Comparison of the diagnostic performance of Magnetic Resonance Imaging (MRI), ultrasound and mammography for detection of breast cancer based on tumor type, breast density and patient's history: A review

Abstract

Objective: Breast cancer is the most common malignancy in women. Mammography and ultrasound are commonly used in a clinical environment as the first choice for breast cancer detection. Magnetic Resonance Imaging (MRI) has been reported to reveal additional information. In the following review MRI, Ultrasound (US) and Mammography (MM) are all compared in terms of their diagnostic performance on breast cancer detection, depending on tumor type, breast density and patient's history.

Key findings: Evaluating each modality alone, MRI provided an overall sensitivity and specificity of 94.6% (range 85.7%-100%) and 74.2% (range 25%-100%) respectively, while mammography showed that the overall sensitivity was at 54.5% (range 27%-86.8%) and specificity was 85.5% (range 62.9%-98.8%). The overall sensitivity and specificity of ultrasound was 67.2% (range 26.9%-87.5%) and 76.8% (range 18.8%-96.9%). When combining the results of all three techniques, it resulted in a sensitivity of 97.7% (range 95%-100%) and a specificity of 63.3% (range 37.1%-87.5%). In addition, contrast-enhanced mammography (CE-MM) and MRI (CE-MRI) illustrated an overall sensitivity and specificity for CE-MM was 90.5% (range 80.9%-100%) and 52.6% (range 15%-76.1%) and for CE-MRI, the overall sensitivity and specificity was 91.5% (range 89.1%-93.8%) and 64.7% (range 43.7%-85.7%).

Conclusion: As modalities alone, the highest sensitivity has been observed for MRI and the lowest sensitivity for mammography regardless breast type, density, and history. Sensitivity is even more increased from the combination of US + MRI or MM + MRI or MRI + MM + US. The specificity seems to be affected by the size, type of the tumor and patient's history, however based on breast density, the highest specificity was observed by US alone.

Implications for practice: Breast cancer screening is of outmost importance and identifying the best technique will improve cancer management. Combining techniques increases diagnostic ability compared with using modalities alone. CE-MM can be a viable option in dense breast tissue when there are contraindications to MRI as it also has high sensitivity based on the type of breast cancer.

Keywords: Breast cancer; Diagnostic performance; Magnetic resonance imaging (MRI); Mammography (MM); Ultrasound (US).