title: DCE-MRI of the breast in a stand-alone setting outside a complementary strategy - results of the TK-study.
abstract: OBJECTIVE
  To evaluate the accuracy of MRI of the breast (DCE-MRI) in a stand-alone setting with extended indications.
  
  
  METHODS
  According to the inclusion criteria, breast specialists were invited to refer patients to our institution for DCE-MRI. Depending on the MR findings, patients received either a follow-up or biopsy. Between 04/2006 and 12/2011 a consecutive total of 1,488 women were prospectively examined.
  
  
  RESULTS
  Of 1,488 included patients, 393 patients were lost to follow-up, 1,095 patients were evaluated. 124 patients were diagnosed with malignancy by DCE-MRI (76 TP, 48 FP, 971 TN, 0 FN cases). Positive cases were confirmed by histology, negative cases by MR follow-ups or patient questionnaires over the next 5 years in 1,737 cases (sensitivity 100 %; specificity 95.2 %; PPV 61.3 %; NPV 100 %; accuracy 95.5 %). For invasive cancers only (DCIS excluded), the results were 63 TP; 27 FP; 971 TP and 0 FN (sensitivity 100 %; specificity 97.2 %; PPV 70 %; NPV 100 %; accuracy 97.5 %).
  
  
  CONCLUSIONS
  The DCE-MRI indications tested imply that negative results in DCE-MRI reliably exclude cancer. The results were achieved in a stand-alone setting (single modality diagnosis). However, these results are strongly dependent on reader experience and adequate technical standards as prerequisites for optimal diagnoses.
  
  
  CONCLUSIONS
  • DCE-MRI of the breast has a high accuracy in finding breast cancer. • The set of indications for DCE-MRI of the breast is still very limited. • DCE-MRI can achieve a high accuracy in a 'screening-like' setting. • Accuracy of breast DCE-MRI is strongly dependent on technique and reader experience. • A negative DCE-MRI effectively excludes cancer.
authors.affiliation: Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany, clemens.kaiser@umm.de.
authors.forename: Clemens G
authors.initials: CG
authors.lastname: Kaiser
authors.forename: C
authors.initials: C
authors.lastname: Reich
authors.forename: M
authors.initials: M
authors.lastname: Dietzel
authors.forename: P A T
authors.initials: PA
authors.lastname: Baltzer
authors.forename: J
authors.initials: J
authors.lastname: Krammer
authors.forename: K
authors.initials: K
authors.lastname: Wasser
authors.forename: S O
authors.initials: SO
authors.lastname: Schoenberg
authors.forename: W A
authors.initials: WA
authors.lastname: Kaiser
mesh_terms: D000328:Adult; D001706:Biopsy; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media