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Breast cancer screening with MRI: more false-positives, more biopsies
Clinical Question
Does breast cancer screening with magnetic resonance imaging, alone or with mammography, improve diagnostic yield?
Bottom line
Screening with magnetic resonance imaging (MRI) is not for everyone. Women who undergo breast cancer screening with MRI are much more likely to be referred for biopsy—that will ultimately be negative—than if they have screening mammography alone. This is even true of women with a personal history of breast cancer. The benefit of possible early detection of breast cancer with MRI has to be carefully weighed against unnecessary additional diagnostic maneuvers. 2b
Reference
Study design: Cohort (prospective)
Funding: Government
Setting: Outpatient (any)
Synopsis
This study analyzed data collected in 6 Breast Cancer Surveillance Consortium registries throughout the United States, comprising 812,164 women undergoing a total of 2,048,994 digital mammographies, breast MRIs, or both between the years of 2003 and 2013. Most women had no history of breast cancer; those who did have a personal history of breast cancer received their diagnosis at least 6 months prior. In women without a personal history of breast cancer, age-adjusted biopsy rates were much higher following MRI than mammography alone: 8.47% versus 1.49%. Ductal carcinoma in situ and invasive biopsy yield were significantly higher following mammography in women with a prior history of breast cancer. High-risk benign lesions (lobular carcinoma and atypical hyperplasia) were more commonly identified by MRI, regardless of personal history of breast cancer.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Not sure how available this is in Canada
We gp’s used to biopsy 2 to 3 suspicious skin moles for each confirmed malignancy. Then the payment agency denied payment for each biopsy proven non-malignant. The move was supposed to save harms. No one counted the catastrophic harms to patients with missed malignant melanomas.
On reste un peu coincé par les rapports des radiologues quand ils nous recommandent un MRi et décevant que même ce to n’augmente pas la certitude qu’une lésion est bénigne.
good poem