Which exam is best for supplemental imaging of women with dense breast tissue?
It is widely agreed that women with dense breast tissue should undergo supplemental imaging in addition to their routine mammogram screening, but the jury is still out on which modality is best for cancer detection in this group.
Recent findings from the Breast screening Risk Adapted Imaging for Density (BRAID) trial could change that. The trial offers new insight into which supplemental exam—contrast enhanced mammography (CEM), abbreviated breast MRI with contrast (AB-MRI) or automated whole breast ultrasound (ABUS)—offers the most thorough assessment of dense breast tissue.
Experts shared their interim findings this week in The Lancet.
“Women with dense breasts have an increased probability of their cancer being detected at a later stage at screening, or as an interval cancer (cancer detected between screening rounds), with resulting worse prognosis,” corresponding author Fiona J Gilbert, MBChB FRCR, with the department of radiology at the University of Cambridge, and colleagues explained. “In the USA, reporting of breast density for women is mandated by the Food and Drug Administration since September 2024. However, there is no consensus on the management of women with dense breasts with the benefits of supplemental imaging unclear.”
The trial includes data from more than 9,000 women with dense breast tissue and negative breast cancer screening exams. The women were randomized to one of four groups based on the follow-up imaging they received—either ABUS, CEM, AB-MRI or the none at all.
Cancer detection rates were significantly higher for CEM and AB-MRI compared to ABUS. CEM detected cancer in 19.2 per 1,000 patients, while AB-MRI detected 17.4 and ABUS detected 4.2, respectively. Of the cancers detected, 15 spotted on AB-MRI, 15.7 on CEM and 4.2 on ABUS were considered invasive in nature. What’s more, the cancers identified on CEM and AB-MRI were also half the size of the cancers missed on ABUS.
Researchers determined that both CEM and AB-MRI detect three times as many invasive cancers as ABUS, prompting them to suggest contrasted imaging techniques may be the most effective cancer detection method in women with dense breast tissue.
“This study shows that contrast-enhanced techniques such as abbreviated MRI and contrast-enhanced mammography have a superior performance compared with whole breast ultrasound,” the authors noted. “This is in line with systematic reviews of performance, although no other study has directly compared these techniques in the same cohort of average-risk women.”
The group went on to suggest that the findings from their trial could be of aid in developing models that estimate the cost benefits of utilizing contrasted imaging exams in this population of women.
Learn more about the findings here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.