Further research is needed to better understand the relationship between screening methods and clinical outcome. The additional imaging recommendation rate was 7.5% (95% CI, 6.2%-9.0%) with abbreviated breast MRI vs 10.1% (95% CI, 8.7%-11.8%) with DBT ( P = .02) and the PPV was 19.6% (95% CI, 13.2%-28.2%) vs 31.0% (95% CI, 17.0%-49.7%), respectively ( P = .15).Ĭonclusions and Relevance Among women with dense breasts undergoing screening, abbreviated breast MRI, compared with DBT, was associated with a significantly higher rate of invasive breast cancer detection. Digital breast tomosynthesis detected 7 of 17 women with invasive cancer and 2 of 6 women with DCIS. Abbreviated breast MRI detected all 17 women with invasive cancer and 5 of 6 women with DCIS. No interval cancers were observed during follow-up. The reference standard was positive for invasive cancer with or without DCIS in 17 women and for DCIS alone in another 6. Results Among 1516 enrolled women, 1444 (median age, 54 years) completed both examinations and were included in the analysis. Pathology of core or surgical biopsy was the reference standard for cancer detection rate and PPV interval cancers reported until the next annual screen were included in the reference standard for sensitivity and specificity. All outcomes are reported at the participant level. Secondary outcomes included sensitivity, specificity, additional imaging recommendation rate, and positive predictive value (PPV) of biopsy, using invasive cancer and ductal carcinoma in situ (DCIS) to define a positive reference standard. Main Outcomes and Measures The primary end point was the invasive cancer detection rate. Follow-up ascertainment of cancer diagnoses was complete through September 12, 2019.Įxposures All women underwent screening by both DBT and abbreviated breast MRI, performed in randomized order and read independently to avoid interpretation bias. Objective To compare the screening performance of abbreviated breast magnetic resonance imaging (MRI) and digital breast tomosynthesis (DBT) in women with dense breasts.ĭesign, Setting, and Participants Cross-sectional study with longitudinal follow-up at 48 academic, community hospital, and private practice sites in the United States and Germany, conducted between December 2016 and November 2017 among average-risk women aged 40 to 75 years with heterogeneously dense or extremely dense breasts undergoing routine screening. Importance Improved screening methods for women with dense breasts are needed because of their increased risk of breast cancer and of failed early diagnosis by screening mammography.
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