As reported in JAMA by Christiane K. Kuhl, MD, PhD, and colleagues, the ECOG-ACRIN EA1141 trial has shown that abbreviated breast magnetic resonance imaging (MRI) was associated with a significantly higher invasive breast cancer detection rate vs digital breast tomosynthesis among women with dense breasts.
Christiane K. Kuhl, MD, PhD
Study Details
The cross-sectional study involved 1,444 evaluable average-risk women aged 40 to 75 with heterogeneously dense or extremely dense breasts undergoing routine screening between December 2016 and November 2017 at 47 sites in the United States and 1 in Germany. All women underwent screening by both abbreviated breast MRI and digital breast tomosynthesis, performed in randomized order and read independently.
The primary endpoint was invasive cancer detection rate. Core or surgical biopsy pathology was the reference standard for the cancer detection rate.
Abbreviated MRI vs Digital Breast Tomosynthesis
Among the 1,444 women (of 1,516 enrolled) who completed both examinations, the reference standard was positive for invasive cancer with or without ductal carcinoma in situ (DCIS) in 17 women and for DCIS alone in an additional 6 women. No interval cancers were observed during follow-up.
KEY POINTS
- Abbreviated breast MRI was associated with a significantly higher invasive cancer detection rate vs digital breast tomosynthesis.
- For detection of invasive disease and DCIS, sensitivity was 95.7% vs 39.1% and specificity was 86.7% vs 97.4%.
Abbreviated MRI identified all 17 women with invasive cancer and 5 of 6 with DCIS. Digital breast tomosynthesis identified 7 of 17 women with invasive cancer and 2 of 6 with DCIS. The invasive cancer detection rate was 11.8 per 1,000 women for abbreviated MRI vs 4.8 per 1,000 women for digital breast tomosynthesis (difference = 7/1,000 women, P = .002).
For detection of invasive disease and DCIS, sensitivity was 95.7% vs 39.1% (P = .001) and specificity was 86.7% vs 97.4% (P < .001). Positive predictive value of biopsy was 19.6% (21 of 107 women) vs 31.0% (9 of 29 women; P = .15). Additional imaging (through callback or short-term follow-up) was required in 7.5% vs 10.1% of women (P = .02; not significant after Bonferroni adjustment).
In post hoc analysis, sensitivity, specificity, and positive predictive value for abbreviated MRI vs digital breast tomosynthesis using invasive cancer alone as the reference standard were 100% vs 41.2%, 86.4% vs 97.3%, and 15.0% vs 24.1%.
The investigators concluded: “Among women with dense breasts undergoing screening, abbreviated breast MRI, compared with digital breast tomosynthesis, was associated with a significantly higher rate of invasive breast cancer detection. Further research is needed to better understand the relationship between screening methods and clinical outcome.”
Dr. Kuhl, of the Department of Diagnostic and Interventional Radiology, University Hospital Aachen, is the corresponding author for the JAMA article.
Disclosure: The study was supported by grants from the National Cancer Institute and funding from Bracco Diagnostics Inc. For full disclosures of the study authors, visit jamanetwork.com.
