When breast ultrasound fails to differentiate between intraductal papilloma (IDP) and ductal secretions, emerging research suggests that abbreviated breast magnetic resonance imaging (MRI) may be a viable alternative.
For a new retrospective study, recently published in the European Journal of Radiology, researchers compared the use of abbreviated MRI (AB-MRI) and full diagnostic breast MRI (FDB-MRI) in 62 patients (mean age of 46.05) who had inconclusive ultrasound findings. The AB-MRI protocol consisted of fat-suppressed pre-contrast T1 MRI, initial post-contrast T1 MRI and subtracted images from FDB-MRI, according to the study.
While FDB-MRI offered higher sensitivity than AB-MRI (87.5 percent vs. an average of 70.85 percent for two reviewing radiologists), the study authors noted no statistically significant difference for either MRI approach in comparison to pathology results that confirmed 48 cases of IDPs.
The researchers pointed out that FDB-MRI protocol can take between 25 to 30 minutes to perform in contrast to six to seven minutes for AB-MRI. The average reading time for FDB-MRI was 71.21 seconds in comparison to 43.49 seconds for AB-MRI, according to the study authors.
“Our study demonstrates that AB-MRI can be used as a cost-effective and time-saving imaging tool in the differentiation of IDP and ductal secretion. Our findings support that AB-MRI provides moderate-to-high diagnostic accuracy in making this distinction and significantly reduces imaging and interpretation times,” wrote lead study author Gulbanu Guner, M.D., who is affiliated with the Department of Radiology at the Umraniye Training and Research Hospital in Istanbul, Turkey, and colleagues.
Three Key Takeaways
1. AB-MRI Is a time- and cost-efficient alternative. For detection of intraductal papillomas (IDPs), abbreviated breast MRI (AB-MRI) significantly reduces imaging and interpretation time compared to full diagnostic breast MRI (FDB-MRI), taking about 6–7 minutes versus 25–30 minutes for imaging, and 43.49 seconds versus 71.21 seconds for interpretation.
2. Comparable diagnostic performance to FDB-MRI. Despite FDB-MRI having higher sensitivity, AB-MRI demonstrated no statistically significant difference in diagnostic accuracy for differentiating between IDPs and ductal secretions when compared to pathology results.
3. Higher specificity with AB-MRI. AB-MRI showed slightly higher specificity (57.14 percent) than FDB-MRI (50 percent), possibly due to its focused sequence evaluation, which may help reduce false positives caused by benign enhancing findings.
The study authors also noted comparable positive predictive value (PPV) between FDB-MRI (85.71 percent) and AB-MRI (an average of 84.96 percent). While acknowledging a lack of statistical significance, the researchers found that AB-MRI offered higher specificity (57.14 percent) in contrast to FDB-MRI (50 percent).
“This finding may reflect the focused evaluation of key post-contrast sequences, which potentially minimizes overinterpretation of subtle, non-specific findings. In contrast, the broader sequence set in FDB-MRI may increase false-positive rates by revealing benign enhancing foci such as adenosis or fibrosis,” pointed out Guner and colleagues. “Differences in patient population or lesion characteristics could also contribute to this observation, underscoring the importance of protocol optimization.”
(Editor’s note: For related content, see “Abbreviated MRI and Contrast-Enhanced Mammography Provide Fourfold Higher Cancer Detection than Breast Ultrasound,” “Study: Abbreviated Breast MRI Offers Equivalent Accuracy to mpMRI for Women with Dense Breasts” and “Study Questions Utility of Ultrafast Breast MRI for Challenging Lesions and Moderate/Marked BPE.”)
Beyond the inherent limitations of a single-center retrospective study, the authors acknowledged the small cohort size and lack of external validation.
