CAD for MRI – pro

M Levin, MD — Thu, 30 Aug 2012 17:20:43 +0000

CAD assists radiologist in interpreting MRIs by color coding areas with differing accumulation of contrast. Its value has not been proven. Computer-aided detection has been used to aid radiologists’ interpretation of contrast-enhanced MRI of the breast, which is sometimes used as an alternative to mammography or other screening and diagnostic tests because of its high sensitivity in detecting breast lesions, even among those in whom mammography is less accurate (e.g., younger women and those with denser breasts). The BlueCross and BlueShield Association’s Technology Evaluation Center (TEC) Medical Advisory Panel (2006) assessed the evidence on the use of CAD with MRI of the breast by comparing the sensitivity, specificity, and recall rate (percentage of patients asked to come back for further evaluation) of MRI with and without the use of commercially available CAD systems in detecting malignant lesions, evaluating the extent of disease in women with cancer, or gauging the impact of treatment. According to this assessment, many of the studies on the use of CAD with MRI of the breast mainly reported on the development of CAD systems, or testing new CAD approaches. The assessment noted that few of them evaluated commercially available CAD systems. The TEC assessment stated that the literature is unclear on how CAD systems are to be used. In the case of CAD with mammography, the radiologist reads the original films first, makes a diagnosis, and then reviews the CAD results. Based on the available evidence, the Blue Cross and Blue Shield Association Medical Advisory Panel concluded that there is insufficient evidence to evaluate if the use of CAD systems would maintain or increase the sensitivity, specificity, and recall rates of MRI of the breast. The TEC assessment concluded that, given the inability to evaluate these intermediate outcomes, it is impossible to evaluate the impact of CAD on health outcomes such as treatment success and survival of patients with breast cancer. As such, the CAD method required farther testing and is investigational.

Bruening W, Launders J, Pinkney N, et al. Effectiveness of noninvasive diagnostic tests for breast abnormalities. Comparative Effectiveness Review No. 2. Prepared by the ECRI Evidence-Based Practice Center for the Agency for Healthcare Research and Quality (AHRQ). AHRQ Publication No. 06-EHC005-EF. Rockville, MD: AHRQ; February 2006.

Muralidhar GS, Bovik AC, Sampat MP et al. Computer-aided diagnosis in breast magnetic resonance imaging. Mt Sinai J Med. 2011 Mar-Apr; 78(2):280-90. doi: 10.1002.msj.20248.

Dorrius MD, der Weide MC, van Ooijen PM et al. Computer-aided detection in breast MRI: a systematic review and meta-analysis. Eur Radiol. 2011 Aug;21(8):1600-8. Epub 2011 Mar 15

Sung Eun Song et al, Computer-aided detection (CAD) system for breast MRI in assessment of local tumor extent, nodal status, and multifocalit Cancer Imaging201515:1

NCCN, Detection 2018

MRI to screen preoperatively for DCIS – pro

M Levin, MD — Wed, 20 Jun 2012 23:41:26 +0000

Most guidelines recommend breast MRI for screening in women with high-risk of developing breast cancer and to clarify diagnostic uncertainties after mammography and ultrasound. As use of MRI has increased, many other situations for which, MRI might be helpful came to the fore. Unfortunately, literature support for most of them, is lacking.

Currently, guidelines indicate MRI for screening of women at high risk based on family history or for clarifying diagnostic dilemmas that are unable to be clarified by mammography and ultrasound. Some physicians adopt the strategy of using MRI to decide between a mastectomy and lumpectomy, when DCIS is present. The reasoning is that if widespread DCIS is found, a mastectomy would be performed rather than a lumpectomy. This strategy has not been formally evaluated and is not recommended by guidelines. A clinical trial is ongoing: Breast MRI as a Preoperative Tool for DCIS, NCT00605982. The purpose of this study is to see how often MRI can find other areas of cancer in women with one area of breast cancer, and to determine how having the MRI test affects their treatment. The study also aims to follow women who enter the study over a 10-year period to determine how often the breast cancer comes back.

ACR says: ” Invasive carcinoma and ductal cardinoma in situ (DCIS) – Breast MRI may be useful to determine the extent of disease and the presence of multifocality and multicentricity in patients with invasive carcinoma and ductal carcinoma in situ (DCIS). MRI can detect occult disease up to 15% to 30% of the time in the breast containing the index malignancy. MRI determines the extent of disease more accurately than standard mammography and physical examination in many patients. It remains to be conclusively shown that this alters recurrence rates relative to modern surgery, radiation, and systemic therapy.”

REFERENCES:

Kuhl CK, Schrading S, Bieling HB, et al. MRI for diagnosis of pure ductal carcinoma in situ: A prospective observational study. Lancet. 2007;370(9586):485-492.

http://www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/breast/MRI_Breast.pdf – 2008

Read the Layperson version here.

Cancer Treatment Today » MRI

CAD for MRI – pro

MRI to screen preoperatively for DCIS – pro