Relative Timing of Mammography and MRI Screening Influences Diagnostic Performance
New BCSC study suggests that updated approaches for evaluating combined versus alternating breast cancer screening may improve the accuracy of multimodality performance evaluation
For women at high risk of developing breast cancer, screening with both mammography and supplemental MRI is recommended. While the timing of each test is not specified by guidelines, typically observed patterns include testing either in combination (MRI within 90 days of mammograph) or in alternating sequence (tests occurring approximately six months apart). Substantial overlap of follow-up periods after testing is a distinct feature of multimodality breast cancer screening, which is not accounted for in current American College of Radiology (ACR) recommendations for independent evaluation of each screening modality. During these overlapping follow-up periods, a single breast cancer can be attributed to multiple preceding screening examinations, influencing diagnostic performance evaluation.
In a new study published online in the Journal of the American College of Radiology, Breast Cancer Surveillance Consortium researchers evaluated 8,260 pairs of mammography and MRI examinations (3,810 combined screening pairs and 4,450 alternating screening pairs). Performance was calculated using ACR guidance, and also with approaches which eliminated overlapping follow up periods and attributed breast cancers to a single preceding screening test.
For combined screening, a single follow-up period that eliminated overlapping follow-up periods decreased false-negatives and increased cancer detection rates and sensitivity. For alternating screening, full capture of breast cancer outcomes for accurate performance calculation may depend on prospective designation of individuals selected for this testing strategy because supplemental MRI screens are not obtained after screen detection by the index mammogram. These results suggest that performance evaluation that considers separate approaches for assessing combined versus alternating screening performance can improve our understanding of the accuracy and effectiveness of multimodality screening strategies.
Lee JM, Ichikawa L, Kerlikowske K, Buist DSM, Lee CI, Sprague BL, Henderson LM, Onega T, Wernli KJ, Lowry KP, Stout NK, Tosteson ANA, Miglioretti DL. Relative timing of mammography and MRI for breast cancer screening: Impact on performance evaluation. J Am Coll Radiol 2024 Jul 3:S1546-1440(24)00597-0. doi: 10.1016/j.jacr.2024.06.020. PMID: 38969253. [Link]
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By: Janie Lee, MD