0:00

Here's some, uh, data now from my institution.

0:04

Um, we started doing abbreviated MR with

0:07

the, um, full support of our chairman,

0:10

Dr. Shaw, who you know is a leader in,

0:12

uh, MRI and so many other things.

0:15

Um, we were able to convince him, or he was

0:18

involved in this decision that we were going

0:20

to start an abbreviated protocol for women

0:23

with dense breasts and non-actionable mammograms.

0:25

And we started this back in 2016,

0:28

and I'll share some of our results.

0:29

We chose not to be in the ACRIN study because

0:31

we were doing this at our, um, our site instead.

0:34

Again, average-risk women who did

0:37

not qualify for full protocol MR.

0:40

Dense breasts had a non-actionable

0:42

screen in the prior year, and we do

0:46

a T2, which is about 4 minutes, a pre-

0:48

gad and a post-gad, each one about 2.3 minutes.

0:51

3 minutes.

0:51

So, for a total of about 8.

0:53

6 minutes, we do our post-scatter

0:56

around 20 to 30 seconds after injection.

0:58

So, a total of 8.

1:00

6 minutes about, and then

1:01

the reconstruction is done.

1:03

We'll talk about that should be done,

1:05

not while the patient's on the table.

1:07

So in this publication, we have 511 women.

1:10

Um, some of them got excluded

1:12

because of some different issues.

1:14

They weren't dense.

1:15

Um, they hadn't had a tomo.

1:17

Um, there was some gad extravasation

1:19

and they didn't want to come back, et

1:20

cetera, but here were our outcomes.

1:22

We did have, um, 13 patients who

1:24

are put in category three and that's

1:26

category three for follow-up MR.

1:27

Um, Um, and then 42 patients

1:30

that were category 4 or 5.

1:33

Some opted not to have biopsies performed.

1:35

Believe it or not.

1:36

Some had biopsies canceled.

1:38

I don't have the data on who

1:40

refused and what happened to her.

1:42

But we had 12 cancers in 11 women, and I'm

1:45

going to show you some of these examples in

1:47

a moment of the 38 patients with 39 biopsies.

1:50

Um, the majority, of course, had benign

1:53

results, but there were 12 patients with

1:55

13 cancers, a pretty good predictive value

1:58

at around 31 percent of those recommended

2:01

for biopsy. Seven invasive, five high grade is good.

2:04

PPV 2 and good PPV 3.

2:07

The 13 patients assigned the BI-RADS category

2:09

3, there was actually one cancer in that group.

2:14

Eight months after the category 3 recommendation,

2:16

we did a biopsy and it was a small cancer.

2:19

So overall, our cancer detection rate, remember,

2:22

average-risk women, just dense breasts, 27.

2:25

4 after negative DBT or non-actionable study.

2:31

That's incredibly high.

2:32

It's higher than Christiane Kuhl's and others.

2:34

Um, very, very high.

2:37

A couple of examples.

2:38

So here's one.

2:39

You can see the, uh, the MIP up top

2:41

and then the axial, uh, uh, re-, um, uh,

2:43

subtraction on the bottom on the left.

2:46

And then we've got the, um,

2:48

sagittal reconstruction.

2:49

You can see this irregular mass in the

2:51

posterior, somewhat lateral breast right there.

2:55

There.

2:55

And this was an invasive ductal

2:57

carcinoma, ER/PR positive, HER2 negative.

3:00

Here's one again, fairly dense.

3:02

Look at the way that little

3:02

round ball is not distorting.

3:04

It's buried in the band of glandular tissue.

3:07

And that was invasive ductal carcinoma.

3:11

That one we actually brought back.

3:13

We did extra views.

3:15

Maybe there's actually distortion

3:17

now on the tomosynthesis.

3:19

I think there is and the targeted

3:21

ultrasound showed the lesion look at

3:22

it in that band of dense breast tissue.

3:25

And again, that was whoops.

3:27

That was an invasive ductal carcinoma.

3:28

And so we did bring her

3:30

back for additional imaging.

3:32

Um, here's a woman who had

3:34

a, um, lesion on both sides.

3:38

We actually recommended biopsy of the left area

3:42

of linear enhancement and said, if the left was

3:46

positive, then she should have the right biopsy.

3:49

And so we kind of hedged a little bit on

3:50

this one, but they were both high grade.

3:53

Those are images there.

3:57

Um, so I just wanted to share with

3:59

you a very recent publication.

4:01

Um, this is a meta-analysis of, um, of

4:06

supplemental breast cancer screening in women

4:08

with dense breasts and a negative mammogram.

4:10

And this is supplemental in this case is defined.

4:13

This is a non-American study as supplemental

4:16

with tomosynthesis in addition to

4:18

2D mammography, ultrasound and MRI.

4:21

They looked at 22 studies and, um, about 261.

4:26

1000 screens.

4:27

I know this is very, very busy, but if

4:29

you like references, um, here you go.

4:32

And I just want to circle here.

4:33

The MR results.

4:35

You can see the incremental cancer detection 25.

4:39

7 very large invasive cancers.

4:42

Additional almost.

4:43

20 per 1000, um, uh, there were some

4:47

interval cancers, as you can see

4:48

their increase in incremental pretty

4:50

good PPV 1 and PPV 3 as well, MR.

4:55

R.

4:55

superior in incremental cancer

4:57

detection, both in situ and invasive

5:00

and really no statistical significance

5:02

across the modalities and PPV 1 and 3.

5:04

So, pretty impressive results again,

5:06

and this very, very large meta-analysis.

5:09

Incremental DCIS per thousand screens.

5:12

I mean, very interesting.

5:14

There you go.