Supplemental Screening & the Latest Research
New Survey: Supplemental Screening ABUS Better Tolerated than MRI or CEM
DBI European Educator for Albania, and attending radiologist at the University of Cambridge and Cambridge University Hospitals, Dr. Iris Allajbeu, and colleagues, published a survey of 159 BRAID trial participants assessing patient acceptance, experience, and feedback for different methods of supplemental screening in women with dense breasts and negative mammography. Each of automated breast ultrasound (ABUS), abbreviated MRI (AB-MRI) and contrast-enhanced mammography (CEM) were generally well accepted by patients.
- When compared to standard mammography, nearly all participants rated ABUS as the same or better; nearly 1 in 6 women rated AB-MRI as worse and 1 in 10 rated CEM as worse.
- Mild or severe discomfort was common with ABUS and CEM.1
- Anxiety before or during the imaging was least common with ABUS.
- AB-MRI was well-received, with several women highlighting benefits, such as reduced pain due to less breast compression and improved detection accuracy. However, AB-MRI was associated with a higher proportion of negative feedback, suggesting that for some patients, its benefits may be outweighed by procedural drawbacks.
- Withdrawal from the study was due to adverse patient experience for 151 women overall and was much more common with contrast-enhanced methods than with ABUS,2 making ABUS the most well tolerated imaging method.
Previously, we summarized the greater cancer detection rates from CEM and AB-MRI compared to ABUS in the first round of screening in the BRAID trial.3 Cancer detection rates were similar at 7-9.5/1000 across all three modalities in the second round of screening.3 False alarm rates were higher for CEM and AB-MRI in the first round and comparable across modalities in the second round.4
1 40/44 (90.1%) of ABUS participants reported discomfort as did 38/48 (79.2%) of CEM participants, compared to only 14/38 (36.8%) of MRI participants.
2 Of 151 withdrawals due to adverse patient experience, 69 were in women having CEM, 66 in women having AB-MRI, and only 12 in women having ABUS.
3 Cancer detection rates were 15/1572 (9.5/1000) for ABUS+MG; 9/1051 (8.6/1000) for AB-MRI+MG; and 6/870 (7.0/1000) for CEM in the second round. (By comparison, cancer detection rates in the first round were 4.2/1000 for ABUS; 17.4/1000 for AB-MRI; and 19.2/1000 for CEM after a negative mammogram.)
4 Recall rates in the second round were 4.3% for ABUS; 3.5% for AB-MRI; and 4.7% for CEM. In the first round, recall rates were 4.0% for ABUS; 9.7% for AB-MRI; and 9.7% for CEM.
Updated Overview: International Atomic Energy Agency Panel Endorses Molecular Breast Imaging
An IAEA international expert panel has provided an updated overview of MBI using dual head detectors and 99mTc-sestamibi as a complement to mammography, especially in women with dense breasts or inconclusive conventional imaging. They conclude that “it remains a valuable modality in breast imaging, offering high sensitivity for the detection of small, node negative disease and detection of large, advanced cancers that are undetected by mammographic screening. MBI is performed at a safe radiation dose, is well-tolerated by patients, and has exceedingly low risk of adverse events.”
The ACR 2021 position is that MBI is “usually not appropriate” for screening in dense breasts due to whole body radiation exposure, though the radiation dose has decreased and additional promising prospective multicenter results have come out since that time.