Oncology News
|
September 30, 2007
Magnetic Resonance Mammography in High-risk Patients
MR Mammography has evolved as a diagnostic adjunct for many aspects of breast imaging, yet where it has shown the most benefit is in high-risk patients.
The benefits of MR mammography are clearly understood in terms of sensitivity, specificity, and positive and negative predictive value. It has been found that certain types of breast cancer which cannot be detected with a conventional mammogram, on clinical examination, or with ultrasound, are often picked up by specialists using magnetic resonance mammography.
With support for a more confident diagnosis, doctors can deliver more targeted therapies. MR Mammography therefore may impact patient management and reduce overall cost of care for high-risk patients.
Research has helped validate these assumptions.
MRI for high-risk patients A study published recently by a group at the University of Milan proved that MRI enabled detection of otherwise unsuspected cancers in a population of women who were …
Of the 278 women who underwent breast cancer screening with traditional methods and the addition of MR mammography, cancer was detected in 18. Interestingly, 6 of those 18 (33%) were occult on all modalities except MRI. This study confirmed the value of MRI in surveillance of high-risk women and at the same time underscored the results cannot be applied to average- or low-risk patients.
Contralateral detection Another important study suggested that women with known cancer who receive magnetic resonance mammography examinations can benefit from the detection of early contralateral cancers.3
The study found that…
The detection rate is statistically significant and may impact care management from both the perspective of the patient as well as the financial burden on the healthcare industry.
Ipsilateral evaluation MR mammography also provides additional information for the evaluation of ipsilateral disease. Particularly in ductal carcinoma in situ, MR mammography has been found to help clinicians the true extent of disease – which is often more extensive than thought from initial mammographic or sonographic findings.3
Additional advantages A similar study revealed that MRI had the highest sensitivity, specificity and positive predictive value for the detection of invasive as well as intraductal cancers.4
Fine tuning care management A group of researchers at University of Chicago, Chicago, IL found that care management was altered with breast MRI in 22% of 140 known breast cancer patients who underwent MR mammography.
The MRI findings resulted in
They concluded that with MR mammography it may be possible to tailor treatment (in patients with unifocal lesions) with targeted therapies and/or percutaneous ablation.
Benefits are tangible All indications suggest that early diagnosis of patients at high-risk can impact overall care management.
For patients with an existing, previously undetected, early cancer in either the ipsilateral or contralateral breast, use of MR may help
For the healthcare system, synchronous treatment of multiple cancers and finely targeted therapies may have a substantial cost impact.
1 Morris E, et al. MRI of occult breast carcinoma in a high-risk population. AJR. 2003;181:619-626 2Sardanelli F, et al. High breast cancer risk Italian trial. Radiology. 2007;242:698-713 3Wiener J, et al. Assessment of suspected breast cancer by MRI: a prospective clinical trial using a combined kinetic and morphologic analysis. AJR. 2005;184:878-886 4Kuhl CK, et al. Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions? Radiology. 1999;211:101-110. 5 Newstead GM, et al. Breast MRI for cancer detection. Philips Advanced Breast MR Imaging and Spectroscopy Course; May 4-5, 2007; Cleveland, Ohio.
Related Links: + Read full clinical abstract by Bernadette M. Kaufman |
|
