Impact of breast MR in non-screening Australian clinical practice: audit data from a single-reader single-centre site.
OBJECTIVE
The aim of this study was to evaluate the accuracy and clinical impact of single-reader breast MR (BMR) used as a clinical 'problem solving' tool.


METHODS
Observational, retrospective, ethics approved data collection for all BMR were from May 2006 to February 2009 (n=143). Cases were stratified into groups according to indication for referral. MR data included single-reader MR diagnosis and breast imaging reporting and data system category (per-patient basis), MR descriptors of lesions (breast imaging reporting and data system lexicon), lesion number and location. Composite reference standard was established from surgical histology, core histology, cytology, MR imaging follow-up, conventional imaging follow-up and clinical follow-up in that order of priority. Impact was qualitatively captured by estimating change in management as the result of BMR.


RESULTS
Eighty-two cases were included and 61 were excluded (41 insufficient follow-up times, three known benign mass for clarification, two worried well screening and 15 other reasons). There was no statistically significant difference in included and excluded patient profiles. Our largest group of referrals was of patients with suspicious or unhelpful conventional imaging. BMR identified five malignancies in that group but missed four. In our smaller group of patients with metastatic axillary lymph nodes, BMR identified the occult primary cancer in all five cases.


CONCLUSIONS
In this 'problem solving' patient population, breast MR shows greatest impact in patients with carcinoma metastases to axillary nodes, but primary not visible. In symptomatic women with unhelpful imaging or with suspicious imaging but no pre-MR diagnosis, MR identified 5/41 carcinomas, but missed 4/41.
Flinders Medical Centre, Department of Radiology, Adelaide, South Australia, Australia. esberelbarhoun@yahoo.com.au
Esber N
EN
El-Barhoun
Alexander G
AG
Pitman
D000328:Adult; D000368:Aged; D001315:Australia; D001940:Breast / Q000473:pathology; D001941:Breast Diseases / Q000473:pathology*; D001943:Breast Neoplasms / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity