Radiologists should carefully consider the use of MRI-directed ultrasound in patients with newly diagnosed breast cancer, experts charged in a new analysis published Monday.
Magnetic resonance maintains high sensitivity, proving useful for supplemental screening or planning prior to surgery. But its low specificity at distinguishing those who have disease poses potential challenges, often leading to further evaluation with ultrasound, potentially to guide biopsy, Mayo Clinic researchers detailed in Clinical Imaging.
Radiologist Santo Maimone, MD, and colleagues set out to evaluate the effectiveness of MRI-directed ultrasound, contending the appropriate use of this tool is of “utmost importance” as patients await triage. They’re urging others to “choose wisely” when using this strategy, especially among those with new diagnoses.
“Not all implementations of MRI-directed US are high-yield, with some adding time, costs, and potentially unnecessary workups or biopsies,” Maimone, a breast imaging specialist with Mayo’s Department of Radiology in Jacksonville, Florida, and colleagues wrote Sept. 6. “Utilization of US following MRI is variable, both among and within practices, as are success rates for sonographic detection.”
For their study, researchers retrospectively analyzed instances where breast cancer patients underwent MRI at a single institution, spanning 2006-2017. Altogether, 275 patients received MRI-directed US for 361 breast lesions, with nearly 52% found on ultrasound. Out of those detected, 91.4% (or 171) were masses and 8.6% were nonmass enhancements, with masses 14 times more likely to be seen, the authors noted. Masses with irregular shapes or margins and invasive carcinomas were more frequently detected.
“Sonographic detection rate for NME was 16% in this study, in a population of patients with breast cancer in which additional malignant involvement might be anticipated, further demonstrating its ineffectiveness for this task,” the research team concluded. “Fine-tuning the utilization of MRI-directed US will prevent downstream practice inefficiencies and could help simplify surgical and oncologic management plans for patients with new breast cancer diagnoses. As MRI access and throughput increase, practices should reexamine their use of MRI-directed US and consider proportionally increasing MRI biopsy capacity to accommodate additional procedures.”
Read more about their findings in Clinical Imaging here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.