Comparison between mammogram and mri in detecting breast cancer

Comparison between mammogram Comparison between mammogram and MRI mammogram in detecting and MRI mammogram in detecting

breast diseasebreast disease

Comparison between mammogram Comparison between mammogram and MRI mammogram in detecting and MRI mammogram in detecting

breast diseasebreast disease

Nordina binti Nordin

Supervior: Miss Angela Lema Anak Thomas Sudin

Degree in Medical Imaging (HONS)

UniversitI Teknologi Mara

Outline:Outline:

o Introductiono Literature reviewo Research hypothesiso Methodologyo Resultso Discussiono Recommendation

Researchers had noted that there are some problems with mammography:

some palpable or non palpable lesion is not visible by mammography (Kopans, 1992).radiodense breast tissue can obscure cancermammography also is not good enough to differentiate whether the lesion is benign or malignant (Kopans, 1992).

Objective of the study :

to evaluate the accuracy of MRI compare with mammography in detecting breast disease or pathologies.

Sensitivity of MRI mammogram: Sensitivity of MRI mammogram:

Authors: MammogramMRI

Mammogram Note:

Malur et al. (2000) 83.70% 94.60%

Stoutjesdijk et al. (2001) 46.20% 100% From 13 detected breast cancer

Pediconi et al. (2006) 77% 100%

Menell (2006) 3% 64% Of 33 breasts, (DCIS)

Hope (2007) 52% 98% Of 89 women, (DCIS)

Advantages of MRI mammogram:Advantages of MRI mammogram:

Authors: Advantages

Kopans(1992)

Better delineate the extent of a breast cancer Improve the detection of early breast cancers in the radiographically

dense breast

Blumenthal(1997)

Able to pinpoint suspicious lesions camouflaged behind dense breast tissue

Mammograms have been unable to penetrate sufficiently to accurately detect

Harmon(2004)

2 times more effective than mammography in detecting multiple tumors Better than mammography for detecting the presence and extent of

disease

Grady(2007)

Can find tumors in the other breast that mammograms miss in women who have newly diagnosed cancer in one breast

MRI is more superior to mammography in detecting breast disease or pathologies.

METHODOLOGYMETHODOLOGY

Retrospective study:

Hospital Sungai Buloh, Selangor (film reviewed from year 2007 to Aug 2008).

Samples were chosen randomly (40 – 55 years old).

Films prospectively reviewed by a radiologist.

Radiologist:

aware of the study’s aim and design.

blinded to the initial imaging reports or the final diagnoses.


Sample’s details printed on the mammography and MRI films de-identified.

Each film was labeled by number.

Radiologist was given a form specially formatted for this study purposes.

The sensitivity and specificity of both modalities were compared according to:

previous report by previous radiologists and current findings by the radiologist participated in this study.

with the support of biopsy result.

METHODOLOGYMETHODOLOGYRadiologists’ findings were recorded on according to the following rating scale (BIRADS category):

0 = incomplete assessments

1 = negative (no significant abnormally)

2 = benign

3 = probably benign

4 = suspicious abnormality

5 = highly suspicious of malignancy

Categories 0 - 2 were considered negative for cancer

Categories 3 - 5 were considered positive for cancer


15 samples underwent mammogram and MRI mammogram examination

Each sets of films being interpreted on separated days according to availability of radiologist in charge in this study

All data were then analyzed by using excel software.

RESULTSRESULTS

Figure 1:

87% considered (-ve) for cancer (BIRADS 0 - 2) 13% considered (+ve) for cancer (BIRADS 3 - 5)

Figure 2:


0

1

2

3

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7

No of films

BIRADS 0 BIRADS 1 BIRADS 2 BIRADS 3 BIRADS 4 BIRADS 5

BIRADS category

MAMMOGRAM OF RIGHT BREAST

0

1

2

3

4

5

6

No of films


BIRADS category

MRI MAMMOGRAM OF RIGHT BREAST

RESULTSRESULTS

0

1

2

3

4

5

6

7

8

No of films


BIRADS category

MAMMOGRAM OF LEFT BREAST

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

No of films


BIRADS category

MRI MAMMOGRAM OF LEFT BREAST

Figure 3:


Figure 4:


RESULTSRESULTS

Biopsy was performed on 12 right breasts and 10 left breasts that showed breast abnormalities during MRI examination.

All were confirmed positive ductal carcinoma in situ (DCIS) accept 1 right breast, diagnosed as benign.

THE ACCURACY OF MRI THE ACCURACY OF MRI COMPARE WITH MAMMOGRAMCOMPARE WITH MAMMOGRAM

Result from mammogram & MRI mammogram grafts of right breast:

Decrease 20 % (-ve) for cancer Increase 80 % (+ve) for cancer

Variance of negative result - 67 % Variance of positive result - 67 %

Mammography only detected 2 cases that consider positive for cancer, compared with 12 cases detected by MRI.

0

1

2

3

4

5

6

7

No of films


BIRADS category

MAMMOGRAM OF RIGHT BREAST

0

1

2

3

4

5

6

No of films


BIRADS category

MRI MAMMOGRAM OF RIGHT BREAST

THE ACCURACY OF MRI THE ACCURACY OF MRI COMPARE WITH MAMMOGRAMCOMPARE WITH MAMMOGRAM

Result from mammogram & MRI mammogram grafts of left breast:

Decrease 29% (-ve) for cancer Increase to 71% (+ve) for cancer

Variance of negative result - 29 % Variance of positive result - 71 %

• Mammography not detected at all cases that positive for cancer, compared with 10 cases detected by MRI.

there are only 14 films from the left breast as one patient had done mastectomy of the left breast

0

1

2

3

4

5

6

7

8

No of films


BIRADS category

MAMMOGRAM OF LEFT BREAST

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

No of films


BIRADS category

MRI MAMMOGRAM OF LEFT BREAST

EXPLANATION OF BIRADS EXPLANATION OF BIRADS CATEGORY CATEGORY

BIRADS (breast imaging reporting and data system) classification:Recommended and published by an American College of Radiology.

BIRADS ASSESSMENT EXPLAINATION

0Assessment incomplete Utilized when further imaging evaluation or retrieval of prior films is required

1 Negative There is nothing to comment on

2 Benign findingNormal assessment, but the interpreter chooses to describe a benign finding in the mammography report

3Probably benign finding Have less than 2 percent risk of malignancy

4Suspicious abnormality

Do not have the classic appearance of malignancy but have a wide range of probability of malignancy (2-95 %)

5Highly suspicious of malignancy Findings that are classic breast cancers, with more than 95 % likelihood of malignancy

(Zonderland, 2006)(Zonderland, 2006)

EXPLANATION OF BIRADS EXPLANATION OF BIRADS CATEGORYCATEGORY

CE-MRI is the fact that tumors enhance and enhance more than normal tissues.

Tumors need many blood vessels to grow; the concentration of the contrast agent at their location will be higher than in surrounding tissues

appear as brighter areas in the images.

For MRI mammogram, BIRADS categories are categorized according to the enhancement curve for different types of tissues.

(Mehnert et al., 2006)

Type of curve: BIRADS Explanation

Type I a. BIRADS 1 (negative)A kinetic behavior with a persistent uptake is considered a sign of benignity

b. BIRADS 2 (benign)

Type II BIRADS 3 (probably benign)A kinetic behavior with a clear plateau phase can be found both inbenign and in malignant features

Type III

BIRADS 4 (suspicious abnormality)or BIRADS 5 (highly suspicious of malignancy)

Kinetic behavior with a strong uptake followed by a rapid washoutis considered a sign of malignancy

Enhancement curve for different types of tissuesMehnert et al. (2006)

SENSITIVITY AND SPECIFICITYSENSITIVITY AND SPECIFICITY

Sensitivity of the right breast:Out of 15 films, 12 films of MRI mammogram that show BIRADS 3 and above

11 was proven by biopsy confirmed have ductal carcinoma in situ (DCIS).

Only 1 film actually only benign finding.

Specificity of the right breast:3 films of MRI mammogram show BIRADS 1 and 2

all was reported as the same as previous radiologist’s report which confirmed negative for cancer.

SENSITIVITY AND SPECIFICITYSENSITIVITY AND SPECIFICITY

Sensitivity of the left breast: Out of 14 films, 10 films of MRI mammogram that show BIRADS 3 and above

10 was proven by biopsy confirmed have ductal carcinoma in situ (DCIS).

Specificity of the left breast:4 films of MRI mammogram show BIRADS 1 and 2

all was reported as the same as previous radiologist’s report which confirmed negative for cancer.

SENSITIVITY AND SPECIFICITYSENSITIVITY AND SPECIFICITYThe sensitivity for malignant lesion detection for both right and left breast was:

100 % for MRI mammogram 18 % for mammography.

Out of 21 samples with DCIS; Mammography identified 2 cases (10%)MRI mammography identified 21 cases (100%).

Overall mammograms missed up to 90 % of the breast cancers

that are present at the time of screening.

CONCLUSIONCONCLUSION

MRI can detect pathologies missed by mammography

MRI more superior to mammography in detecting breast disease or pathologies

RECOMMENDATIONRECOMMENDATION

Perform further study on MRI mammogram with more samples.

Perform prospective study on MRI mammogram within 12 months period.

Future study – comparing ultrasound and MRI of the breast.

ACKNOWLEDGEMENTACKNOWLEDGEMENT

Dr Yun (Head of Department of MI Department of H. Sg. Buloh)

Dr Rofiah (Radiologist of H. Sg. Buloh)

Miss Angela Lema (Project supervisor)

Personnel of Hospital Sungai Buloh

Lecturers, family, & friends.

REFERENCEREFERENCEBlumenthal, S.J., 1997. Testimony on battle against breast cancer, [Online]. Available:

http://www.hhs.gov/asl/testify/t97020a.html [accessed 23 March 2008].

Grady, D., 2007. Call to increase MRI use for breast exam, [Online]. Available: http://www.nytimes.com/2007/03/28/health/28mri.html [accessed 23 March 2008].

Harmon, R., 2004. MRI significantly better than mammography for detecting number and size of tumors in breast cancer, [Online]. Available: http://www.innovations report.com/html/reports/medicine_health/report/ [accessed 23 March 2008].

Hope, J., 2007. MRI scans beat mammograms in detecting breast cancer, [Online]. Available: http://www.dailymail.co.uk/ [accessed 23 March 2008].

Kopans, D.B., 1992. Detecting breast cancer not visible by mammography, [Online]. Available: www.cancernetwork.com/ [accessed 23 March 2008].

Malur, S., Wurdinger, S., Moritz, A., Michels, W., & Schneider, A., 2001. Contrast Comparison of written reports of mammography and MRI for preoperative evaluation of breast lesions, [Online]. Available: http://www.pubmedcentral.nih.gov/articlerender.fcgi [accessed 23 March 2008].

Mehnert, A., Bengtsson, E., McMahon, K., Kennedy, D., Wilson, S., & Crozier, S., 2006. Improved breast cancer detection enabled by rapid visualization of suspicious lesions in DCE-MRI of the breast, [Online]. Available: http://www. E:\Breast Cancer Detection using DCE-MRI.mht [accessed 23 March 2008].

Menell, J.H., 2006. MRI can detect breast disease missed by mammography, [Online]. Available:http://www.medicalnewstoday.com/ [accessed 23 March 2008].

Pediconi, F., Catalano, C., Padula, S., Roselli, A., Moriconi, E., Dominelli, V., Pronio, A.M., Kirchin, M.A., & Passariello, R., 2006. Contrast-enhancement magnetic resonance mammography, [Online]. Available: http://www.springerlink.com/content/ [accessed 23 March 2008].

Stoutjesdijk, M.J., Boetes, C., Jager, G.J., Beex, L., Bult, P., Hendriks, J.H.C.L., Laheij, R.J.F., Massuger, L., Wobbes, T., & Barentsz, J.O., 2001. MRI and mammography in women with a hereditary risk of breast cancer, [Online]. Available: http://jnci.oxfordjournals.org/cgi/content/ [accessed 23 March 2008].

Zonderland, H., 2006. Introduction to the Breast Imaging Reporting and Data System, [Online]. Available: http://www.radiologyassistant.nl/en/ [accesses 23 March 2008].

Health & Medicine

Comparison between mammogram and mri in detecting breast cancer