In summary, this is a complete, concise, updated text on MR mammog-raphy.
An overview of breast MRI
It will be most beneficial as a reference for users who prefer the European approach to breast MR imaging, which uses subtracted dynamic imaging methods. The image quality may be disappointing for those who favor high-spatial-resolution anatomic images for interpretation, but the book has value as a reference for pathologic lesion categorization that is unique for current breast MR imaging texts.
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Digital Posters Close Figure Viewer. Previous Figure Next Figure. A total of women were clinically asymptomatic and therefore eligible for study participation. Of those, 49 women underwent only one surveillance round and were lost to follow-up thereafter. The data sets of these women were discarded from analysis because of lack of validation. Accordingly, the final study cohort consisted of a total of clinically asymptomatic high-risk women. Demographic data, mutational status, fraction of women with or without personal history of breast cancer, and familial risk levels of the final cohort are listed in [ Table 1 ].
Women were observed for a mean observation period of 5. Prevalence and incidence of breast cancer in the cohort were calculated for the entire observation period of 1, woman-years. The analysis of the diagnostic accuracy of the three imaging techniques under investigation was based on a total 1, annual surveillance rounds for which data on all three imaging modalities were available. Data of another annual surveillance rounds that were collected in 86 of participants during the first 2 years of the study were incomplete in that no mammogram was obtained in accordance with the protocol specified below ; these data sets were not considered for analysis of diagnostic accuracies.
In the entire cohort of participants, a total of 43 breast cancers were identified in 41 patients: 34 invasive cancers and nine DCIS. Thirty-one cancers were identified in 30 women without previous history of cancer, and another 12 cancers in 11 women with history of breast cancer.
Two cancers were palpable at the time of diagnosis one at the regular screening interval; one was the interval cancer diagnosed in-between screening rounds ; the remaining cancers were clinically asymptomatic ie, not palpable. None of the 43 cancers were diagnosed by CBE alone; the two cancers that were clinically palpable at the time of diagnosis were also visualized with breast ultrasound and MRI yet not with mammography.
Practical MR Mammography eBook by Uwe Fischer - | Rakuten Kobo
The diagnostic indices of the three imaging modalities were, however, calculated per breast with cancer, not per single cancer. The diagnostic indices of the different imaging modalities in the different risk categories are listed in [ Tables 2 ] through [ 4 ].
TNM stages and nuclear gradings of primary cancers are listed in [ Table 5 ]. Prognostically relevant details of the cancers itemized by imaging mode of detection are listed in [ Table 6 ]. Of the 40 cancers that were diagnosed by imaging studies, 14 cancers were identified by mammography, 17 cancers were identified by ultrasound, 21 cancers were identified if mammography and ultrasound were combined, 39 cancers were identified by MRI, and all 40 cancers were identified if MRI was combined with mammography.
The one additional cancer that was diagnosed only by means of mammography was a recurrent DCIS plus microinvasive component in a year-old patient. This lesion had been correctly classified as suggestive of abnormality BI-RADS 4 on mammography due to clustered calcifications that had newly developed compared with previous films.
Focus and foci
The lesion had also been identified, but falsely categorized as probably benign on MRI. No additional cancer was diagnosed only by means of ultrasound at the regular annual surveillance rounds.
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However, two of the 43 cancers were diagnosed at the half-yearly ultrasound screening study. Nineteen cancers were diagnosed only by means of MRI [ Fig 1 ] ; these included five intraductal all high grade and 14 invasive cancers with a median size of 7.
In both groups, MRI maintained its high sensitivity level [ Table 2 ]. The rate of recommendations for short-term follow-up did not differ statistically significantly between mammography and MRI; both mammography and MRI had significantly lower rates of BI-RADS 3 categories compared with breast ultrasound. If mammography and ultrasound were read in combination, the number of false-positive diagnoses increased to None of these findings turned out to be breast cancer on follow-up. In this prospective cohort study comparing three different breast imaging modalities mammography, high-frequency breast ultrasound, and MRI in patients at high familial risk for breast cancer, we found that MRI had the highest sensitivity, specificity, and positive predictive value for the detection of invasive as well as of intraductal cancer.
Among the total study population, 19 cancers were diagnosed by means of MRI alone, whereas only one a second primary cancer was diagnosed by means of mammography alone. Our results demonstrate that systematic surveillance with MRI allows an early diagnosis of familial or hereditary breast cancer. MRI of the breast has already been demonstrated to be of clinical value for local staging before breast cancer surgery and for the assessment of patients with inconclusive conventional imaging findings. However, MRI in our hands offered the highest sensitivity for invasive as well as intraductal cancers [ Table 6 ].
This high sensitivity was not achieved at the expense of specificity, which was equivalent to that achieved with mammography, and significantly higher than that achieved with breast ultrasound. We suppose that this is mainly due to the fact that in our cohort, all imaging studies—notably including MRI—were interpreted by readers who had substantial expertise with the respective imaging modalities. Our own primary results, [ 22 ] currently published material on MRI screening in women at increased genetic risk, [ 24 - 26 ] as well as these results after several years of follow-up are concordant in that MRI seems to be significantly more sensitive compared with mammography.
If breast ultrasound is used in combination with mammography, it can help compensate for some but by far not for all of the shortcomings of mammography, and it causes a substantial number of false-positive diagnoses. If MRI is available for surveillance, mammography proved to be of limited and ultrasound of no additional value.
Practical MR Mammography: High-Resolution MRI of the Breast, Uwe Fischer
Screening ultrasound may, however, be useful to bridge the relatively long time interval between the annual surveillance rounds. In view of the insufficient diagnostic accuracy of mammography and breast ultrasound, we propose that breast MRI should be considered an integral part of surveillance programs for women at high familial risk—in particular in documented carriers of pathogenic BRCA mutations, but also for women without documented mutation.
However, it is noteworthy that also in this group, MRI offered the highest sensitivity while maintaining its high specificity—findings that may be used to justify further studies. Our data suggest that, compared with mammography or even the combined use of mammography and high-frequency breast ultrasound, surveillance with MRI does allow an earlier diagnosis of familial breast cancer.
It provides clear answers to all questions pertaining to MR mammography and support for special problems. Help Centre. Track My Order. My Wishlist Sign In Join. Be the first to write a review. Add to Wishlist. Ships in 15 business days. Link Either by signing into your account or linking your membership details before your order is placed. Description Product Details Click on the cover image above to read some pages of this book! A practical, systematic guide to performing and evaluating high-quality breast MRI from one of the world's leading authorities High-resolution MR mammography is superior to all other breast imaging modalities for the detection of invasive and intraductal breast cancer forms.
How does one proceed during the examination? How does one arrive at a diagnosis precisely and reliably? How can mistakes be avoided?