Professor Christiane Kuhl, Department of Radiology, University of Bonn, Germany and colleagues studied 7319 women over a five-year period who had been referred to an academic breast centre. The women received MRI in addition to conventional mammography for diagnostic assessment and screening, with the aim of discovering the sensitivity of each method for diagnosing ductal carcinoma in situ (DCIS). Mammograms and MRI scans were then assessed independently by different radiologists, and the relative sensitivity of each method of detection was assessed by comparing the biological profiles of mammography-detected DCIS with those of MRI-detected DCIS.
The researchers found that of 167 women who had a diagnosis of DCIS, 153 (92%) were diagnosed by MRI compared with 93 (56%) diagnosed by mammography. Whereas the sensitivity of MRI for diagnosing DCIS increased with nuclear grade, that of mammography decreased. Of 89 women diagnosed with “high grade” DCIS, 87 (98%) were diagnosed by MRI, but only 46 (52%) by mammography. Accordingly, almost half (48%) were missed by mammography but diagnosed by MRI alone. They also found that age, menopausal status, personal or family history of breast cancer, and breast density of women with MRI-only diagnosed disease did not differ significantly from those of women with mammography-diagnosed DCIS. The higher sensitivity of MRI was not associated with an unduly high number of false positive diagnoses - the positive predictive value of both methods was comparable, with 55% for mammography, and 59% for MRI.
The authors conclude: “Our study suggests that the sensitivity of film screen or digital mammography for diagnosing DCIS is limited…MRI could help improve the ability to diagnose DCIS, especially DCIS with high nuclear grade.”
In the accompanying Comment, Dr Carla Boetes and Dr Ritse Mann, Radboud University Nijmegen Medical Centre, Netherlands, say: “These findings can only lead to the conclusion that MRI outperforms mammography in tumour detection and diagnosis. MRI should thus no longer be regarded as an adjunct to mammography but as a distinct method to detect breast cancer in its earliest stage. A large-scale multicentre breast-screening trial with MRI in the general population is essential.”
Tony Kirby | alfa
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