A survey by the European Society of Breast Imaging on the utilisation of breast MRI in clinical practice

Abstract

Objectives: While magnetic resonance imaging (MRI) is considered a helpful diagnostic tool in breast imaging, discussions are ongoing about appropriate protocols and indications. The European Society of Breast Imaging (EUSOBI) launched a survey to evaluate the utilisation of breast MRI in clinical practice.

Methods: An online survey reviewed by the EUSOBI board and committees was distributed amongst members. The questions encompassed: training and experience; annual breast MRI and MRI-guided-intervention workload; examination protocols; indications; reporting habits and preferences. Data were summarised and subgroups compared using χ2 test.

Results: Of 647 EUSOBI members, 177 (27.4%) answered the survey. The majority were radiologists (90.5%), half of them based in academic centres (51.9%). Common indications for MRI included cancer staging, treatment monitoring, high-risk screening and problem-solving, and differed significantly between countries (p≤0.03). Structured reporting and BI-RADS were mostly used. Breast radiologists with ≤10 years of experience preferred inclusion of additional techniques, such as T2/STIR (p=0.03) and DWI (p=0.08) in the scan protocol. MRI-guided interventions were performed by a minority of participants (35.4%).

Conclusions: The utilisation of breast MRI in clinical practice is generally in line with international recommendations. There are substantial differences between countries. MRI-guided interventions and functional MRI parameters are not widely available.

Key points: • MRI is commonly used for the detection and characterisation of breast lesions. • Clinical practice standards are generally in line with current recommendations. • Standardised criteria and diagnostic categories (mainly BI-RADS) are widely adopted. • Younger radiologists value additional techniques, such as T2/STIR and DWI. • MRI-guided breast biopsy is not widely available.

Keywords: Breast; Magnetic resonance imaging; Practice Guideline; Radiologists; Survey and Questionnaires.

Conflict of interest statement

Guarantor

The scientific guarantor of this publication is Pascal A.T. Baltzer.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise (Pascal A.T. Baltzer).

Methodology

• retrospective

• observational

• multicentre study

Figures

Fig. 1

Countries where the participants were working at the time of the survey (3/189 did not answer, 1.6%). Four different geographical areas were distinguished: southern; northern and eastern European countries; and non-European countries. Southern and northern countries were considered together as western European countries. Other: countries of various geographical areas in which only one person answered the survey. Footnotes: The number of responders is indicated in the horizontal -axis

Fig. 2

Clinical setting (a) and current position (b) of the people who participated in the survey

Fig. 3

Indications for pre-operative breast MRI in different clinical settings (a) and geographical areas (b). Footnotes: Pre-OP: pre-operative MRI; ILC: invasive lobular carcinoma; APBI: accelerated partial breast irradiation; DCIS: ductal carcinoma in situ; B3: high-risk lesions/lesions with uncertain malignant potential

Fig. 4

Common indications for breast MRI in the different clinical settings. Footnotes: CUP: carcinoma of unknown primary; NAC: neoadjuvant chemotherapy; BCS: breast-conserving surgery