Health Editor Note: Here is a subject from the Coverage from the Radiological Society of North America (RSNA) 2017 Annual Meeting. We discussed breast screenings for cancer in previous postings and whether we agree on the current methods of finding breast cancer we all want to give women with breast cancer a fighting chance.
Finding quicker, more accurate ways to find breast cancer in its earliest stages is essential for breast health. With cancer, the earlier it is detected and addressed the greater the chance of survival. The information below is an absolute necessity for any woman who fears the onset of breast cancer. Breast cancer is the number one type of cancer in women and second in the cause of cancer death, with lung cancer holding the top slot.
Current diagnostics have been less than successful for women who need an accurate diagnosis. We are going to show you how this has changed and tell you exactly what you need to ensure your survival. Never see a medical professional without being informed. There are breast centers all over the U.S. that have refined the diagnosis and treatment of breast cancers.
These centers have patient-friendly protocols, such as telling the woman immediately the results of a mammogram, ultrasound, or breast MRI. She no longer has to wait for her doctor to get the results and share them with her. The woman makes her own decisions about whether to have a biopsy at the time a tumor is found by ultrasound.
No longer the drive home and the anguish of coming back for that biopsy. Discussed below is a diagnostic procedure that can be ordered, one we believe you need, and if this is not offered to you, you damn well should get a good explanation.
Fast MRI Improves Breast Cancer Screening
Ingrid Hein, November 30, 2017
Abbreviated MRI protocols could dramatically improve the diagnosis of breast cancer and lead to the earlier diagnosis of a lot more women, especially those with fast-growing cancers, according to an ongoing study.
“Mammograms detect slow-growing cancers but, notoriously, deliver false negatives for rapid-growing cancers,” said Christiane Kuhl, MD, from the University of Aachen in Germany.
“We have good reason to search for other methods,” she pointed out.
Traditionally, MRI has only been used to characterize cancer, and to map known diseases. “But we are seeing that it’s by far the most accurate imaging method for diagnosis,” she told Medscape Medical News. Disease detection is just one of the many uses for MRI scans enabling the medical world to improve its ability to diagnose the disease early.
“Breast MRI has the sensitivity profile we want to see in screening methods used today,” Dr. Kuhl said.
She and her colleagues are conducting the ongoing large-scale phase 2 EA1141 trial to investigate the utility of abbreviated MRI for screening in 1450 women with dense breast tissue who are at average risk for breast cancer (NCT02933489).
At the Radiological Society of North America (RSNA) 2017 Annual Meeting in Chicago, Dr. Kuhl discussed the premise for the EA1141 trial.
Mammograms detect slow-growing cancers but, notoriously, deliver false negatives for rapid-growing cancers.
Host-related factors, such as breast tissue density, and tumor-related factors contribute to the failure of mammographic screening to detect biologically relevant breast cancer.
Biologically relevant cancers can exhibit features that render them indistinguishable from normal or benign breast tissue on mammography. “But only a small fraction of women qualify for breast MRI,” she explained.
A typical MRI study takes up to 40 minutes and generates several hundred images. An abbreviated MRI has a 3-minute magnet time and an abridged image interpretation time (about 30 seconds), generates only one precontrast and one postcontrast T1 weighted image set, and uses maximum-intensity projections to fuse the first postcontrast subtracted images into one single high-contrast image.
“The new era is about finding more, earlier, than using targeted therapies to be more efficient,” she said, explaining that her group started publishing studies that showed the advantages of abbreviated MRI in 2014. “Surprisingly, it’s still considered new,” she said.
In an early study, the diagnostic accuracy of an abbreviated breast MRI was shown by Dr Kuhl’s team to be equivalent to that of a diagnostic protocol that took 17 minutes (J Clin Oncol. 2014;32:2304-2310). In addition, because women were diagnosed with greater efficiency, the cancer yield increased by 18.2 per 1000 people, as reported by Medscape Medical News.
In a more recent study, the team showed that MRI screening improves the early diagnosis of prognostically relevant breast cancer in women at average risk for breast cancer (Radiology. 2017;283:361-370).
Currently, there are about 16 publications that confirm that abbreviated MRI is the best way to detect breast cancer, Dr. Kuhl reported. It is generally agreed, however, that “it’s way too expensive.”
“If it’s just a matter of cost, let’s find other ways,” she said. Maybe with the abbreviated MRI “, we will change the way we screen for breast cancer in the foreseeable future.”
“It’s been difficult for people to think outside the box,” she said, adding that MRI does not have to be a long process. “Having dedicated magnets optimized for fast patient throughput will be crucial for taking advantage of this approach.”
Benefits of Fast MRI
Fast MRI protocols can also improve the diagnosis of conditions other than breast cancer. Dr. Kuhl’s group recently showed that abbreviated parametric MRI improved the detection of clinically significant prostate cancer in men with elevated levels of prostate-specific antigen (Radiology. 2017;285:493-505).
And in a study also presented at the RSNA meeting, a 5-minute MRI protocol was as accurate as a standard knee MRI for the evaluation of internal derangement of the knee.
“The two were diagnostically interchangeable, particularly for our patients who have claustrophobia or pain,” said Erin Alaia, MD, assistant professor of radiology at NYU Langone Health in New York City.
For their study, Dr Alaia and her colleagues assessed patients who underwent MRI at two academic centers from January 2015 to July 2016. Of the 146 patients, 100 underwent 3T MRI (100 scans) and 46 underwent 1.5T MRI (50 scans).
Four musculoskeletal radiologists evaluated menisci, ligaments, cartilage, and bone, and compared five fast multiplanar 2D FSE sequences using parallel imaging with 5 standard sequences.
“We compared and saw the same results,” Dr. Alaia reported.
“We just need to get the image quality that’s necessary for the diagnosis,” said her colleague Naveen Subhas, MD, associate professor of radiology at the Cleveland Clinic. “That’s going to take some time for a lot of people to get their heads around.”
“From volume-based to value-based imaging, I think this is a paradigm shift that’s going to happen,” Dr. Subhas said.
Dr. Khul, Dr. Alaia, and Dr. Subhas have disclosed no relevant financial relationships.
Radiological Society of North America (RSNA) 2017 Annual Meeting: Abstract SPSH50A, presented November 30, 2017; abstract SSA14-05, presented November 26, 2017.
Carol graduated from Riverside White Cross School of Nursing in Columbus, Ohio and received her diploma as a registered nurse. She attended Bowling Green State University where she received a Bachelor of Arts Degree in History and Literature. She attended the University of Toledo, College of Nursing, and received a Master’s of Nursing Science Degree as an Educator.
She has traveled extensively, is a photographer, and writes on medical issues. Carol has three children RJ, Katherine, and Stephen – one daughter-in-law; Katie – two granddaughters; Isabella Marianna and Zoe Olivia – and one grandson, Alexander Paul. She also shares her life with her husband Gordon Duff, many cats, and two rescues.
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