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They stated that randomized trials are needed to determine the clinical value of detecting additional disease which changes surgical treatment in women with apparently localized breast cancer.
In a review on the utility of MRI for the screening and staging of breast cancer, Patani and Mokbel (2008) stated that while MRI can facilitate local staging, especially the evaluation of ipsilateral multi-centric or multi-focal lesions as well as synchronous contralateral disease that may be missed by conventional imaging; however, efficacy with respect to clinically relevant and patient oriented end-points has yet to be addressed in the context of clinical trials.
The ACS panel also identified several risk subgroups for which the available data are insufficient to recommend either for or against MRI screening (Saslow et al, 2007).
They include women with a personal history of breast cancer, carcinoma in situ, atypical hyperplasia, and extremely dense breasts on mammography.
The use of CAD may also reduce the time needed to interpret breast MRI images, which currently takes much longer than reading mammograms.
The Blue Cross and Blue Shield Association’s Technology Evaluation Center (TEC) Medical Advisory Panel (2006) assessed the evidence on the use of CAD with MRI of the breast by comparing the sensitivity, specificity, and recall rate (percentage of patients asked to come back for further evaluation) of MRI with and without the use of commercially available CAD systems in detecting malignant lesions, evaluating the extent of disease in women with cancer, or gauging the impact of treatment.
New imaging techniques are being developed to overcome these limitations, enhance cancer detection, and improve patient outcome.
Although mammography is an effective screening tool, it does have limitations, especially in women with dense breasts.Positive predictive value was 66 % (95 % confidence interval [CI]: 52 % to 77 %) and TP: FP ratio was 1.91 (95 % CI: 1.09 to 3.34).