Title:Clinical Usefulness of Abbreviated MRI Protocol in Breast Cancer Detection
Volume: 20
Author(s): Marlina Tanty Ramli Hamid*, Kai Seng Loi, Wai Yee Chan, Nazimah Ab Mumin, Shamsiah Abdul Hamid, Faizatul Izza Rozalli and Kartini Rahmat*
Affiliation:
- Department of Radiology, Faculty of Medicine, University Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Department of Biomedical Imaging, University Malaya Research Imaging Centre, Kuala Lumpur, Malaysia
Keywords:
Full diagnostic protocol, Abbreviated protocol, MRI, Breast cancer, Screening, Benign, Malignant.
Abstract:
Background:
The use of breast MRI for screening has increased over the past decade, mostly in women with a high risk of breast cancer. Abbreviated breast
MRI (AB-MR) is introduced to make MRI a more accessible screening modality. AB-MR decreases scanning and reporting time and the overall
cost of MRI.
Objective:
This study aims to evaluate the diagnostic efficacy of abbreviated MRI protocol in detecting breast cancer in screening and diagnostic populations,
using histopathology as the reference standard.
Materials and Methods:
This is a single-centre retrospective cross-sectional study of 134 patients with 198 histologically proven breast lesions who underwent full
diagnostic protocol contrast-enhanced breast MRI (FDP-MR) at the University Malaya Medical Centre (UMMC) from 1st January 2018 to 31st
December 2019. AB-MR was pre-determined and evaluated with regard to the potential to detect and exclude malignancy from 3 readers of
varying radiological experiences. The sensitivity of both AB-MR and FDP-MR were compared using the McNemar test, where both protocols'
diagnostic performances were assessed via the receiver operating characteristic (ROC) curve. Inter-observer agreement was analysed using Fleiss
Kappa.
Results:
There were 134 patients with 198 lesions. The average age was 50.9 years old (range 27 – 80). A total of 121 (90%) MRIs were performed for
diagnostic purposes. Screening accounted for 9.4% of the cases, 55.6% (n=110) lesions were benign, and 44.4% (n=88) were malignant. The
commonest benign and malignant lesions were fibrocystic change (27.3%) and invasive ductal carcinoma (78.4%). The mean sensitivity,
specificity, positive predictive value, and negative predictive value for AB-MR were 0.96, 0.57, 0.68 and 0.94, respectively. Both AB-MR and
FDP-MR showed excellent diagnostic performance with AUC of 0.88 and 0.96, respectively. The general inter-observer agreement of all three
readers for AB-MR was substantial (k=0.69), with fair agreement demonstrated between AB-MR and FDP-MR (k=0.36).
Conclusion:
The study shows no evidence that the diagnostic efficacy of AB-MR is inferior to FDP-MR. AB-MR, with high sensitivity, has proven its
capability in cancer detection and exclusion, especially for biologically aggressive cancers.
