- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04619186
Diffusion-Weighted MRI for Breast Cancer Screening in Women With a Personal History of Breast Cancer
March 15, 2021 updated by: Woo Kyung Moon, Seoul National University Hospital
Comparison of Diffusion-Weighted MRI and Mammography Alone or Combined Mammography and Ultrasonography for Screening Women With a Personal History of Breast Cancer (DIMRISC-2 Study)
Women with personal history of breast cancer (PHBC) are at risk of developing second breast cancers in the conserved and contralateral breast.
Because early detection of second breast cancers at the asymptomatic phase can improve relative survival by 17-28%, guidelines recommend annual mammography screening in women with PHBC.
However, lower sensitivity and higher interval cancer rates are observed in women with a PHBC compared with women without, especially in women 50 years or younger and those with dense breasts.
In a multicenter comparison study of 754 women, MRI screening detected 3.8 additional cancers and ultrasonography detected 2.4 additional cancers, and increased sensitivity over mammography alone.
However, the use of breast MRI is limited not only by high costs and long examination time but also by high false-positive findings.
In addition, the use of intravenous gadolinium-based contrast agent is contraindicated in women with renal impairment or contrast material allergy contrast.
Supplemental ultrasonography in patients with PHBC reports lower sensitivity with high interval cancer rate.
Thus, there is a need to develop a more safe, accurate, and cost-effective supplemental imaging modality for screening in women with PHBC.
Diffusion-weighted (DW) MRI is an unenhanced fast, functional modality that measures the movement of water molecules to create tissue contrast.
Breast malignancies exhibit hindered diffusion and appear hyperintense on DW MRI with low apparent diffusion coefficient (ADC) compared to normal surrounding tissue.
Multiple studies have shown that the use of DW MRI can significantly reduce the false positives and unnecessary benign biopsy of breast MRI.
Several studies have shown that DW MRI has a potential to detect mammography occult breast cancers with less false positives compared to ultrasonography.
These observations have led to the consideration of utilizing DW MRI to screen women with PHBC.
In Diffusion-weighted MRI for Breast Cancer Screening (DIMRISC-2) study, we hypothesized that the screening performance of high-resolution DW MRI at 3.0 T should be superior to mammography alone or combined mammography and ultrasonography in women with PHBC.
In our institution, alternating conventional imaging and DW MRI screening is offered for patients who have undergone breast surgery and at increased risk of an interval second breast cancer.
Study Overview
Status
Not yet recruiting
Conditions
Detailed Description
- Primary objective: to compare the screening performance of DW MRI versus mammography alone or combined mammography and ultrasonography in women with PHBC.
- Secondary objective: to compare the tumor and patient characteristics detected by DW MRI and combined mammography and ultrasonography in women with PHBC.
- This is a prospective, single center, observational cohort study.
- A total of 1694 women will be enrolled in this study.
- Two latest 3.0 T MRI scanners with dedicated 16- or 18-channel bilateral breast coil are used for DW MRI. For DW MRI screening, the high-resolution echo-planar imaging sequence is designed to have an in-plane resolution of 1.3 x 1.3 mm and a slice thickness of 3 mm. Three b values of 0, 800, and 1200 sec/mm2 are used and ADC maps are generated based on the b=0 and 800 sec/mm2 DW MRI data. The DW MRI images are reconstructed into single summation images with maximum-intensity projections (MIPs) in the sagittal and axial planes. In addition, T1-weighted imaging sequence is also obtained with in-plane resolution of 1.0 x 1.0 mm and a slice thickness of 1 mm.
- All patients with PHBC undergo digital two-dimensional mammography and physician-performed whole-breast ultrasonography on the same day. DW MRI and conventional imaging (mammography and ultrasonography) are alternatively scheduled at 6-month intervals and the order has been randomized.
- Mammography alone, combined mammography and ultrasonography, and DW MRI will be interpreted independently according to the Breast Imaging Reporting and Data System (BI-RADS) and likelihood of malignancy (Score range, 0%-100%) by trained radiologists. DW MRI interpretation guidelines to be used in this study are based on both qualitative and quantitative assessments. Radiologists are required to successfully complete a training case series of 100 DW MR studies prior to interpreting the DW MRI.
- A negative examination result is defined as a final assessment BI-RADS category of 1, 2, 3 and a positive examination result is defined as a final assessment BI-RADS category of 4 or 5.
- Biopsies of DW MRI-detected lesions are performed under ultrasonography guidance whenever possible or with MR guidance if there is no correlative ultrasonography finding. Pathology of core or surgical biopsy and 1 year follow up is the reference standard.
Study Type
Observational
Enrollment (Anticipated)
1694
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
25 years and older (ADULT, OLDER_ADULT)
Accepts Healthy Volunteers
No
Genders Eligible for Study
Female
Sampling Method
Non-Probability Sample
Study Population
Women who underwent breast conservation therapy or mastectomy and at increased risk of an interval second breast cancer
Description
Inclusion Criteria:
- Women over 25 years of age at the time of enrollment
- Women who underwent breast conservation therapy or mastectomy and at increased risk of an interval second breast cancer (Age <50 at first cancer diagnosis; Breast density BI-RADS category 3 and 4; First degree family history; First breast cancer was an interval cancer or symptomatic presentation; First breast cancer was grade 2, 3 or ER and PR negative)
Exclusion Criteria:
- Women with signs or symptoms of breast cancer
- Women who had bilateral mastectomy
4. Women who had known metastatic disease 5. Pregnant or lactating women 6. Women with claustrophobia or metallic foreign body
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Cancer detection rate (CDR)
Time Frame: Baseline to up to 1 year
|
Number of detected cancers (invasive cancer and DCIS) /1000 women
|
Baseline to up to 1 year
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Sensitivity
Time Frame: Baseline to up to 1 year
|
Number of positive examinations with a tissue diagnosis of cancer within 1 year/All examinations with tissue diagnosis of cancer within the same period
|
Baseline to up to 1 year
|
Specificity
Time Frame: Baseline to up to 1 year
|
Number of negative examinations without tissue diagnosis of cancer within 1 year/All examinations without tissue diagnosis of cancer within the same period
|
Baseline to up to 1 year
|
Recall rate
Time Frame: Baseline to up to 1 year
|
Percentage of women screened with recommendation for further imaging prior to next routine examination
|
Baseline to up to 1 year
|
Positive predictive value (PPV)
Time Frame: Baseline to up to 1 year
|
PPV1: True positive/True positive + False positive
|
Baseline to up to 1 year
|
Accuracy
Time Frame: Baseline to up to 1 year
|
Proportion of true positive results (both true positive and true negative) in the population -The area under the (receiver operating characteristic) curve (AUC) |
Baseline to up to 1 year
|
Interval cancer rate
Time Frame: Baseline to up to 1 year
|
Breast cancer diagnosed within 1 year of a negative screening result because of clinical symptoms/1000 women
|
Baseline to up to 1 year
|
Characteristics of detected cancers
Time Frame: Baseline to up to 1 year
|
Tumor size, type, grade, molecular subtype, and lymph node metastasis
|
Baseline to up to 1 year
|
Characteristics of women with DW-MRI detected cancer
Time Frame: Baseline to up to 1 year
|
Age, menopausal status, breast density, family history
|
Baseline to up to 1 year
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Study Chair: Woo Kyung Moon, MD, PhD, Seoul National University Hosptial
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (ANTICIPATED)
June 30, 2021
Primary Completion (ANTICIPATED)
November 30, 2022
Study Completion (ANTICIPATED)
November 30, 2024
Study Registration Dates
First Submitted
October 30, 2020
First Submitted That Met QC Criteria
November 1, 2020
First Posted (ACTUAL)
November 6, 2020
Study Record Updates
Last Update Posted (ACTUAL)
March 17, 2021
Last Update Submitted That Met QC Criteria
March 15, 2021
Last Verified
March 1, 2021
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- Breast Cancer Screening
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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