Breast MRI moderately useful for detecting breast cancer, but does not eliminate need for biopsy

December 07, 2004

In women with breast lesions that are suspicious for cancer, based on clinical examination or mammography, performing a breast MRI has high sensitivity but only moderate specificity for detecting breast cancer, but does not necessarily eliminate the need for tissue sampling, according to a study in the December 8 issue of JAMA.

Mammography is the primary imaging modality used to detect clinically occult breast cancer, according to background information in the article. However, mammography has limitations in both sensitivity and specificity that have led to exploration of other imaging techniques. Magnetic resonance imaging (MRI) has been evaluated for breast imaging because of its value for assessing soft tissues of the body. Previous research has indicated that additional lesions seen by MRI that are not visible on the mammogram have been reported to be present in between 27 percent and 37 percent of patients. The use of MRI to evaluate women with mammographically or clinically suspicious breast lesions who are undergoing biopsy has shown high potential.

David A. Bluemke, M.D., Ph.D., of Johns Hopkins University School of Medicine, Baltimore, and colleagues conducted a study to determine the accuracy of breast MRI in conjunction with mammography for the detection of breast cancer in patients with suspicious mammographic or clinical findings. The International Breast MR Consortium was conducted at 14 university hospitals in the United States and Europe from June 2, 1998, through October 31, 2001. The study included 821 patients referred for breast biopsy based on suspicious mammographic, clinical or ultrasound findings. Patients had MRI examinations performed prior to breast biopsy; MRI results were interpreted at each site, with MRI investigators blinded to pathological results.

The researchers found that MRI correctly detected cancer in 356 of 404 cancer cases (ductal carcinoma in situ [DCIS] or invasive cancer), resulting in a sensitivity of 88.1 percent, and correctly identified as negative for cancer 281 of 417 cases without cancer, resulting in a specificity of 67.7 percent. MRI performance was not significantly affected by mammographic breast density, tumor histology, or menopausal status.

"In conclusion, MRI shows high sensitivity and moderate specificity for breast cancer. However, for lesions that are mammographically or clinically suspicious, tissue sampling of the breast may not be avoided with the use of MRI," the authors write. (JAMA. 2004; 292: 2735-2742. Available post-embargo at www.jama.com)
-end-
Editor's Note: This study was funded by grants from the National Cancer Institute. Gadolinium contrast agents were provided by Amersham Health, Berlex Laboratories, and Bracco Diagnostics. Co-author Dr. Weatherall has received a research grant from Philips Medical Systems. Co-author Dr. Schnall has received a research grant from Siemens Medical Systems and has a royalty agreement with USA Instruments.

Editorial: Magnetic Resonance Imaging in Breast Cancer - One Step Forward, Two Steps Back?

In an accompanying editorial, Monica Morrow, M.D., of the Fox Chase Cancer Center, Philadelphia, writes that whether MRI will result in a meaningful clinical benefit is an open question, and one that should have been answered prior to its widespread adoption.

"Even the performance of mastectomy does not eliminate the problem of local tumor recurrence, so it is unrealistic to believe that an additional imaging study will do so. Evidence of clinical benefit in terms of overall survival, disease-free survival, or quality of life is the established standard for new therapeutic modalities in breast cancer. When imaging studies are used to select therapy, the same rigorous standards must be applied."

"Perhaps a more important issue is whether MRI will allow identification of a subset of patients who require no breast irradiation, or perhaps only partial breast irradiation. Only a clinical trial can definitely resolve these issues. In the absence of trials with a clinical end point, breast cancer patients undergoing MRI should be advised that this step forward in technology may take them right back to the 1970s and result in a mastectomy for disease that can be controlled with radiation," Dr. Morrow writes.

(JAMA. 2004; 292: 2779-2780. Available post-embargo at www.jama.com)

The JAMA Network Journals

Related Breast Cancer Articles from Brightsurf:

Oncotarget: IGF2 expression in breast cancer tumors and in breast cancer cells
The Oncotarget authors propose that methylation of DVDMR represents a novel epigenetic biomarker that determines the levels of IGF2 protein expression in breast cancer.

Breast cancer: AI predicts which pre-malignant breast lesions will progress to advanced cancer
New research at Case Western Reserve University in Cleveland, Ohio, could help better determine which patients diagnosed with the pre-malignant breast cancer commonly as stage 0 are likely to progress to invasive breast cancer and therefore might benefit from additional therapy over and above surgery alone.

Partial breast irradiation effective treatment option for low-risk breast cancer
Partial breast irradiation produces similar long-term survival rates and risk for recurrence compared with whole breast irradiation for many women with low-risk, early stage breast cancer, according to new clinical data from a national clinical trial involving researchers from The Ohio State University Comprehensive Cancer Center - Arthur G.

Breast screening linked to 60 per cent lower risk of breast cancer death in first 10 years
Women who take part in breast screening have a significantly greater benefit from treatments than those who are not screened, according to a study of more than 50,000 women.

More clues revealed in link between normal breast changes and invasive breast cancer
A research team, led by investigators from Georgetown Lombardi Comprehensive Cancer Center, details how a natural and dramatic process -- changes in mammary glands to accommodate breastfeeding -- uses a molecular process believed to contribute to survival of pre-malignant breast cells.

Breast tissue tumor suppressor PTEN: A potential Achilles heel for breast cancer cells
A highly collaborative team of researchers at the Medical University of South Carolina and Ohio State University report in Nature Communications that they have identified a novel pathway for connective tissue PTEN in breast cancer cell response to radiotherapy.

Computers equal radiologists in assessing breast density and associated breast cancer risk
Automated breast-density evaluation was just as accurate in predicting women's risk of breast cancer, found and not found by mammography, as subjective evaluation done by radiologists, in a study led by researchers at UC San Francisco and Mayo Clinic.

Blood test can effectively rule out breast cancer, regardless of breast density
A new study published in PLOS ONE demonstrates that Videssa® Breast, a multi-protein biomarker blood test for breast cancer, is unaffected by breast density and can reliably rule out breast cancer in women with both dense and non-dense breast tissue.

Study shows influence of surgeons on likelihood of removal of healthy breast after breast cancer dia
Attending surgeons can have a strong influence on whether a patient undergoes contralateral prophylactic mastectomy after a diagnosis of breast cancer, according to a study published by JAMA Surgery.

Young breast cancer patients undergoing breast conserving surgery see improved prognosis
A new analysis indicates that breast cancer prognoses have improved over time in young women treated with breast conserving surgery.

Read More: Breast Cancer News and Breast Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.