malignant (n = 20) findings based on histopathology or imaging follow-up. Four readers independently assessed examinations in three separate sessions (theoretic abbreviated protocol, which included the first postcontrast acquisition; theoretic abbreviated protocol with addition of a T2-weighted sequence; and the standard full protocol) and assigned BI-RADS categories. Categories 3–5 were considered to represent positive examinations. Interreader agreement was assessed, and diagnostic performance was compared by use of pooled reader data. RESULTS. Interreader agreement on BI-RADS category, expressed as kappa values, was 0.55 for the standard, 0.45 for the abbreviated, and 0.57 for the abbreviated plus T2-weighted protocols. Pooled sensitivity was 94% for the standard, 92% for the abbreviated, and 90% for the abbreviated plus T2-weighted protocols (all p > .001). Pooled specificity was 80% for the standard, 71% for the abbreviated, and 83% for the abbreviated plus T2-weighted protocols (p < .001 for abbreviated plus T2-weighted compared with both standard and abbreviated). Pooled PPV was 19% for the standard, 14% for the abbreviated, and 20% for the abbreviated plus T2-weighted protocols (p < .001 for abbreviated compared with both standard and abbreviated). Pooled NPV was 100% for the standard, 99% for the abbreviated, and 99% for the abbreviated plus T2-weighted (all p > .001) protocols. Pooled accuracy was 80% for the standard, 73% for the abbreviated, and 83% for the abbreviated plus T2-weighted protocols (p < .001 for abbreviated compared with both standard and abbreviated plus T2-weighted). CONCLUSION. The abbreviated protocol without T2-weighted imaging had suboptimal performance. However, addition of the T2-weighted sequence yielded comparable sensitivity and accuracy and a small increase in specificity compared with the full protocol. CLINICAL IMPACT. The findings support implementation of abbreviated MRI with T2-weighted imaging for breast cancer screening of patients with BRCA mutations. © American Roentgen Ray Society |
| Keywords: | adult; controlled study; human tissue; aged; middle aged; retrospective studies; young adult; gene mutation; major clinical study; genetics; mutation; histopathology; nuclear magnetic resonance imaging; follow up; magnetic resonance imaging; diagnostic accuracy; sensitivity and specificity; breast cancer; image analysis; breast; cancer screening; clinical protocol; pathology; diagnostic imaging; breast neoplasms; retrospective study; tumor suppressor gene; diagnostic value; breast tumor; intermethod comparison; cancer classification; genetic screening; performance; heterozygote detection; breast mri; receiver operating characteristic; breast cancer screening; interrater reliability; kappa statistics; diagnostic test accuracy study; gadolinium pentetate meglumine; high risk; procedures; brca genes; humans; human; female; article; abbreviated mri protocol; benign breast tumor; t2 weighted imaging |
| Journal Title: | American Journal of Roentgenology |
| Volume: | 218 |
| Issue: | 5 |
| ISSN: | 0361-803X |
| Publisher: | American Roentgen Ray Society |
| Date Published: | 2022-05-01 |
| Start Page: | 810 |
| End Page: | 821 |
| Language: | English |
| DOI: | 10.2214/ajr.21.27022 |
| PUBMED: | 34935399 |
| PROVIDER: | scopus |
| PMCID: | PMC9422039 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 June 2022 -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
Related MSK Work