Abbreviated MRI is superior to whole-breast ultrasound for detection of cancer in dense breasts

1. Abbreviated MRI detected three times as many invasive cancers compared with ABUS.

2. Contrast-enhanced mammography detected a greater number of invasive cancers compared to ABUS, although this was not statistically significant.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Women with dense breasts face barriers in breast cancer detection since standard mammograms are less effective for them. It is unclear which supplemental imaging method works best for the detection of breast malignancies in this group. This randomized controlled trial aimed to compare abbreviated MRI, automated breast ultrasound (ABUS), and contrast-enhanced mammography with standard mammography in detecting cancer among women with dense breasts. The primary outcome of this study was the rate of cancer detection, while the key secondary outcome was the recall and biopsy rates resulting from each supplemental imaging technique. According to study results, abbreviated MRI and contrast-enhanced mammography detected three times more invasive cancers than ABUS. Although this study was well done, it was limited by not addressing the potential for overdiagnosis associated with additional cancer detection.

Click to read the study in The Lancet

Relevant Reading: Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence

In-depth [randomized controlled trial]: Between Oct 18, 2019, and Mar 30, 2024, 37,774 patients were screened for eligibility across 10 breast screening sites in the UK. Included were patients aged 50–70 with dense breasts and a negative screening mammogram who were invited to undergo supplemental imaging. Altogether, 6,305 patients (2,130 in abbreviated breast MRI, 2,141 in ABUS, and 2,034 in contrast-enhanced mammogram) were included in the final analysis. The primary outcome of cancer detection rate was highest for contrast-enhanced mammography (19.2 per 1000, 95% confidence interval [CI] 13.7-26.1) and abbreviated MRI (17.4 per 1000, 95% 12.2-23.9), both significantly higher than ABUS (4.2 per 1000, 95% 1.9-8.0). The detection rate for abbreviated MRI was significantly higher than for ABUS (p=0.047). Overall, findings from this study suggest that abbreviated MRI and contrast-enhanced mammography are more effective than ABUS at detecting breast cancer in women with dense breasts.

Image: PD

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