Contrast-enhanced magnetic resonance imaging (CE-MRI) may offer significant utility in ruling out breast cancer in patients with high-risk lesions, according to a new meta-analysis.
For the meta-analysis, recently published in European Radiology, researchers reviewed CE-MRI data from seven studies and 479 patients with a total of 493 high-risk breast lesions. The study authors noted an average breast cancer prevalence of 17 percent for patients from the reviewed studies.
The meta-analysis authors found that CE-MRI offered a pooled sensitivity of 91.3 percent. They also determined that CE-MRI provided a pooled specificity rate of 68.8 percent.
While there were six missed cases of small low-grade ductal carcinoma in situ (DCIS), the researchers pointed out that CE-MRI did not miss any invasive cancer.
“Given the natural history of DCIS, these findings suggest that MRI could safely rule out malignancy in a majority of high-risk lesions. This is highly relevant since high-risk lesions comprise a significant and rising amount of biopsy specimens, and their management is both more costly and invasive than in other breast lesions,” noted lead meta-analysis author Giulia Vatteroni, M.D., who is affiliated with the Department of Biomedical Sciences at Humanitas University in Milan, Italy, and colleagues.
In sub-analysis data, the researchers determined that that CE-MRI had pooled sensitivity of 91.3 percent and pooled specificity of 68.8 percent for the five retrospective studies included in the meta-analysis. For the two prospective studies, the meta-analysis authors noted a 90.9 percent pooled sensitivity and an 88.9 pooled specificity.
Three Key Takeaways
• High negative predictive value for invasive cancer. CE-MRI demonstrated high pooled sensitivity (approximately 91 percent) and did not miss any invasive cancers, supporting its role as a reliable tool to rule out malignancy in patients with high-risk breast lesions.
• Potential to reduce unnecessary surgery. With malignancy prevalence less than 2 percent in MRI-negative high-risk lesions and only a few missed low-grade DCIS cases, structured imaging follow-up may be a safe alternative to surgical excision for selected patients.
• Performance varies by study design and histology. CE-MRI showed higher specificity in prospective studies and good diagnostic performance in atypical ductal hyperplasia (ADH), suggesting particular value in tailored, histology-specific management pathways.
Examining the impact of CE-MRI in patients with high-risk histology, the researchers pointed out a 91 percent pooled sensitivity rate and a 63.9 percent pooled specificity among patients with mixed histology. For women who had atypical ductal hyperplasia (ADH), they found that CE-MRI provided pooled sensitivity and specificity of 92 percent and 74.6 percent respectively.
“Given that the prevalence of malignancy in MRI-negative high-risk lesions is < 2% and no invasive cancers were identified in our meta-analysis, structured imaging follow-up (e.g., at 1–2 years, practically a return to screening) appears to be a reasonable and safe alternative to surgical excision,” posited Vatteroni and colleagues.
(Editor’s note: For related content, see “Breast MRI Study Suggests Black Women Are 31 Percent More Likely to Have High BPE,” “Study: MRI May Help Predict Outcomes in Treatment for Triple-Negative Breast Cancer” and “What New Prospective Research Reveals About Ultrafast Breast MRI.”)
In regard to study limitations, the authors acknowledged a dearth of studies on the use of breast MRI with respect to long-term outcomes in patients with high-risk lesions. For the reviewed studies, the researchers conceded a lack of standard protocols for breast MRI, underreported or unclear methodologies in patient selection and a lack of detailed information on radiological characteristics for high-risk lesion subtypes.
