MRI spectroscopy--NYC area residents with ? of recurrence or new lesion>1cm

[Lani]

MR Spectroscopy Aids Breast Cancer Diagnosis


By Will Boggs, MD

NEW YORK (Reuters Health) Jun 07 - Proton magnetic resonance (MR) spectroscopy improves the accuracy in diagnosing breast cancer, according to a report in the June issue of Radiology.

"We want physicians to become aware of this technique and encourage patients to sign up as volunteers for our studies," Dr. Lia Bartella from Memorial Sloan-Kettering Cancer Center, New York told Reuters Health. "We are hoping that incorporating this technique as part of the routine breast MRI examination in the future will reduce the number of benign biopsies for women undergoing breast MRI."

Dr. Bartella and colleagues evaluated the diagnostic performance of MR spectroscopy in 56 women with suspicious lesions or biopsy-proven cancers at MR imaging by using histologic findings as the reference standard.

MR spectroscopy showed a positive choline peak in 34 of 57 lesions, the authors report, including all 31 malignant lesions.

The three false-positive lesions included a fibroadenoma, a chronic inflammatory lesion with atypia, and a lesion with atypical ductal hyperplasia and columnar cell alteration.

All lesions with a negative choline peak on MR spectroscopy were benign, the results indicate.

After eliminating 17 BI-RADS category six lesions and all biopsy-proved cancers at the time of initial MR imaging, the positive predictive value of MR spectroscopy was 82% (compared with 35% for MRI alone), the researchers note, and there were no false-negative recommendations for biopsy when MRI and MR spectroscopy were combined.

The investigators say that incorporating MR spectroscopy into the work-up could have made biopsy of 23 out of 40 lesions (58%) unnecessary, without missing any of the cancers.

"We are very happy with our results so far and with the clinical application of MR spectroscopy," Dr. Bartella said. "It is a short 10-minute scan at the end of the clinical breast MRI. We think it has a lot of potential in greatly improving patient care."

Dr. Bartella stressed that MR spectroscopy remains an investigational tool. "We are currently conducting another study that will compare MR spectroscopy on 1.5T with spectroscopy on 3T," she said.

"We want to see if 3T is as accurate or more accurate and whether we can evaluate smaller lesions due to the higher field strength. We are also about to start a new study where we will investigate whether we can predict response to neoadjuvant chemotherapy with MR spectroscopy very shortly after commencing the treatment."

Radiology 2006;239:686-692.