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DCE-MRI of the breast in a stand-alone setting outside a complementary strategy - results of the TK-study

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Abstract

Objectives

To evaluate the accuracy of MRI of the breast (DCE-MRI) in a stand-alone setting with extended indications.

Materials and methods

According to the inclusion criteria, breast specialists were invited to refer patients to our institution for DCE-MRI. Depending on the MR findings, patients received either a follow-up or biopsy. Between 04/2006 and 12/2011 a consecutive total of 1,488 women were prospectively examined.

Results

Of 1,488 included patients, 393 patients were lost to follow-up, 1,095 patients were evaluated. 124 patients were diagnosed with malignancy by DCE-MRI (76 TP, 48 FP, 971 TN, 0 FN cases). Positive cases were confirmed by histology, negative cases by MR follow-ups or patient questionnaires over the next 5 years in 1,737 cases (sensitivity 100 %; specificity 95.2 %; PPV 61.3 %; NPV 100 %; accuracy 95.5 %). For invasive cancers only (DCIS excluded), the results were 63 TP; 27 FP; 971 TP and 0 FN (sensitivity 100 %; specificity 97.2 %; PPV 70 %; NPV 100 %; accuracy 97.5 %).

Conclusion

The DCE-MRI indications tested imply that negative results in DCE-MRI reliably exclude cancer. The results were achieved in a stand-alone setting (single modality diagnosis). However, these results are strongly dependent on reader experience and adequate technical standards as prerequisites for optimal diagnoses.

Key Points

• DCE-MRI of the breast has a high accuracy in finding breast cancer.

• The set of indications for DCE-MRI of the breast is still very limited.

• DCE-MRI can achieve a high accuracy in a ‘screening-like’ setting.

• Accuracy of breast DCE-MRI is strongly dependent on technique and reader experience.

• A negative DCE-MRI effectively excludes cancer.

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Acknowledgments

The scientific guarantor of this publication is Prof. Dr. med. Stefan O. Schoenberg. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Clemens G. Kaiser, J. Krammer, K. Wasser & S. O. Schoenberg

  2. Institute of Diagnostic and Interventional Radiology I, Friedrich-Schiller-University Hospital Jena, Jena, Germany

    C. Reich & W. A. Kaiser

  3. Department of Neuroradiology, Friedrich-Alexander-University Hospital Erlangen-Nürnberg, Erlangen, Germany

    M. Dietzel

  4. Institute of Radiology and Nuclear Medicine, Medical University Vienna, Vienna, Austria

    P. A. T. Baltzer

Authors
  1. Clemens G. Kaiser
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  2. C. Reich
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  3. M. Dietzel
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  4. P. A. T. Baltzer
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  5. J. Krammer
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  6. K. Wasser
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  7. S. O. Schoenberg
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  8. W. A. Kaiser
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Corresponding author

Correspondence to Clemens G. Kaiser.

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Kaiser, C.G., Reich, C., Dietzel, M. et al. DCE-MRI of the breast in a stand-alone setting outside a complementary strategy - results of the TK-study. Eur Radiol 25, 1793–1800 (2015). https://doi.org/10.1007/s00330-014-3580-4

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  • DOI: https://doi.org/10.1007/s00330-014-3580-4

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