When it comes to early breast cancer detection, which medical imaging modality is best: full-field digital mammography, digital breast tomosynthesis, or breast MRI? A new study in Clinical Radiology picks winners – and brings the receipts.
Breast imagers are fortunate to have many technologies at their disposal, each with its own strengths and weaknesses.
- X-ray-based mammography tools like FFDM and DBT are easily available and relatively low cost, while breast MRI delivers the highest resolution but is expensive, less available, and more time-intensive to perform.
So when does it make sense to use each modality? Researchers from China tested four techniques – FFDM, DBT, and breast MRI at 1.5T with accelerated and full protocols – in 329 patients with early-stage breast cancer (maximum tumor diameter ≤ 2 cm).
- They also analyzed results according to breast tissue density, as dense breast tissue is not only a cancer risk factor but can also obscure lesions on X-ray-based modalities.
Across the study sample, researchers found…
- There was little difference in sensitivity between the four techniques for women with non-dense breast tissue, with FFDM, DBT, and accelerated breast MRI achieving 91% compared to 94% for full-protocol breast MRI.
- But breast MRI pulled ahead in sensitivity for women with dense breast tissue, both with accelerated and full protocols (95% and 94%) beating DBT and FFDM (90% and 83%).
- Accelerated breast MRI had performance comparable to the full protocol regardless of breast density, but at almost half the median scan time (8 vs. 15 minutes).
- Accelerated and full-protocol breast MRI had the same specificity (94%), ahead of both DBT and FFDM (88% and 83%).
What to make of the results? Researchers said the findings in women with non-dense breast tissue reinforce that X-ray-based modalities are sufficient.
- For women with dense breast tissue, accelerated breast MRI offers performance close enough to the full protocol that breast imaging practices can feel comfortable offering the faster exam.
The Takeaway
It’s no surprise that breast MRI beat both FFDM and DBT mammography for early breast cancer detection in women with dense breast tissue. But it is intriguing that there wasn’t much difference between breast MRI with either accelerated or full protocols. That’s good news for practices that want to make this powerful modality accessible to more women.