For breast cancer detection, Habib Rahbar, M.D., said it’s well established in the literature that vascular-based studies such as magnetic resonance imaging (MRI) and contrast-enhanced mammography (CEM) provide more optimal sensitivity in comparison to X-ray based or anatomic-based studies. During a recent podcast, Dr. Rahbar noted tradeoffs between breast MRI and CEM.
“We know that CEM or contrast enhanced mammography is probably a little bit more specific than MRI (with a) little fewer false positives, but at a cost of a little bit of a sensitivity hit. That’s probably due to the fact that the conspicuity of some of the lesions is not quite as dramatic on CEM,” maintained Dr. Rahbar, a professor and executive vice chair of radiology at the University of Washington School of Medicine.
“ … (For an additional breast cancer screening test), I still prefer MRI because I think it’s the best tool that we have. But CEM and other contrast-based approaches have a real role too, because there could potentially be improved access and might be cheaper for us to implement in some areas as well.”
During the podcast, Stamatia Destounis, M.D., noted that a standardized protocol for abbreviated breast MRI remains elusive. While Emily Conant, M.D., acknowledged studies that shows T2-weighted MRI impacts outcomes less than five percent of the time, all of the panelists emphasized the value of T2-weighted imaging for increasing the specificity of abbreviated breast MRI.
While emphasizing “remarkable” cancer detection with abbreviated breast MRI, standardized reimbursement will likely be the key driver for implementation, according to Dr. Conant, a professor emeritus with the Department of Radiology at the University of Pennsylvania Health System. However, Dr. Destounis expressed concern that evaluation of abbreviated breast MRI for CPT coding may trigger a negative re-evaluation of full breast MRI.
“The concern is that this may turn out to be kind of a hit all across the board for many of us that have breast MRI practices in an outpatient, private setting. And I can tell you it’s not a money maker. We’re just breaking even because we don’t get the high reimbursement from that full (breast MRI) protocol. So I think that there’s some concern there about what a new CPT code may look like for us,” noted Dr. Destounis, the managing partner of Elizabeth Wende Breast Care in Rochester, New York, and chair of the American College of Radiology’s Breast Imaging Commission.
(Editor’s note: For related content, see “The Reading Room Podcast: Current and Emerging Insights on Abbreviated Breast MRI, Part 1,” “Possible Real-Time Adaptive Approach to Breast MRI Suggests ‘New Era’ of AI-Directed MRI” and “Abbreviated MRI and Contrast-Enhanced Mammography Provide Fourfold Higher Cancer Detection than Breast Ultrasound.”)
For more insights from Dr. Destounis, Dr. Conant and Dr. Rahbar, listen below or subscribe on your favorite podcast platform.