1. In a large cohort of women who underwent breast magnetic resonance (MR) imaging, a significant number had extramammary findings, a minority of which were clinically important.
2. Additional imaging studies and follow-up evaluation of incompletely characterized extramammary findings identified using breast MR imaging was not associated with significantly higher cost.
Evidence Rating Level: 2 (Good)
Study Rundown: Breast MR imaging provides information on a wealth of physical and physiologic tissue features and depicts, with high spatial resolution, the cross-sectional anatomy of breast lesions. The modality has accordingly emerged as an important tool to help detect, diagnose, and stage breast cancer. As with any imaging test, there exists the potential for incidental findings, the frequency and significance of which are not always readily apparent. The goal of the present study was to review and evaluate the frequency of such findings on breast MR imaging and to explore the clinical impact of additional imaging with particular attention paid to patient outcomes and cost. The results suggest that a significant percentage of breast MR imaging studies contain incidental findings, and that many of these findings provoke additional radiographic evaluation. Less than one percent of breast MR imaging studies contained clinically-significant incidental findings, the most common of which were unknown extramammary malignancies. Follow-up imaging evaluation as a result of incidental findings was associated with a minimal increase in overall health care expenditures. The primary limitation of the trial was its retrospective methodology and reliance on dictated radiology reports rather than direct image visualization. These results underscore the importance of clinical practice guidelines for incidental finding management and emphasize the low prevalence of unexpected disease in patients undergoing advanced breast imaging.
Click to read the study in Radiology
Relevant Reading: Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer
In-Depth [retrospective cohort]: A review was undertaken of breast MR imaging examinations performed over a one-year period using an institutional database. Both screening and diagnostic studies were included for evaluation. Reports were reviewed for the presence or absence of incidental extramammary findings, alongside any recommendations for further evaluation. Incidental findings were categorized according to the computed tomography (CT) colonography reporting and data system (C-RADS) scheme. Of the 2324 imaging reports reviewed, 391 (16.8%) had incidental extramammary findings. A total of 105 findings (4.5%) with either E3 or E4 C-RADS grades—indicating need for follow-up imaging—were analyzed with respect to management and clinical outcomes. Overall, 86 patients (3.7%; CI95% 3.0-4.5%) underwent further imaging and a clinically important finding was found in nine patients (0.4%; CI95% 0.2%-0.7%), including 5 undiagnosed malignancies. Additional imaging evaluations for incidental extramammary findings contributed an additional $16, on average, to the cost of each patient’s care.
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Image: PD
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