Breast Density Changes the Breast-imaging Landscape

Cristen Bolan, MS

Disclosures

Appl Radiol. 2013;42(3):20-25. 

In This Article

Roles of Breast MRI and MBI

Breast MRI is the gold standard for acquiring functional data for high-risk patients with dense breasts and patients with a strong family or genetic history (BRCA1 or BRCA2 genes) of breast disease. Although breast MRI is not a routine screening procedure, the study led by Dr. Berg[5] found MRI detected additional invasive cancers not seen on mammography or ultrasound.

Still, there has been criticism of breast MRI for its high false-positive rates, resulting in unnecessary biopsies, surgical procedures, and anxiety for the patient. "Those false-positive rates are higher in conventional breast MRI systems than in dedicated breast MRI units," said Alan Hollingsworth, MD, Medical Director, breast surgeon at Mercy Women's Center at Mercy Health Center, Oklahoma City, OK.

In a recent multi-center trial,[8] managed by ACR Image Metrix (the American College of Radiology's clinical research organization), Dr. Hollingsworth and other researchers found that dedicated breast MR systems led to better diagnostic performance for sensitivity, specificity, negative predictive value, positive predictive value, and area under the receiver operating characteristic curve than what has been reported for breast MR imaging on conventional breast MRI systems.

"False-positive rates from previously reported trials using whole-body breast MRI have typically been between 30% to 50%. The dedicated breast MRI system offers a significant improvement in performance," noted Dr. Hollingsworth. "Even within the 93 false positives, 27% were high-risk histologies, for which excision is often recommended.[8] This kind of performance should provide breast radiologists and surgeons alike with a higher level of diagnostic confidence, and could have significant impact on the role of breast MRI."

While most conventional MRI systems have special coils for breast imaging, there is only one FDA-approved MRI device designed specifically for breast imaging. The unit is the Aurora 1.5T Dedicated Breast MRI System with Bilateral SpiralRODEO, and it was the MRI system used in the study. The low frequency of false-positive and false-negative findings associated with this dedicated breast MRI system may allow for use of breast MRI with low-risk patients in both the screening and diagnostic environments.

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